Mini Med School: Autism

 

 

 

 

 

 

 

 

 

 

 

Objectives

 

At the end of this class, you will be able to:

 

1. Discuss the signs of autism.
2. Care for the child with autism.

 

Introduction

 

It has been found that 1 in every 150 children in our country who are 8 years old, and older,  have autism. As many as 1.5 million people in the US have it and the number has been on the rise over the last couple of years.

 

It is usually seen by the time the child is 3 years of age. People of all kinds and people in all income levels can be affected by autism. Early care helps these children very much. The cost of this disorder is great. Special education, housing, therapy and care costs add up.

 

It seems to run in some families. Some families may have more than one child with it.

 

Males get it more than females. Boys are 4 times more likely to have it than girls.

 

The Signs

 

 

 

 

Autism has three (3) major problems:

 

1. poor communication
2. poor social interaction
3. narrow interest and/or behavior that is done over and over again.

 

These problems can be very small or they can be so bad that it makes it very hard for the person to live their life as others do.

 

Some parents see it first when the child is just a baby. The baby may not be paying attention to the parent or other things that should interest them or they may just look at one thing for a very long period of time while not paying attention to other things around them. The mother or father may think that they have a problem with hearing because they do not respond to their name or the voice of the parent.

 

They may not respond to their name. They may not even look the person in the eyes. They may not know what a smile means. They may not know what an angry tone of voice means.

 

Some children also do the same thing over and over again. They may sit on the floor and rock back and forth for a long time. They may bite their own hand or bang their own head against the wall for no reason. They may also say, or “sing song”,  the same words over and over again. Some say that these children talk “at people” rather than “with people”.

 

These children may not like change. They like everything to be the same all of the time. They may not be able to tell people what they want. They may laugh or cry for no reason that the parent can see. They like to be alone. They have little or no eye contact and they may spin objects and be VERY attached to some thing or things, but not people. They may also have a lot of “temper tantrums”.

 

They have no fear. They have no fear of danger so they have to be kept safe. They may go from being over active to being very slow and not active at all. They may also not have good motor skills. For example, they may not be able to hold a toy or stack blocks as well as another child.

 

They tend to stay away from other people and other children. They may not want to be even near or play with their sister or brother.

 

They may not start to talk when they should be able to. They may call themselves by their name and not use the words “I” or “me”. They may say, “Joe wants a cookie” and NOT “I want a cookie”.

 

Some of these children can not even feel pain but they may be VERY sensitive to sounds and touch. Some do not even like being hugged because they are so aware of touch and they do not like it.

 

These children also have more problems than other children. Some of the other things that they can also have are:

 

• fragile X which causes mental retardation,
• tumors on the brain,
• epilepsy and seizures,
• Tourette syndrome,
• problems with learning,  and
• attention deficit disorder.

 

There is no medical test for autism. It is diagnosed after the child’s communication, growth and behavior is seen.

 

What Causes It?

 

 

 

We are not very sure about what causes it. It may come from a number of things, such as:

 

• genes;
• environment; and
• childhood vaccines.

 

Some say that many things may cause it. It seems to run in families and it is seen more when the child has:

 

• fragile X;
• mental retardation;
• seizures;
• sleep problems;
• poor muscles;
• no feeling of pain;
• no feeling of cold;
• measles (rubella) while in the mother's body.

 

It is also seen more often when the mother has been exposed to some things while they are pregnant. Some of these things are:

 

• drugs;
• mercury;
• an infection like a virus;
• bug killers; and
• not had enough vitamins, like zinc.

 

There is no way to prevent it because the cause of it is not clear. Scientists are looking into brain scans and some genetic code differences that may give us an idea of the cause in the future.

 

There is also no cure for it, but these children can be helped with special things.

 

Caring for the Person with Autism

 

 

One of the biggest problems that these children have is talking and relating to others. These children do not learn to talk as soon as others.

 

Some of the things that you can do with these children to help them to talk are below.

