Aspergers

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ASPERGERS

• Tammy Marie Baker RN
• Pediatric Educational Series

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DSM 299.80 Aspergers Disorder (or Asperger
Syndrome)
An Asperger/HFA screening tool must meet all six
areas defined by the DSM-IV description of
Asperger Syndrome (A-F below) to qualify for a
positive rating from First Signs A. Qualitative
impairment in social interaction, as manifested
by at least two of the following (1) marked
impairment in the use of multiple nonverbal
behaviors, such as eye-to-eye gaze, facial
expression, body postures, and gestures to
regulate social interaction (2) failure to
develop peer relationships appropriate to
developmental level (3) a lack of spontaneous
seeking to share enjoyment, interests, or
achievements with other people (e.g., by a lack
of showing, bringing, or pointing out objects of
interest to other people) (4) lack of social or
emotional reciprocity B. Restricted, repetitive,
and stereotyped patterns of behavior, interests,
and activities, as manifested by at least one of
the following (1) encompassing preoccupation
with one or more stereotyped and restricted
patterns of interest that is abnormal either in
intensity or focus (2) apparently inflexible
adherence to specific, nonfunctional routines or
rituals (3) stereotyped and repetitive motor
mannerisms (e.g., hand or finger flapping or
twisting, or complex whole-body movements) (4)
persistent preoccupation with parts of objects C.
The disturbance causes clinically significant
impairment in social, occupational, or other
important areas of functioning. D. There is no
clinically significant general delay in language
(e.g., single words used by age 2 years,
communicative phrases used by age 3 years). E.
There is no clinically significant delay in
cognitive development or in the development of
age-appropriate self-help skills, adaptive
behavior (other than in social interaction), and
curiosity about the environment in childhood. F.
Criteria are not met for another specific
pervasive developmental disorder or schizophrenia.
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what is Aspergers syndrome

• Aspergers is classified as one of the
  Developmental Disorders
• Child with Aspergers exhibit unusual
  preoccupation or limited interest in a particular
  subject or fascination to the point of selective
  preoccupation with that activity
• Regimes are repetitive and ritualistic
• Speech and language peculiarities including voice
  tones and formal inflections, literal
  interpretation of speech communication and
  language delays
• Social awkwardness with emotionally inappropriate
  behaviors and inability to interact with peers in
  successful relationships and manor. Socially
  delayed in relationships
• Non verbal communication is limited, facial
  expression is limited, peculiar and unfazed by
  environmental factors or interactions. Staring
  gaze or unresponsive to others.
• Motor movements are clumsy and uncoordinated

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What Does Aspergers Look like?
A unique individual with a different focal
view.....
Aspergers looks like a child
struggling to be in the world...
A child wrapped up in his own world....
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symptoms of AspergersDifficulties with social
functioning, particularly in the rough and tumble
of a school environmentSensory issues, where
they are oversensitive to bright light, loud
sounds and unpleasant smellsObsessive
interests, with a focus on one subject to the
exclusion of all othersSocial isolation and
struggles to make friends due to a lack of
empathy, and an inability to pick up on or
understand social graces and cues (such as
stopping talking and allowing others to
speak)A rigid Insistence on routine (where any
change can cause an emotional and physiological
meltdown)A need to know when everything is
happening in order not to feel completely
overwhelmed

• Difficulties with social functioning especially
  outside their own environment such as school
  setting
• Sensory issues under or oversensitivity to
  environmental factors such as bright light, loud
  sounds and unpleasant smells, touch, seams in
  clothing, water or external pressure light or
  deep pressure
• Obsessive interests, with a focus on one subject
  to the exclusion of all others
• Social isolation and struggles to make friends
  due to a lack of empathy, and an inability to
  pick up on or understand social graces and cues
  (such as stopping talking and allowing others to
  speak)
• A rigid Insistence on routine (unexpected changes
  any change can cause an emotional and
  physiological meltdown)
• Structural Obsession/ Dependent needing to
  know when everything is happening in order not to
  feel completely overwhelmed

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treatment modalities
Treatment Modalities are not limited but include
Multidimensional and Multidisciplinary Approach

• Prescribed Medicationsindividualized
• Special Education IEP /Advocasey
• Behavioral Alterationssocial skills/psychologist
• Group Therapy
• Occupational TherapySensory Needs/tolerance/input
  
• Speech TherapyCommunication needs.
• PhysicalTherapymotor/ trunk coordinations/core
  strengthening

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Nursing Assessment incorporates the child's
communication, social, sensory, and behavioral
skills and successful strategies for successful
outcomes.
The Aspergers child has special needs that extend
beyond his acute medical diagnosis and problems
which need to be incorporated into his POC.

