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Hagerstown Community College

Nursing 229
Clinical Prep Card

Condition/Disease Autism
Description
Autism spectrum disorder (ASD) manifests in early childhood and is characterized by qualitative
abnormalities in social interactions, markedly aberrant communication skills, and restricted repetitive
behaviors, interests, and activities (RRBs).
Pathophysiology
In patients with autism, neuroanatomic and neuroimaging studies reveal abnormalities of cellular
configurations in several regions of the brain, including the frontal and temporal lobes and the cerebellum.
Enlargements of the amygdala and the hippocampus are common in childhood. Markedly more neurons are
present in select divisions of the prefrontal cortex of autopsy specimens of some children with autism,
compared with those without autism.
Magnetic resonance imaging (MRI) studies have suggested evidence for differences in neuroanatomy and
connectivity in people with autism compared with normal controls. Specifically, these studies have found
reduced or atypical connectivity in frontal brain regions, as well as thinning of the corpus callosum in
children and adults with autism and related conditions.
Clinical Manifestations
Signs
Abnormal social interactions
Absence of smiling when greeted by parents and other
familiar people

Symptoms

Absence of typical responses to pain and physical

injury
Language delays and deviations
Susceptibility to infections and febrile illnesses
Absence of symbolic play
Repetitive and stereotyped behavior
Developmental regression
Absence of protodeclarative pointing
Abnormal reactions to environmental stimuli

Diagnostic Tests
Abnormal motor movements (eg, clumsiness, awkward walk, hand flapping, tics)
Dermatologic anomalies (eg, aberrant palmar creases)
Abnormal head circumference (eg, small at birth, increased from age 6 months to 2 years, [4] normal in
adolescence [5] )
Orofacial, extremity, and head/trunk stereotypies (eg, purposeless, repetitive, patterned motions, postures,
and sounds)
Self-injurious behaviors (eg, picking at the skin, self-biting, head punching/slapping)
Physical abuse inflicted by others (eg, parents, teachers)
Sexual abuse: External examination of genitalia is appropriate; if bruises and other evidence of trauma are
present, pelvic and rectal examinations may be indicated

Collaborative Care
Intensive individual special education
Speech, behavioral, occupational, and physical therapies (eg, assisted communication, auditory integration
training, sensory integration therapy, exercise/physical therapy)
Social skills training in some children with autism spectrum disorder, including those with comorbid anxiety
disorders; children with autism spectrum disorder and comorbid ADHD may benefit less from social skills
training

POSSIBLE Nursing Diagnoses and Interventions


Diagnosis

Interventions

Impaired verbal communication r/t speech and


language delays

Determine clients own perception of communication


difficulties and potential solutions when possible.
The Communication Confidence Rating Scale for
Aphasia (CCRSA) was found to be an effective tool
for assessment of the self-report of communication
confidence among clients with aphasia

Self neglect r/t impaired socialization

Monitor individuals with acute or chronic mental


and complex physical illness for defining
characteristics for self-neglect. EBN & EB:Medical
and psychiatric conditions probably underlie most
cases of self-neglect, as demonstrated in this sample
of impaired older adults

Psychosocial Implications
Impaired family coping
Disturbed personal identity
Discharge Planning
Ensure patient has access and is aware of appropriate sources of information. Often times the primary
individual that will be educated is the caregiver of patient, depending on severity of autism.
Teaching Needs: Acute illness and home care
Because local boards of education may be ignorant about the needs of children with autistic spectrum
disorder and related conditions, pediatricians and parents should seek advice from knowledgeable sources
such as the Autism Society of America, which maintains a Web site and offers a toll-free hotline at 1-800-3AUTISM, providing information and referral services to the public. Legal assistance may be necessary to
influence a board of education to fund appropriate education for a child with autistic disorder and related
conditions.
People with developmental disabilities, including Asperger syndrome, are vulnerable to sexual abuse, with the
most severely disabled being at highest risk. Parents and caregivers need to be aware of this increased risk.
Additionally, children with Asperger syndrome must be trained to recognize impending sexual abuse and to
develop plans of action to abort it.[

Almost half of a sample of more than 1000 children with autism spectrum disorders exhibited elopement,
wandering away from home, school, and other safe environments. Parents of children with autism spectrum
disorders need to be warned that there is a fair chance that their child, without warning, may walk away from
home or school to go to an environment where there is a risk for potential danger. Additionally, parents need
to be advised to request that teachers and other caregivers vigilantly watch the child to prevent elopement.
Prevention/Health Promotion
No pharmacologic agent is effective in the treatment of the core behavioral manifestations of autistic disorder,
but drugs may be effective in treating associated behavioral problems and comorbid disorders (eg, selfinjurious behaviors, movement disorders). The possible benefits from pharmacotherapy must be balanced
against the likely adverse effects on a case-by-case basis (eg, venlafaxine may increase high-intensity
aggression in some adolescents with autism[8] )
Medications used in managing related behavioral problems and comorbid conditions in children with autism
include the following:

Second-generation antipsychotics (eg, risperidone, aripiprazole, ziprasidone)

SSRI antidepressants (eg, fluoxetine, citalopram, escitalopram)

Stimulants (eg, methylphenidate)