Adapting What We Already Know NY Presbyterian/Weill Cornell Medical Center Child Life In-Service April 28, 2011 Laura Mari...
Autism Spectrum Disorder <ul><li>Autistic Disorder </li></ul><ul><li>Asperger’s Disorder </li></ul><ul><li>Childhood Disin...
Aggression in ASDs <ul><li>Children with ASDs tend to be 4-5 years behind in social maturity </li></ul><ul><li>Aggressive ...
ASD in the Hospital <ul><li>About 560,000 children in the US have an ASD </li></ul><ul><li>Children with ASD are more like...
Our Role <ul><li>Research shows that members of the healthcare team often find children with ASD to be awkward and inappro...
At Admission <ul><li>As usual, assess the following: </li></ul><ul><li>-developmental level </li></ul><ul><li>Where are th...
Familiarize Child to Floor <ul><li>Walk around ward </li></ul><ul><li>Show staff picture board </li></ul><ul><li>If have d...
Set Up Schedule <ul><li>CONSISTENCY!! </li></ul><ul><li>Break down routine into simple steps and procedures </li></ul><ul>...
Procedures <ul><li>Use the treatment room </li></ul><ul><li>Prepare, prepare, prepare leading up to feared event!! </li></...
Distractions Hudson (2006), Sounders (2005)
Do What We Do Best <ul><li>ADVOCATE! </li></ul><ul><li>For a consistent schedule </li></ul><ul><li>For thorough preparatio...
<ul><li>Autism Society. (2008). About autism. Retrieved March 11, 2011, from http://www.autism-society.org/ </li></ul><ul>...
<ul><li>Scarpinato, N., Bradley, J., Kurbjun, K., Bateman, X., Holtzer, B., & Ely, B. (2010). Caring for children with an ...
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ASDs in Hospitals

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  • It is important for child life specialists to realize that children aren’t going to come into the hospital with a main diagnosis as an ASD. Rather, it is the job of the CLS to look in the children’s chart notes to see what disorder on the spectrum the child has. Autism is diagnosed by looking at a range of factors including social interaction, communication challenges, and limited range of interests and behaviors.
  • We are most likely to see children wish ASD to come to the hospital because of the following.
  • Research shows that members of the healthcare team often find children with ASDs to be awkward and inappropriate. Therefore, they often get avoided when they are at the hospital. It’s a child life specialists job to make sure this doesn’t happen.
  • Just like any other child, it is important at admission to the hospital to assess the child’s developmental level and somatosensory level. Also it’s important to figure out what brings on emotional disturbances and what are effective interventions to ease them. Eye contact may be overwhelming for children with ASDs. Looking past the child or using a puppet while talking may be helpful. Also, children with ASDs tend to be very interested in few things such as a type of animal, escalators, doors, etc. Finding those things out from parents or the child is key in building a relationship.
  • Children with ASDs feel much relief when they are familiar with their environment. At admission take them on a quick walk around the ward, Show them the staf picture board and point out your picture. If you have a digital camera, let them take pictures of different people and areas so they can review the pictures at a later time. Also, it’s important to show them the playroom and treatment room when it is clean and empty. It may take a few times of looking at the empty playroom for the child to be ready to enter it.
  • Consistency adds to a child’s sense of safety. It could be helpful to set up a schedule with the child so that they know what is going to happen throughout the day. Using pictures and drawings is important since they tend to communicate through pictures. Also, many caregivers practice writing short narrative about what is going to happen with their child as a character in the story. This has been shown to be very helpful. The child can re-read the story and/or illustrate it at any time. Also, it is important to remember to talk to the child about changes that might occur throughout the day. When talking to children with ASDs, it’s also important to use simple sentences with a calm, soothing voice. It is hard for children to answer open-ended questions to stick with choice questions. When preparing for procedures, show simple pictures and explain with simple sentences what is going to happen in a step-by-step process.
  • It’s imperative to use the treatment room for procedures so that the child can feel safe in his own room. Many children are hypersensitive to touch so advocate for the use of numbing creams or Versed for invasive procedures. Also, encourage everyone to keep their voices and lights as low as possible. If possible, introduce the child to people in the treatment room prior to the procedure. Encourage the child to bring along a favorite object and set up an award system. For every step of the procedure they pass, give a sticker or small token.
