Autism spectrum disorder (ASD) is characterized by impairments in social interaction and communication, as well as restricted interests and repetitive behaviors. The DSM-5 criteria include deficits in social communication and interaction across multiple contexts, as well as restricted, repetitive patterns of behavior, interests, or activities. ASD is thought to have both genetic and environmental factors, with studies finding alterations in brain structure and connections. Treatment involves behavioral and educational therapies, while risperidone and aripiprazole have been approved to treat irritability in children with ASD.

1. Autistic disorder
Prepared by:
Sajad Abood Salman

2. Autism Spectrum Disorder
Autism Spectrum Disorder
A disorder that is characterized by impairment in
social interaction skills and interpersonal
communication and a restricted repertoire of
activities and interests (Black & Andreasen,2011).

3. In DSM-IV-TR(APA, 2000), the category AutismSpectrum
Disorders encompassed a broad spectrum of diagnosis
that included autistic disorder, Rett’s disorder, childhood
disintegrative disorder, pervasive developmental
disorder not otherwise specified, and Asperger’s
disorder.
Clinical Findings

4. The DSM-5 groups these disorders into a single
diagnostic category—autism spectrum disorder
(ASD)
. The diagnosis is adapted to each individual by
clinical specifiers (e.g., level of severity, verbal
abilities) and associated features (e.g., known
genetic disorders, epilepsy, intellectual
disability) (APA, 2013).

5. ASD is characterized by a withdrawal of the child
into the self and into a fantasy world of his or her
own creation.
The child has markedly abnormal or impaired
development in social interaction and
communication and a markedly restricted
repertoire of activity and interests, some of
which may be considered somewhat bizarre.

6. 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.
Epidemiology and Course

7. 1. Genetics
2.Physiological Implications
3. Neurological Implications
4.Perinatal Influences
Predisposing Factors

8. Research has revealed strong evidence that genetic
factors play a significant role in the etiology of ASD.
 Studies have shown that parents who have one child
with ASD are at increased risk for having more than
one child with the disorder.
 Other studies with both monozygotic and dizygotic
twins also have provided evidence of a genetic
involvement.
1. Genetics

9.  A number of linkage studies have implicated areas on
several chromosomes in the development of the
disorder, most notably chromosomes 2, 7, 15, 16, and 17
(Brkanac et al, 2008; Shriber, 2012; Ursano et al,
 Other studies have implicated a region on chromosome
11 and aberrations in a brain-development gene called
neurexin 1 (Autism Genome Project Consortium, 2007).
Research into how genetic factors influence the
development of ASD is ongoing.

10. Ursano, Kartheiser, and Barnhill (2008) listed a number
of medical conditions that may be implicated in the
predisposition to ASD These include:
 tuberous sclerosis
 fragile X syndrome
 maternal rubella
 congenital hypothyroidism
 Phenylketonuria
 Down syndrome
 Neurofibromatosis
 Angelman’ssyndrome
2.Physiological Implications

11. Imaging studies have revealed a number of
alterations in major brain structures of individuals
with ASD which include:
 In one recent study, the investigators found a
disproportionate enlargement in temporal lobe white
matter and an increase in surface area in the temporal,
frontal, and parieto-occipital lobes (Hazlett et al, 2011).
3.Neurological Implications

12.  Other imaging studies have revealed an overall
impairment in brain connectivity networks associated
with attention, consciousness, and selfawareness (Black
& Andreasen, 2011).
 The role of neurotransmitters, such as serotonin,
dopamine, and epinephrine, is currently under
investigation.

13.  In a study by researchers at Kaiser Permanente in
Oakland, California, it was found that women who
suffered from asthma and/or allergies around the time
of pregnancy were at increased risk of having a child
affected by ASD (Croen et al, 2005).
 Women with asthma and allergies recorded during the
second trimester had a greater than two fold elevated
risk of having a child affected by the disorder.
 The researchers have postulated that this may be due to
maternal immune response during pregnancy or that
asthma and allergy may share environmental risk factors
with ASD.
4.Perinatal Influences

14. Background Assessment Data (Symptomatology)
The symptomatology presented here is common among
children with ASD. This information, as well as knowledge
about predisposing factors associated with the disorder,
is important in creating an accurate plan of care for the
client.
Because ASD is a spectrum disorder, the symptomatology
described here would be observed on a degree-of-gravity
continuum from mild to more severe.
Application of the Nursing Process to Autism
Spectrum Disorder

15. 1 Social Interaction impairment
2 Communication and Imaginative impairment
3 Restricted and repetitive activities and interests.
Childhood autism is defined by the early onset of
symptoms in three domains

16.  difficult in forming interpersonal relationships with
others.
 little interest in people and often do not respond to
others’ attempts at interaction.
 As infants they may have an aversion to affection and
physical contact.
1 Social Interaction impairment

17.  As toddlers, the attachment to a significant adult may
be either absent or manifested as exaggerated
adherence behaviors.
 In childhood, there is failure to develop cooperative
play, imaginative play, and friendships.
 Those children with minimal handicaps may eventually
progress to the point of recognizing other children as
part of their environment, if only in a passive manner.

