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Autism
By-Isha Thapa Magar
Nursing Instructor
PBBN 2nd Year
Introduction
 Autism is a disorder of neural
developmental characterized by
impaired social interaction and
communication, and by restricted
and repetitive behavior.
 Impairment is in three primary areas:
1. Social interaction
2. Verbal and nonverbal
communication, and
3. Repetitive behaviors or interests
 The risk is 3-4 times higher in males than
females.
 The onset is before 3 years of age.
 Autism is a group of developmental
brain disorders, collectively called
autism spectrum disorder (ASD) &
Pervasive Developmental Disorder
(PDD).
Autism
Autism
 In the DSM-IV, PDD included five types or
categories:
1. Autistic disorder (classic autism)
2. Asperger’s disorder (Asperger
syndrome)
3. Pervasive developmental disorder not
otherwise specified (PDD-NOS)
4. Rett’s disorder
5. Childhood disintegrative disorder
(CDD).
1. Autistic Disorder/Autism /Classic
Autism
 Impairments in social & communication ar
eas are severe &
sustained & present before age of 3 years.
 Speech delay is a core feature of Autism.
 There is likely to be a restricted range of ac
tivities &
interests.
 Also referred to as classic autism.
 Individuals with Autism may also have an i
ntellectual disability.
2.Asperger’s Syndrome
 Social impairments is severe &
sustained, but impairments are not as sev
ere in
communication area & language generally
develops at typical age.
 Impairments seem less in very young chil
d, and
become more apparent in preschool or sch
ool.
 Individuals with Asperger’s Syndrome ha
ve an average or high IQ level.
3. Pervasive developmental disorder not
otherwise specified ( atypical autism)
 Individuals is
diagnosed with PDD‐NOS if they
have some characteristics of ASDs that imp
act their daily life, but do not meet criteri
a for a diagnosis of Autism or Asperger’s S
yndrome
 PDD‐NOS is also known as Atypical Auti
sm.
4. Childhood disintegrative disorder
 Is very rare
 Child develops autism after age of 3
years of age.
 Child has a normal development up until
this.
5. Rett syndrome
 Is a neuro-developmental disorder that
exclusively affects girl child.
 Characterized by normal development till 6
months to 2years of age followed by
gradual loss of purposeful hand
movements & development of
characteristic, stereotypical hand
movements; loss of previously acquired
speech; psychomotor retardation; ataxia,
deceleration of head circumference; and
autistic symptoms.
Etiology
Exact cause of autism is unknown.
Genetic Factors
• concordance rate for monozygotic twins
– 92% and
• concordance rate for dizygotic twins –
30%
• Chromosomal abnormalities
- Fragile X syndrome; is most common
known genetic cause for autism.
- Tuberous sclerosis,
- Phenylketonuria and
- Angelman syndrome.
Children with severe congenital sensory
impairments (visual and/or auditory)
Environmental Factors
 Children born to mothers over 35 & to
fathers over 50 years of age.
 Closer spacing of pregnancies, prematurity,
low birth weight, & being a first-born child.
 Infection during pregnancy e.g. rubella
infection, cytomegalovirus infections.
 First-trimester exposure to thalidomide,
valproic acid during pregnancy
Biochemical Factors
 At least 1/3rd of patients with autistic
disorder have elevated plasma
serotonin.
 Medical factors
- Post-natal neurological infections
(meningitis, encephalitis)
- Congenital rubella,cytomegalovirus,
phenylketonuria & perinatal axphyxia.
Psychodynamic, parenting influences and
social environment
 Parental rejection
 Child responses to deviant parental
personality characteristics,
 Family break-up, Stress
 Insufficient stimulation & faulty
communication patterns.
 refrigerator parents indicates lack of warmth
and affectionate behavior of parents.
Neuro-anatomical studies
- Enlargement of lateral ventricles &
cerebellar degeneration.
Abnormalities in brain functioning
- Defects in temporal lobe & lateral lobe
of brain, limbic system, 3rd ventricle of
brain & brain stem.
Clinical
Features
Autism
Autism
Autism
Autism
 Impairment in social interaction
- Absent social smile
- Lack of eye-to- eye contact
- Lack of awareness of others' existence
or feelings; treats people as furniture.
- Lack of attachment to parents and
absence of separation anxiety.
- No or abnormal social play; prefers
solitary games.
- Marked impairment in making friends
- Lack of imitative behavior
- Absence of fear in presence of danger
Impairments in communication
- Lack of or delay in spoken language
- Inability to sustain conversation with
others
- Stereotyped or repetitive use of
language
- No mode of communication such as
babbling, facial expression, gestures,
etc.