  • The best distraction toys for children with ASDs are bubbles, magic wands, flashlights, pinwheels, squishy balls, playdough, slinky, music, movies, simple books, cars, spinning toys, beanbags, pillows, and of course their own belongings.
  • As professionals in child life, we advocate for children. This is the same situation. We need to advocate for children with ASDs in healthcare settings for a consistent schedule, thorough preparation, sensitivity, simplicity, and understanding. Let’s discuss this case study.
  • ASDs in Hospitals

    1. 1. Adapting What We Already Know NY Presbyterian/Weill Cornell Medical Center Child Life In-Service April 28, 2011 Laura Marie Romeo, Child Life Assistant
    2. 2. Autism Spectrum Disorder <ul><li>Autistic Disorder </li></ul><ul><li>Asperger’s Disorder </li></ul><ul><li>Childhood Disintegrative Disorder </li></ul><ul><li>Rett’s Disorder </li></ul><ul><li>Pervasive Developmental Disorder (PDD) </li></ul><ul><li>Diagnosis: </li></ul><ul><ul><li>-impairments in social interaction </li></ul></ul><ul><ul><li>-communication challenges </li></ul></ul><ul><ul><li>-limited range of interests and behaviors </li></ul></ul>http://www.ninds.nih.gov/disorders/autism/autism.htm
    3. 3. Aggression in ASDs <ul><li>Children with ASDs tend to be 4-5 years behind in social maturity </li></ul><ul><li>Aggressive behaviors emerge because: </li></ul><ul><li>-Rigidity </li></ul><ul><li>-Resistance to deviations </li></ul><ul><li>-Poor executive functioning—emotional control </li></ul><ul><li>-Sensory overload </li></ul><ul><li>-Confusion over verbal and non-verbal cues </li></ul><ul><li>-Expect the worst and paranoid thinking </li></ul><ul><li>-Fear and anxiety </li></ul>Geller (2011)
    4. 4. ASD in the Hospital <ul><li>About 560,000 children in the US have an ASD </li></ul><ul><li>Children with ASD are more likely to have: </li></ul><ul><li>-cancer </li></ul><ul><li>-Down syndrome </li></ul><ul><li>-spina bifida </li></ul><ul><li>-seizures </li></ul><ul><li>-sleep disturbances </li></ul><ul><li>-GI disorders </li></ul><ul><li>-psychiatric disorders </li></ul>Scarpinato et al. (2010)
    5. 5. Our Role <ul><li>Research shows that members of the healthcare team often find children with ASD to be awkward and inappropriate </li></ul><ul><li>Therefore they often get avoided at the hospital </li></ul><ul><li>But we already have the tools to make sure that this doesn’t happen! </li></ul>Hudson (2006)
    6. 6. At Admission <ul><li>As usual, assess the following: </li></ul><ul><li>-developmental level </li></ul><ul><li>Where are they at cognitively? Do they go to school? </li></ul><ul><li>-somatosensory level </li></ul><ul><li>What senses are the most active? </li></ul><ul><li>-emotional disturbances </li></ul><ul><li>What triggers fear and anxiety? </li></ul><ul><li>-effective interventions </li></ul><ul><li>What has worked in the past to overcome fears? </li></ul><ul><li>-effective communication </li></ul><ul><li>What method is best…not eye-to-eye, using puppet? </li></ul><ul><li>-personal interests </li></ul>Scarpinato et al. (2010), Verzosa (2009), Hudson (2006)
    7. 7. Familiarize Child to Floor <ul><li>Walk around ward </li></ul><ul><li>Show staff picture board </li></ul><ul><li>If have digital camera, let child take pictures of different parts of floor and people </li></ul><ul><li>Show the playroom and treatment room when it is empty and clean </li></ul>Scarpinato et al. (2010), Sounder (2002), Verzosa (2006), Worth (2008)
    8. 8. Set Up Schedule <ul><li>CONSISTENCY!! </li></ul><ul><li>Break down routine into simple steps and procedures </li></ul><ul><li>-utilize pictures and drawings </li></ul><ul><li>-write a social story about the child’s day at the hospital </li></ul><ul><li>Review any changes that might occur in the schedule </li></ul><ul><li>Language </li></ul><ul><li>-numbered lists </li></ul><ul><li>-simple sentences </li></ul><ul><li>-simple pictures </li></ul><ul><li>-calm voice </li></ul><ul><li>-easier to answer closed questions </li></ul>Help Autism Now Society (2011), Hudson (2006), Scarpinato et al. (2010)