18. Both verbal and nonverbal skills are Affected
Verbal communication
 Language may be totally absent or characterized by immature
structure or idiosyncratic utterances whose meaning is clear
only to those who are familiar with the child’s past experiences.
Nonverbal communication
 facial expression or gestures is often absent or socially
inappropriate.
The pattern of imaginative play is often restricted and
stereotypical.
2 Communication and Imaginative
impairment

19.  resistance or sometimes hysterical responses to the
environmental changes.
Attachment to, or extreme fascination with, objects
that move or spin (e.g., fans) is common.
Routine may become an obsession, with minor
alterations in routine leading to marked distress.
3 Restricted and repetitive activities and
interests

20. Stereotyped body movements (hand-clapping, rocking,
whole body swaying) and verbalizations (repetition of
words or phrases) are typical.
Diet abnormalities may include eating only a few
specific foods or consuming an excessive amount of
fluids.
Behaviors that are self-injurious, such as head banging
or biting the hands or arms, may be evident.

21. Based on data collected during the nursing assessment,
possible nursing diagnoses for the client with ASD
include the following:
1. Risk for self-mutilation related to neurological
alterations; history of self-mutilative behaviors;
hysterical reactions to changes in the environment
2. Impaired social interaction related to inability
to trust; neurological alterations, evidenced by lack of
responsiveness to, or interest in people.
Nursing Diagnosis

22. 3.Impaired verbal communication related to withdrawal
into the self; neurological alterations, evidenced by
inability or unwillingness to speak; lack of nonverbal
expression
4. Disturbed personal identity related to neurological
alterations; delayed developmental stage, evidenced by
difficulty separating own physiological and emotional
needs and personal boundaries from those of others

23. Outcome criteria include short- and long-term goals. Timelines
are individually determined. The following criteria may be used
for measurement of outcomes in the care of the client with ASD.
The Client:
■ exhibits no evidence of self-harm.
■ interacts appropriately with at least one staff member.
■ demonstrates trust in at least one staff member.
■ is able to communicate so that he or she can be understood
by at least one staff member.
■ demonstrates behaviors that indicate he or she has begun the
separation/individuation process.
Outcome Identification

24. The following table provides a plan of care for the child
with ASD, including selected nursing diagnoses,
outcome criteria, and appropriate nursing interventions
and rationales.
Planning/Implementation

25. RATIONALE
NURSING INTERVENTIONS
OUTCOME CRITERIA
1. One-to-one interaction
facilitates trust.
2. Mutilative behaviors may
be averted if the cause can
be determined and
alleviated.
3. Diversion and
replacement activities may
provide needed feelings of
security and substitute for
self-mutilative behaviors.
4. Client safety is a priority
nursing intervention.
1. Work with the child on a one-to-one
basis.
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.
4. Protect the child when self
mutilative behaviors occur. Devices
such as a helmet, padded hand mitts, or
arm covers may provide protection
when the risk for self-harm exists.
Short-Term Goal
• Client will demonstrate
alternative behavior (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.
NURSING DIAGNOSIS: RISK FOR SELF-MUTILATION
RELATED TO: Neurological alterations; history of self-mutilative
behaviors; hysterical reactions to changes in the environment

26. RATIONA
NURSING INTERVENTIONS
OUTCOME CRITERIA
1. Warmth, acceptan
availability, along w
consistency of assig
enhance the establi
and maintenance of
relationship.
2. Familiar objects a
presence of a truste
individual provide s
during times of dist
3. Being able to esta
contact is essential
child’s ability to for
satisfactory interpe
relationships.
1. Assign a limited number of caregivers
to the child. Ensure that warmth,
acceptance, and availability are conveyed.
2. Provide child with familiar objects,
such as familiar toys or a blanket.
Support child’s attempts to interact
with others.
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).
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.
NURSING DIAGNOSIS: IMPAIRED SOCIAL INTERACTION
RELATED TO: Inability to trust; neurological alterations
EVIDENCED BY: Lack of responsiveness to, or interest in, peopl

27. The U.S. Food and Drug Administration (FDA) has approved two
medications for the treatment of irritability associated with ASD:
1.risperidone (Risperdal; in children and adolescents 5 to 16 years)
2.aripiprazole (Abilify; in children and adolescents 6 to 17 years).
The behavior symptoms for which these medications are targeted
include:
■ Aggression
■ Deliberate self-injury
■ Temper tantrums
■ Quickly changing moods
Psychopharmacological Intervention for ASD

28. THANK YOU