• NOte the child's social, communication, and
  behavioral strengths and limitations
• DIscuss the childs abilities with the parents
  and Identify the child's strengths
• utilize the child's fascination and strengths
  during assessment to keep him focused
• use childs favorite activity to refocus and
  distract child when trying to refocus behaviors
• rewards and tokens for good behavior

............Assessment Beyond the Stethoscope
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Nursing management

• Skilled nurse will provide the child a safe
  environment. Limit external stimuli and be aware
  of child sensory concerns. Remove noxious stimuli
  from child's environment if it causes him
  discomfort. ( smells, tastes, texture
  sensitivities)
• Give child notice prior to change or event , do
  not abruptly change routines. Child will not
  handle abrupt changes well.
• Administer medications as prescribed ,educate
  family on meds ,report and adverse reactions or
  medication concerns to the Physician
• Reward child with praise and use Behavioral
  incentives per Behavioral intervention plan.
• Allow child to make choices within safe limits
• utilize therapeutic techniques as prescribed to
  assist child's tolerance of medical procedures.
• Provide consistent schedule and let the child
  know if changes will occur so that the child can
  modulate the change. These children do not
  tolerate abrupt changes and behaviors may
  escalate

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STRATEGIC THERAPEUTIC TECHNIQUES

• Imitation/role-modeling paired with
  reinforcement SN /PCGT demonstrates the desired
  action to the child. When the child imitates the
  action, the parent and/or nurse gives a
  "reinforcer" such as verbal praise.
• High-Probability requests/ low-probability
  requests Requests that have a high likelihood of
  compliance low probability requests (low-p) are
  those with less expectation of compliance.
• Rewards positive reinforcer presented
  immediately following a behavior, causes the
  behavior to increase in frequency and reoccur
• Token systems. A token is a stimulus . It is
  paired or associated with another reinforcer and
  is sometimes called a back-up reinforcer.
  Reinforcers that can be accumulated and exchanged
  for a back-up reinforcer is called a token system
• Shaping a newer behavioral technique. Shaping
  involves rewarding a small stride and slowly
  increasing the expectation before reward is
  given. ( extending tolerance time for procedures
  such a nebulizer or suctioning)

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therapeutic Strategies continued

• Differential reinforcement reinforcing desirable
  behaviors while ignoring unacceptable one
• Choices It is important for children with ASD to
  express preferences and make choices to increase
  personal autonomy. Allow child to make choices.
• Visuals Children who have ASD are usually visual
  learners .Present information with a visual as
  opposed to verbal cues. Visuals create a higher
  success rate with Children with ASD when used to
  foster accomplishing the presented task.
• Distraction techniques role-playing and
  distraction techniques are used to manage
  behavior and task goals foster better outcomes
  and decrease anxiety in Autistic children.

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treatments

• Communication and social skills training
• Children with Aspergers syndrome are taught to
  learn the unwritten rules of socialization and
  communication . Techniques are taught in an
  explicit and rote fashion. Social skills can be
  like learning a foreign language to these
  Children with Aspergers syndrome may also learn
  how to communicate more effectively speak in a
  more natural rhythm, as well as how to interpret
  communication techniques, such as gestures, eye
  contact, tone of voice, humor and sarcasm.
• Cognitive behavioral therapy
• Techniques aimed at curbing problem behaviors,
  such as interrupting, obsessions, meltdowns or
  angry outbursts, and developing skills such as
  recognizing feelings and coping with anxiety.
  Therapy usually focuses on training a child to
  recognize a troublesome situations change in
  environment such as a new place or an event with
  more social demands. Strategies are taught and
  learned to navigate and to cope with the
  situation.

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Medications used to treat Aspergers
Medications may improve specific symptoms such as
anxiety, depression or hyperactivity that can
occur in many children with Aspergers syndrome.

• Aripiprazole (Abilify). may be effective for
  treating irritability related to Asperger's
  syndrome. Side effects may include weight gain
  and an increase in blood sugar levels.
• Guanfacine (Intuniv). may be helpful for the
  problems of hyperactivity and inattention in
  children with Asperger's syndrome. Side effects
  may include drowsiness, irritability, headache,
  constipation and bedwetting.
• Selective serotonin reuptake inhibitors (SSRIs).
  Drugs such as fluvoxamine (Luvox) may be used to
  treat depression or to help control repetitive
  behaviors. Possible side effects include
  restlessness and agitation.
• Risperidone (Risperdal). may be prescribed for
  agitation and irritability. It may cause trouble
  sleeping, a runny nose and an increased appetite.
  This drug has also been associated with an
  increase in cholesterol and blood sugar levels.
• Olanzapine (Zyprexa). Olanzapine is sometimes
  prescribed to reduce repetitive behaviors.
  Possible side effects include increased appetite,
  drowsiness, weight gain, and increased blood
  sugar and cholesterol levels.
• Naltrexone (Revia). may help reduce some of the
  repetitive behaviors associated with Asperger's
  syndrome. However, the use of low-dose naltrexone
  in doses as low as two to four mg a day has
  been gaining favor recently. But, there's no good
  evidence that such low doses have any effect on
  Asperger's syndrome.

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the end...