- Absence of imaginative activity
- Marked abnormality in production of
speech (volume, pitch, stress, rhythm,
rate etc).
- Abstract thinking is impaired.
Restricted, repetitive & stereotyped
patterns of behavior, interests, and
activities
- Rigid and ritualistic
- Stereotyped body movements e.g. hand
flicking or twisting, spinning, head
banging, etc.
- Persistent preoccupation with parts of
objects (e.g. spinning wheels of toys
cars) or attachment to unusual objects.
- Marked restricted range of interests and
a preoccupation with one narrow
interest.
Delays or abnormal functioning in
symbolic or imaginative play
Autism
Diagnosis
History taking
Observation the clinical features of child
DSM-V diagnostic criteria
A. Deficits in social communication & social
interaction
1. Deficits in social-emotional reciprocity
2. Deficits in nonverbal communicative
behaviors used for social interaction
3. Deficits in developing, maintaining, &
understanding social relationships
B. Restricted, repetitive patterns of
behavior, interests, or activities
1. Stereotyped or repetitive motor
movements
2. Inflexible adherence to routines, or
ritualized patterns
3. Highly restricted, fixated interests
4. Hyper- or hypo-reactivity to sensory
input
C. The onset should be before 3 years
of age.
D. Symptoms cause significant
impairment in social, occupational, or
other important areas of current
functioning.
Treatment
 There is no cure for Autism, there are
many behavioral therapies that can
significantly improve an autistic child’s
symptoms, ability to learn, and overall
quality of life.
 There is no medication currently available
to treat autism itself; medication may be
used to treat specific symptoms, such as
hyperactivity, sleep disruption, or
gastrointestinal discomfort.
Behavior and communication
treatments teach children to express
themselves and behave appropriately.
 Applied Behavior Analysis (ABA) is most
effective treatment for autism spectrum
disorder, and uses behavioral principles
to understand and increase positive
behaviors and decrease negative
behavior.
 Speech therapy focuses on improving
verbal and non-verbal communication
skills.
 Occupational therapy helps children
function in their home and school
environments.
Medications are usually combined with
ABA to target specific symptoms:
 Antidepressants like SSRI’s reduce
frequency & intensity of stereotyped
behaviors, decrease anxiety, irritability,
tantrums, and aggressive behavior.
 Antipsychotics like risperidone decrease
hyperactivity, irritability, and ritualistic self-
harming behaviors like skin picking or
head banging.
 Stimulants like adderall improve
concentration & decrease hyperactivity
in children who have mild symptoms of
autism spectrum disorder.
 Anticonvulsants like carbamazepine
decrease seizures.
Dietary approaches manage eating-
related problems and treat nutritional
deficits caused by food selectivity,
ritualistic eating, or food sensitivities and
allergies.
Nursing Management
 Serve child one to one basis.
 Meet child's basic human needs, as
child may not be able to verbalize, nurse
has to be aware of those needs and set
up routine and meet them, e.g.
hydration, nutrition, elimination and rest,
etc.
 Utilizes and teaches certain "behavior
modification techniques", formulates
schedule and fix up activities.
 Encourage child to do activities on his
own, e.g. dressing, hygienic needs.
 Provide moral support to parents as
they were very anxious, depressed and
feeling guilty, clarify their doubts and try
to involve them in meeting child's needs,
as they play an integral and vital role in
providing care to the child.
 Permit limited number of caregivers to
ensure warmth, acceptance, affection
and availability to the child.
 Teaches patients about disease and it's
prognosis, so that they will able to work
with him at appropriate developmental
level.
 Teach child signs, symbols, eye contact
(non-verbal).
 Demonstrate "communication skills",
"social skills". teach importance of
establishing and maintaining good
interpersonal relationship.
 Encourages, appreciates child, ensures
positive and social reinforcement to the
child for exhibition of desirable
behavior, e.g. touching, cuddling,
hugging.
 Motivates child to express or to
communicate his needs verbally.
 Clarifies and makes child to interpret his
behavior.
 Provide the 'language training' to the
child, e.g. verbs, objects and show
action or motion what it means, then he
will follow it easily.
• Help child to learn creative activities,
e.g. drawing, art, mirroring.
 Ensure security and diversion to child.
 Give familiar objects to the child, e.g.
blanket, toys etc. to feel comfortable.
 Assist child to learn their own body
parts
 Protect the child from injuries and
hurting others.