 

• Use signs and pointing to objects to communicate;
• Use pictures or a picture board;
• Sing along with songs on a video or CD; and
• Swing on a swing while learning words.

 

 

Other care can include these things.

 

• Keep the child away from all dangers and cold. They may not feel pain or cold.
• Use a regular routine and stick to it. Give care at the same time and in the same way as much as possible. 
• Vitamins and minerals like vitamins B and C.
• Special diets that do not have wheat or dairy foods.
• Food allergy tests. Any problem foods should then not be given to the child.  
• Medicine to treat some things like fighting with other children, self-injury, anxiety, depression, and problems with school.
• Speech, occupational and/or physical therapy.
• Help with listening to others.
• Help with school work, like reading and math. 
• Music and art may be something that the child likes to do. 
• Animal therapy, like riding a horse.
• Help with the control of behavior.
• Clearing the body of heavy metals.

 

Many of these children are able to grow up and live a nice life with help. Some may be able to live on their own, with help. Others may do better in a group home.

Medicines

 

At times, the doctor may order medicine for the child to treat some of the problems. No medicine can cure it.

 

Some of these medicines work on the brain to control the person’s behavior, attention span, over activity and seizures. It is very important to monitor the person getting these medicines.

 

Some children are also given some vitamins and minerals, like vitamin B, C and cod liver oil. Again, these do not cure it, but it may help some with a nutrition problem.

 

Poor Behavior

A person can react to many things by using poor behaviors. They may hit a person if they are cold. They may slap their sister when she makes them upset. They may yell if they are tired Things that can lead to poor behavior are called “triggers”.

Triggers can be different for different people. Know your patients and what triggers them.

Triggers can be:

• Physical. A person can act poorly because they are too hot, too cold or uncomfortable. They can act out if they are dirty or soiled, tired, sick, thirsty, hungry or in pain. Meeting the physical needs of the patient can stop these physical triggers. For example, give the person a sweater or a blanket if they are cold. Give them a chance to use the bathroom if they have to.
• Emotional. The person may act out if they become sad, lonely or not able to tell another person what they want or need. We can stop these triggers by meeting the patient's needs. Listen to them. Try quiet music or a backrub to calm them down.
• Environmental. Other children, and adults, may act out with poor behavior if they are in an area that has a lot of noise. They can act poorly if the area has too much or too little light. If too much is going on at one time or if the TV or radio is too loud, a person can also act out. Nursing assistants and others should keep the patient care area quiet and calm. It should also be well lit. The temperature of the area should be comfortable to the people in it.
• Communication. A person may get triggered if they can't tell you what they want or need. Spend time with the patient. Listen to them closely. Use the person's name. Be calm. Do NOT argue with the person. Sit with the person. Talk to them slowly and at eye level. Do NOT stand while the person is sitting.
• Related to the care given. Bathing, getting the person out of bed, eating, dressing, and other things can trigger poor behavior. These triggers may  be prevented if we give the person choices, try to keep a regular schedule and do tasks in small steps. Ask the person to do the task with you. Tell them that they did a great job when the bath, or other task, is done. Reward them with smiles and praise. If they resist, stop the task. Try to do the task later.

