This document discusses autism spectrum disorder (ASD), including defining it as a neurodevelopmental disorder affecting social interaction, communication, interests and behavior. It outlines the objectives, introduction, definition, etiology, epidemiology, DSM-V criteria, signs and symptoms, medical management/treatment, nursing diagnoses and goals. ASD is often diagnosed before age 3 and includes impaired social interaction and repetitive behaviors. Genetics and environmental factors may play a role in its causes.

1. Autism spectrum
disorder (ASD).
Presented by : Suaad Saleh

2. Out line
• Introduction of autism disorder.
• Detention of autism disorder.
• Etiology of autism disorder.
• Epidemiology
• DSM-V- of autism disorder.
• Sign and symptoms of autism disorder.
• Medical management of autism disorder.
• Nursing diagnosis in patient with autism
disorder.

3. Objective
• At the end of the presentation student will be
able to :
• Define autism disorder.
• Identify etiology of autism disorder.
• Describe the DMS-V for diagnosis of autism
disorder .
• Describe sign and symptoms of autism
• Describe medical management and treatment of
of autism disorder.
• Apply nursing process for patient with autism
disorder.

4. Introduction
• Autism spectrum disorder (ASD) is a
condition that affects social interaction,
communication, interests and behaviour.
• In children with ASD, the symptoms are
present before three years of age,
although a diagnosis can sometimes be
made after the age of three.

5. Definition
• Autism is a complex neurobehavioral
disorder that includes impairment in social
interaction , verbal and non-verbal
communication combined with retracted
and repetitive behavior. Parent usually
notice sign in the first two year of their
child life.

6. Etiology
• Genetics. Several different genes appear to be involved in autism
spectrum disorder. For some children, autism spectrum disorder can
be associated with a genetic disorder, such as Rett syndrome or
fragile X syndrome. For other children, genetic changes (mutations)
may increase the risk of autism spectrum disorder. Still other genes
may affect brain development or the way that brain cells
communicate, or they may determine the severity of symptoms.
Some genetic mutations seem to be inherited, while others occur
spontaneously.
• Environmental factors. Researchers are currently exploring whether
factors such as viral infections, medications or complications during
pregnancy, or air pollutants play a role in triggering autism spectrum
disorder.

7. Epidemiology
• A study by the Autism and Developmental
Disabilities Monitoring (ADDM) Network and
funded by the Centres for Disease Control and
Prevention (CDC) determined the prevalence of
ASD in the United States to be about 11.3 per
1,000 (1 in 88) children (CDC, 2012b). It occurs
about 4.5 times more often in boys than in girls.
Onset of the disorder occurs in early childhood,
and in most cases it runs a chronic course, with
symptoms persisting into adulthood.

8. DSM-V- for
• A) An autistic disorder diagnoses requires six or more characteristics from the
following lists, with at least two from list 1, and one each from lists 2 and 3:
• 1- Impairment in social interaction (must show at least 2 items from this list)
• Impairment in the use of multiple nonverbal behaviours
• Failure to develop peer relationships appropriate to developmental level
• Lack of attempts to share enjoyment, interests, or achievements with others
• Lack of social or emotional reciprocity
• 2- Impairments in communication (must show at least 1 item from this list)
• Delay in, or lack of, the development of spoken language (not accompanied by an
attempt to compensate through other types of communication, such as gestures or
mime)
• Impairment in the ability to initiate or sustain a conversation with other, for those
with adequate language ability
• Stereotyped and repetitive use of language or idiosyncratic language
• Lack of make-believe play or social imitative play appropriate to developmental level

9. • 3- Restricted, repetitive, or stereotyped patterns of behaviour,
interests, or activities (must show at least 1 item from this list)
• Encompassing preoccupation with stereotyped and restricted patterns
of interest that is abnormal either in intensity or focus
• Inflexible adherence to specific, non-functional routines or rituals
• Stereotyped and repetitive motor mannerisms
• Persistent preoccupation with parts of objects
• (B) Show delays or abnormal functioning in at least one of the
following areas before 3 years of age:
• Social interaction
• Language as used in social communication
• Symbolic or imaginative play
• (C) Not better meet the criteria for by Rett's disorder or childhood
disintegrative disorder