 Administer the medications as
prescribed.
 Make the child to adjust socially to the
environmental.
  

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Autism

  • 1. Autism By-Isha Thapa Magar Nursing Instructor PBBN 2nd Year
  • 2. Introduction  Autism is a disorder of neural developmental characterized by impaired social interaction and communication, and by restricted and repetitive behavior.  Impairment is in three primary areas: 1. Social interaction 2. Verbal and nonverbal communication, and 3. Repetitive behaviors or interests
  • 3.  The risk is 3-4 times higher in males than females.  The onset is before 3 years of age.  Autism is a group of developmental brain disorders, collectively called autism spectrum disorder (ASD) & Pervasive Developmental Disorder (PDD).
  • 6.  In the DSM-IV, PDD included five types or categories: 1. Autistic disorder (classic autism) 2. Asperger’s disorder (Asperger syndrome) 3. Pervasive developmental disorder not otherwise specified (PDD-NOS) 4. Rett’s disorder 5. Childhood disintegrative disorder (CDD).
  • 7. 1. Autistic Disorder/Autism /Classic Autism  Impairments in social & communication ar eas are severe & sustained & present before age of 3 years.  Speech delay is a core feature of Autism.  There is likely to be a restricted range of ac tivities & interests.  Also referred to as classic autism.  Individuals with Autism may also have an i ntellectual disability.
  • 8. 2.Asperger’s Syndrome  Social impairments is severe & sustained, but impairments are not as sev ere in communication area & language generally develops at typical age.  Impairments seem less in very young chil d, and become more apparent in preschool or sch ool.  Individuals with Asperger’s Syndrome ha ve an average or high IQ level.
  • 9. 3. Pervasive developmental disorder not otherwise specified ( atypical autism)  Individuals is diagnosed with PDD‐NOS if they have some characteristics of ASDs that imp act their daily life, but do not meet criteri a for a diagnosis of Autism or Asperger’s S yndrome  PDD‐NOS is also known as Atypical Auti sm.
  • 10. 4. Childhood disintegrative disorder  Is very rare  Child develops autism after age of 3 years of age.  Child has a normal development up until this.
  • 11. 5. Rett syndrome  Is a neuro-developmental disorder that exclusively affects girl child.  Characterized by normal development till 6 months to 2years of age followed by gradual loss of purposeful hand movements & development of characteristic, stereotypical hand movements; loss of previously acquired speech; psychomotor retardation; ataxia, deceleration of head circumference; and autistic symptoms.
  • 12. Etiology Exact cause of autism is unknown. Genetic Factors • concordance rate for monozygotic twins – 92% and • concordance rate for dizygotic twins – 30%
  • 13. • Chromosomal abnormalities - Fragile X syndrome; is most common known genetic cause for autism. - Tuberous sclerosis, - Phenylketonuria and - Angelman syndrome. Children with severe congenital sensory impairments (visual and/or auditory)
  • 14. Environmental Factors  Children born to mothers over 35 & to fathers over 50 years of age.  Closer spacing of pregnancies, prematurity, low birth weight, & being a first-born child.  Infection during pregnancy e.g. rubella infection, cytomegalovirus infections.  First-trimester exposure to thalidomide, valproic acid during pregnancy
  • 15. Biochemical Factors  At least 1/3rd of patients with autistic disorder have elevated plasma serotonin.  Medical factors - Post-natal neurological infections (meningitis, encephalitis) - Congenital rubella,cytomegalovirus, phenylketonuria & perinatal axphyxia.
  • 16. Psychodynamic, parenting influences and social environment  Parental rejection  Child responses to deviant parental personality characteristics,  Family break-up, Stress  Insufficient stimulation & faulty communication patterns.  refrigerator parents indicates lack of warmth and affectionate behavior of parents.
  • 17. Neuro-anatomical studies - Enlargement of lateral ventricles & cerebellar degeneration. Abnormalities in brain functioning - Defects in temporal lobe & lateral lobe of brain, limbic system, 3rd ventricle of brain & brain stem.
  • 23.  Impairment in social interaction - Absent social smile - Lack of eye-to- eye contact - Lack of awareness of others' existence or feelings; treats people as furniture.
  • 24. - Lack of attachment to parents and absence of separation anxiety. - No or abnormal social play; prefers solitary games. - Marked impairment in making friends - Lack of imitative behavior - Absence of fear in presence of danger
  • 25. Impairments in communication - Lack of or delay in spoken language - Inability to sustain conversation with others - Stereotyped or repetitive use of language - No mode of communication such as babbling, facial expression, gestures, etc.