Manage Poor Behavior

• Know your patients and residents. Know what kinds of things lead to poor behavior. Know the things that help your patient to behave correctly. For example, give the patient a bath in the morning if they are better in the morning. A bath during the afternoon or evening may make this patient resist. Very often, poor behavior occurs while care is being given to a person. Try to calm a patient during care. If a patient is calm and happy sitting in a certain place for meals, do NOT make them move to another place unless they choose to. Keep things the same and keep things simple in order to prevent poor behavior. Know the best routine for the person and stick to it.
• Know what triggers poor behavior and try to keep the person from these triggers. Get rid of all physical, emotional, environmental, communication and care triggers. Meet the person's needs so they do NOT react with disturbed behavior.
• Give simple instructions and repeat instructions if needed.
• Listen to the person. Many will act out with poor behavior because they can't make their needs known. They may think that no one is listening to them. They may want, or need, something and no one can understand what they want. They will then get angry, aggressive and hostile to others. Spend time with your patient. Help them tell you what they want. Use pictures if that helps. Repeat back to them what you think they said or wanted to make sure you have really heard and understood them. Be clear and calm when communicating with these patients.
• Observe your patients and how they act with others. If another easily annoys a patient, encourage both to go to a different place. Give them a healthy way to use their energy. If your patient spits on another patient for no reason, talk with your patient and explain to them why this is wrong. Allow the patient to speak and encourage them to do something, like play a group game, rather than spit. Do not get upset if the patient forgets and spits again. Some need constant and short reminders several times a day.
• Approach the person from the side and speak face to face. Speak slowly, calmly and use simple words. Ask simple 'yes', 'no' questions.
• Keep the patient care area simple. Keep noise down. Make sure that there is enough light. Keep schedules and routines the same for people who act out when things are changed. Limit choices if this is best for the person at that time. Some people get nervous and frustrated if they have too many choices. Encourage the child to go to well supervised and structured activities if they are at risk for poor behavior when things are not structured. Also, many do better if they have the same people care for them each day. They may not do well with new people or in rooms with a lot of people that they do not know. Keep the stress low. Keep as many things the same all of the time when ever you can.
• Keep the patient care area safe. Safety is VERY important.
• Try to re-direct poor behaviors by making the person feel safe, secure and needed by others.
• Keep your attention on the person and not the task. It is the person and how they are feeling and what they are trying to communicate that is important. If a person gets angry during an activity of daily living, break the task down into small parts. Help the person to be as independent as they can. Give praise often. Praise the person for their efforts.
• Alternate rest periods with activity. Tired patients may act out with behaviors that are disruptive, unacceptable or dangerous. Encourage sleep by keeping a regular bed time, having the person change into pajamas and providing a quiet environment. They may also do best by getting up at the same time each morning.
• Relieve stress. Promote relaxation and other things that lower stress. Pet therapy, music therapy and socialization or exercise groups can lower stress.
• Report all patient changes to the nurse in charge. If a patient condition or behavior changes they may be at risk for acting out behaviors. Report all patient changes.
• Be a team member. Follow the patient's behavior management plan of care. Everyone on the team must be consistent. They must all say and do the same things with the patient.

MANAGE disruptive, unacceptable or dangerous behaviors when they occur.

• Stay calm, speak softly and show respect. If inappropriate, dangerous or disruptive behavior occurs, speak to the patient(s) calmly, slowly and with respect. Have them sit to chat. Sit next to them.
• Stop the task you are doing.
• Call for help if you need it.
• Meet patient needs. If a person is making noise, find out if they are hungry, thirsty, wet, dirty, in pain, too hot, too cold or tired. Meet these needs. Feed the person that is hungry. Give water to the person who is thirsty, etc.
• Report any disturbed behavior. What triggered the behavior? What happened? When time was it? Where did it happen? How long did the poor behavior continue? Was the behavior mild, moderate or very severe? Who else was involved? What did you do to stop the behavior? Did it work? What made the person return to normal behavior?
  
  

Summary

 

It is very challenging, but rewarding, to get to know and work with a child that has autism.

 

This class has given you some of the skills that you need to care for them well. Look on the internet for more information if you would like to learn more.

 

 

REFERENCES

 

Autism Society of America. (2010). “Autism”. [online].  http://www.autism-society.org/site/PageServer

 

Hockenberry, Marilyn J. and David Wilson. (2010).Wong's Essentials of Pediatric Nursing. 8th Edition. Elsevier Mosby.

 

National Institute of Neurological Disorders and Stroke. (2010). “Autism”. [online]. http://www.ninds.nih.gov/disorders/autism/detail_autism.htm#107103082

Copyright © 2010 Alene Burke