10. Sign and symptoms
• Social interactions and relationships.
• Significant problems developing nonverbal communication skills, such as eye-to-
eyegazing, facial expressions, and body posture.
• Failure to establish friendships with children the same age.
• Lack of interest in sharing enjoyment, interests, or achievements with other
people.
• Lack of empathy. People with autism may have difficulty understanding another
person's feelings, such as pain or sorrow.
• Verbal and nonverbal communication.
• Delay in, or lack of, learning to talk. As many as 40% of people with autism
never speak.
• Problems taking steps to start a conversation.
• Stereotyped and repetitive use of language. People with autism often repeat
over and over a phrase they have heard previously (echolalia).
• Difficulty understanding their listener's perspective. For example, a person with
autism may not understand that someone is using humor. They may interpret
the communication word for word and fail to catch the implied meaning.

11. • Limited interests in activities or play. unusual focus on pieces.
Younger children with autism often focus on parts of toys,
such as the wheels on a car, rather than playing with the
entire toy.
• Preoccupation with certain topics. Ex( older children and
adults may be fascinated by video games, trading cards, or
license plates.
• A need for sameness and routines. Ex (a child with autism may
always need to eat bread before salad and insist on driving the
same route every day to school.
• Stereotyped behaviours Ex.. body rocking and hand flapping

12. Medical management and
treatment
•There's no 'cure' for autism
spectrum disorder (ASD), but
there are a range of specialist
interventions that aim to improve
communication skills and help
with educational and social
development.

13. Pharmacotherapy
• CNS stimulants: Dextroamphetamine, methylphenidate,
pemoline
• Tricyclic antidepressants
• Antipsychotics
• Serotonin specific re-uptake inhibitors
• Clonidine
Psychological therapies
• Behavior modification techniques
• Cognitive behavior therapy
• Social skills training

14. Nursing diagnosis:
1) Risk for self-mutilation related to neurological alterations; history of self-
mutilative behaviors ;hysterical reactions to changes in the environment
• Short-Term Goal
• Client will demonstrate alternative
• behaviour (e.g., initiating interaction between self and nurse) in response to
anxiety within specified time. (Length of time required for this objective will
depend on severity and chronicity of the disorder.)
• Long-Term Goal
• Client will not harm self.
2) Impaired social interaction related to inability to trust; neurological
alterations, evidenced by lack of responsiveness to, or interest in,people
• Short-Term Goal
• Client will demonstrate trust in one caregiver (as evidenced by facial
responsiveness and eye contract) within specified time (depending on severity and
chronicity of disorder).
• Long-Term Goal
• Client will initiate social interactions
(physical, verbal, nonverbal) with caregiver by time of discharge from treatment.

15. Risk for self-mutilation
1. Work with the child on a one-to-one basis. One-
to-one interaction facilitates trust.
2. Try to determine if the self-mutilative behavior
occurs in response to increasing anxiety, and if so,
to what the anxiety may be attributed.
3. Try to intervene with diversion or replacement
activities and offer self to the child as anxiety level
starts to rise. Mutilative behaviors may be averted
if the cause can be determined and alleviated.

16. Impaired social interaction
1. Assign a limited number of caregivers to the child. Ensure that
warmth, acceptance, and availability are conveyed. Warmth,
acceptance, and availability, along with consistency of assignment,
enhance the establishment and maintenance of a trusting relationship.
2. Provide child with familiar objects, such as familiar toys or a blanket.
Support child’s attempts to interact with others. Familiar objects and
presence of a trusted individual provide security during times of
distress.
3. Give positive reinforcement for eye contact with something
acceptable to the child (e.g., food, familiar object).Gradually replace
with social reinforcement(e.g., touch, smiling, hugging). Being able to
establish eye contact is essential to the child’s ability to form
satisfactory interpersonal relationships.

17. SUMMARY
• Autism is a brain disorder that often makes it
hard to communicate with and relate to others.
• Most people with autism will always have some
trouble relating to others. But early diagnosis
and treatment have helped more and more
people who have autism to reach their full
potential.

18. Reference
• http://readingroom.mindspec.org/?page_id=6805
• Essentials of Psychiatric Mental health nursing 6th edition
• https://medlineplus.gov/autismspectrumdisorder.html#cat_95
• https://www.nhsinform.scot/illnesses-and-conditions/brain-
nerves-and-spinal-cord/autistic-spectrum-disorder-
asd#adults-living-with-autism