  • 26. - Absence of imaginative activity - Marked abnormality in production of speech (volume, pitch, stress, rhythm, rate etc). - Abstract thinking is impaired.
  • 27. Restricted, repetitive & stereotyped patterns of behavior, interests, and activities - Rigid and ritualistic - Stereotyped body movements e.g. hand flicking or twisting, spinning, head banging, etc. - Persistent preoccupation with parts of objects (e.g. spinning wheels of toys cars) or attachment to unusual objects.
  • 28. - Marked restricted range of interests and a preoccupation with one narrow interest. Delays or abnormal functioning in symbolic or imaginative play
  • 30. Diagnosis History taking Observation the clinical features of child DSM-V diagnostic criteria A. Deficits in social communication & social interaction 1. Deficits in social-emotional reciprocity 2. Deficits in nonverbal communicative behaviors used for social interaction 3. Deficits in developing, maintaining, & understanding social relationships
  • 31. B. Restricted, repetitive patterns of behavior, interests, or activities 1. Stereotyped or repetitive motor movements 2. Inflexible adherence to routines, or ritualized patterns 3. Highly restricted, fixated interests 4. Hyper- or hypo-reactivity to sensory input
  • 32. C. The onset should be before 3 years of age. D. Symptoms cause significant impairment in social, occupational, or other important areas of current functioning.
  • 33. Treatment  There is no cure for Autism, there are many behavioral therapies that can significantly improve an autistic child’s symptoms, ability to learn, and overall quality of life.  There is no medication currently available to treat autism itself; medication may be used to treat specific symptoms, such as hyperactivity, sleep disruption, or gastrointestinal discomfort.
  • 34. Behavior and communication treatments teach children to express themselves and behave appropriately.  Applied Behavior Analysis (ABA) is most effective treatment for autism spectrum disorder, and uses behavioral principles to understand and increase positive behaviors and decrease negative behavior.
  • 35.  Speech therapy focuses on improving verbal and non-verbal communication skills.  Occupational therapy helps children function in their home and school environments.
  • 36. Medications are usually combined with ABA to target specific symptoms:  Antidepressants like SSRI’s reduce frequency & intensity of stereotyped behaviors, decrease anxiety, irritability, tantrums, and aggressive behavior.  Antipsychotics like risperidone decrease hyperactivity, irritability, and ritualistic self- harming behaviors like skin picking or head banging.
  • 37.  Stimulants like adderall improve concentration & decrease hyperactivity in children who have mild symptoms of autism spectrum disorder.  Anticonvulsants like carbamazepine decrease seizures. Dietary approaches manage eating- related problems and treat nutritional deficits caused by food selectivity, ritualistic eating, or food sensitivities and allergies.
  • 38. Nursing Management  Serve child one to one basis.  Meet child's basic human needs, as child may not be able to verbalize, nurse has to be aware of those needs and set up routine and meet them, e.g. hydration, nutrition, elimination and rest, etc.  Utilizes and teaches certain "behavior modification techniques", formulates schedule and fix up activities.
  • 39.  Encourage child to do activities on his own, e.g. dressing, hygienic needs.  Provide moral support to parents as they were very anxious, depressed and feeling guilty, clarify their doubts and try to involve them in meeting child's needs, as they play an integral and vital role in providing care to the child.  Permit limited number of caregivers to ensure warmth, acceptance, affection and availability to the child.
  • 40.  Teaches patients about disease and it's prognosis, so that they will able to work with him at appropriate developmental level.  Teach child signs, symbols, eye contact (non-verbal).  Demonstrate "communication skills", "social skills". teach importance of establishing and maintaining good interpersonal relationship.
  • 41.  Encourages, appreciates child, ensures positive and social reinforcement to the child for exhibition of desirable behavior, e.g. touching, cuddling, hugging.  Motivates child to express or to communicate his needs verbally.
  • 42.  Clarifies and makes child to interpret his behavior.  Provide the 'language training' to the child, e.g. verbs, objects and show action or motion what it means, then he will follow it easily.
  • 43. • Help child to learn creative activities, e.g. drawing, art, mirroring.  Ensure security and diversion to child.  Give familiar objects to the child, e.g. blanket, toys etc. to feel comfortable.  Assist child to learn their own body parts
  • 44.  Protect the child from injuries and hurting others.  Administer the medications as prescribed.  Make the child to adjust socially to the environmental.