    9. 9. Procedures <ul><li>Use the treatment room </li></ul><ul><li>Prepare, prepare, prepare leading up to feared event!! </li></ul><ul><li>Use lidocaine based topical creams or Versed </li></ul><ul><li>Limit number the people in room </li></ul><ul><li>Introduce people in room (preferably before procedure) </li></ul><ul><li>Bring along favorite objects </li></ul><ul><li>Set up award system (sticker for every step), Praise!! </li></ul><ul><li>Keep voices and lights as low as possible </li></ul><ul><li>Debrief afterwards </li></ul>Hudson (2006), Moffitt (2011), Sounders (2005), Scarpinato et al. (2010), Worth (2008)
    10. 10. Distractions Hudson (2006), Sounders (2005)
    11. 11. Do What We Do Best <ul><li>ADVOCATE! </li></ul><ul><li>For a consistent schedule </li></ul><ul><li>For thorough preparation </li></ul><ul><li>For sensitivity </li></ul><ul><li>For simplicity </li></ul><ul><li>For understanding </li></ul><ul><li>Case Study: 12yr old autistic male in the hospital for trauma. Is physically aggressive at moments. Has started to make sexual comments to women. Nurses openly talk about him and mother in hallways. What do you do? </li></ul>
    12. 12. <ul><li>Autism Society. (2008). About autism. Retrieved March 11, 2011, from http://www.autism-society.org/ </li></ul><ul><li>Geller, L. (2011, Apr 11). Powerpoint lecture on Demystifying aggression: Developing effective interventions. Bank Street College of Education, NY, NY. </li></ul><ul><li>  </li></ul><ul><li>Grandin, T. (1995). Thinking in pictures: And other reports from my life with autism. NY, NY: Vintage Books. </li></ul><ul><li>  </li></ul><ul><li>Help Autism Now Society. (2011). Today I am going to have my blood drawn. Retrieved March 11, 2011, from http://www.helpautismnow.com/blood_draw.html </li></ul><ul><li>  </li></ul><ul><li>Hudson, J. (2006). Prescription for success: Supporting children with autism spectrum disorders in the medical environment. Shawnee Mission, KS: Autism Asperger Publishing Co. </li></ul><ul><li>  </li></ul><ul><li>Moffitt, S. (2011). Hospital preparedness lacking for children with autism. Autism Key. Retrieved March 11, 2011, from http://www.autismkey.com/hospital- preparedness-lacking-for-children-with-autism/ </li></ul><ul><li>  </li></ul><ul><li>National Institute of Neurological Disorders and Stroke. (2011). NINDS autism information page. Retrieved March 11, 2011, from http://www.ninds.nih.gov/disorders/autism/autism.htm </li></ul>
    13. 13. <ul><li>Scarpinato, N., Bradley, J., Kurbjun, K., Bateman, X., Holtzer, B., & Ely, B. (2010). Caring for children with an autism spectrum disorder in the acute care setting. Journal for Specialists in Pediatric Nursing, 15 (3), 244-254. </li></ul><ul><li>  </li></ul><ul><li>Senator, S. (2005). Making peace with autism: One’s family story of struggle, discovery, and unexpected gifts. Boston, MA: Trumpeter Books. </li></ul><ul><li>Sounders, M. C., Freeman, K. G., Depaul, D., & Levy, S. E. (2002). Care for children and adolescents with autism who require challenging procedures. Pediatric Nursing, 28, 555-562. </li></ul><ul><li>Verzosa, Maryanne. (2009). Lu-lu goes to the hospital: Caring for a child with autism spectrum disorder in the healthcare setting. (Masters’ thesis). Retrieved from Bank Street College of Education. </li></ul><ul><li>  </li></ul><ul><li>Worth, T. (Dec 2008). Tips for treating children with autism: To minimize patients’ acting out, rely on careful planning and consistency. Today’s Hospitalist . Retrieved March 11, 2011, from http://www.todayshospitalist.com/index.php?b=articles_read&cnt=731 </li></ul>

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