Autism Spectrum Disorders

1
Autism Spectrum Disorders

• Lewis, pp. 1198-1201

2
Incidence and Types

• 24 to 48 months of age males gt females females
  are more severely affected
• No relation to socioeconomic level or parenting
  style
• Mild to severe types are
• Autistic Disorder
• Aspergers Syndrome
• Pervasive Developmental Disorder

3
Etiology

• Genetic disorder of brain development
• Autosomal recessive pattern
• Immune and environmental factors along with
  genetics may increase chances
• No evidence of link to thimerosal-containing
  vaccines

4
Manifestations

• Abnormal EEG
• Seizures
• Delayed development of hand dominance
• Persistence of primitive reflexes
• Elevated serum serotonin levels
• Brain hypoplasia
• Large head

5
Manifestations

• Shows unusual attachments to objects
• Overly sensitive to light, touch, sound, hearing,
  smell, taste
• Performs repeated body movements
• Language delays or regression
• Nonsense rhyming or word repetition
• Communicates with gestures
• Cannot start or maintain conversation

6
Manifestations

• Behavioral outbursts, preoccupation
• Limited pretend play
• GI/nutritional issuesconstipation, megarectum,
  willful starvation, gagging, mouthing objects,
  eating non-edibles, smelling and throwing food
• Screening for manifestations are main way of
  diagnosing (see Box 42-8, p. 1200)

7
Reported Associations

• Fragile X syndrome (chromosomal abnormality)
• Tuberous sclerosis (skin lesions and various
  tumors)
• Metabolic disorders (thyroid)
• Fetal rubella syndrome

8
Reported Associations

• H. influenzae meningitis
• Structural brain abnormalities
• Parents over 40
• Perinatal complications (uterine bleeding, fetal
  distress, low Apgars, hyperbilirubinemia)

9
Nursing Management

• Highly structured behavior modification with
  routines, consistency, and positive reinforcement
• Increase social awareness of others
• Teach verbal communication skills
• Decrease unacceptable behaviors

10
Pharmacologic Therapy

• Meds to decrease irritability, aggression,
  anxiety, mood swings, hyperactivity
• Risperidol
• SSRIs
• Divalproex
• Ritalin

11
Hospitalized Autistic Child

• Parents present
• Encourage parents to bring in favorite
  possessions
• Limit physical contact when possible
• Private room with low stimulation

12
Parental Support

• Feel guilt and shameneed counseling and support
• Encourage parents to care for child in home with
  family support, if possible. If not, then
  institutional care
• Refer to mental health facilities and facilities
  for developmental disabilities
• Refer to Autism Society of America
  www.autism-society.org