Introduction

Autism is a highly variable, neurodevelopment disorder that first appears during infancy or early childhood. It affects approximately 700,000 people in the United States and occurs in all racial, ethnic, and socioeconomic groups. On average autism is 4 to 5 times more likely to occur in males. It has not been determined what specifically causes autism. Research shows that many factors—environmental, biologic and genetic—may be involved. (Centers for Disease Control and Prevention, 2009).

Video: What is Autism (Centers for Disease Control, 2009)

Diagnosis can be difficult since there is no medical test to detect the disorder. Developmental screening accompanied by a comprehensive evaluation by a specialist confirms the diagnosis. It can be detected as early as 18 months, however many children are diagnosed much later, which delays treatment.

Autism’s defining characteristics include a marked impairment in the use of nonverbal behaviors, failure to develop peer relationships appropriate to developmental level, and lack of social or emotional reciprocity.

A person with autism might:

• Not respond to their name by 12 months.
• Not point at objects to show interest (point at an airplane flying over) by 14 months.
• Not play "pretend" games (pretend to "feed" a doll) by 18 months.
• Avoid eye contact and want to be alone.
• Have trouble understanding other people's feelings or talking about their own feelings.
• Have delayed speech and language skills.
• Repeat words or phrases over and over (echolalia).
• Give unrelated answers to questions.
• Get upset by minor changes.
• Have obsessive interests.
• Flap their hands, rock their body, or spin in circles.
• Have unusual reactions to the way things sound, smell, taste, look, or feel.(Centers for Disease Control and Prevention, 2009).

Reference:

Centers for Disease Control and Prevention. (2009). Autism Spectrum Disorders (ASDs). Retrieved from: http://cdc.gov/ncbddd/autism/hcp-dsm.html

Risks and benefits of treatment options for autism

by Claire Lockwood

Because autism is a spectrum disorder and behavioral manifestations are uniquely individual, there is no single “best treatment” plan. Interventions that are helpful to one child may be non-therapeutic for another. Treatment should be discussed with a primary care provider before implementation, and should be tailored to each child's individual needs.

Currently there are several types of treatment. Outlined below are four main categories of treatment, which include: 1) Behavior and Communication Approaches, 2) Dietary Approaches, 3) Medication, and 4) Complementary and Alternative Medicine.

1. Behavior and Communication Approaches. There are many types of behavior and communication approaches, including occupational therapy, speech therapy, sensory integration theory, and applied behavioral analysis. Specific kinds of applied behavioral analysis include: Discrete Trial Training (DTT), Early Intensive Behavioral Intervention (EIBI), Pivotal Response Training (PRT), and Verbal Behavior Intervention (VBI). To learn more about each of these behavior and communication approaches please visit the Centers for Disease Control website at: http://www.cdc.gov/ncbddd/autism/treatment.html#types
2. Dietary Approaches. Most dietary approaches have been developed by therapists, but have not been substantiated to the point of widespread recommendation. Dietary approaches, like all other therapeutic interventions, must be tailored to the individual. Dietary adjustment may include removing a particular type of food or enhancing a diet with vitamin and mineral supplements. The idea behind dietary modification is that certain foods trigger symptoms of ASDs. Some mothers of autistic children allege that diet plays a part in the way their child behaves and feels. Always consult with a doctor or dietician before implementing dietary changes.
3. Medication. There is no medicine that cures autism and no medicine that targets the predominant symptoms. However, there are medications that relieve specific behavioral manifestations not uncommon to individuals with ASD. Medications may address anger/aggression, hyperactivity, depression, seizure disorders, or the inability to focus. To learn more about pharmacological interventions, please visit http://www.nimh.nih.gov/health/publications/autism/complete-index.shtml#pub4
4. Complementary and Alternative Medicine. “CAM” therapy is often controversial since it is not usually advertised by physicians. According to the CDC website, “as many as one third of parents of children with an ASD may have tried complementary or alternative medicine treatments, and up to 10% may be using a potentially dangerous treatment” (ASDs, 2010). Visit the National Institute of Health website for more information on CAM: http://nccam.nih.gov/health/whatiscam/#1

It is difficult to weigh the risks and benefits of various forms of therapy since each patient requires an individually tailored treatment plan. However, according to the National Institute of Mental Health, most professionals agree that early intervention is important and that “most individuals with ASD respond well to highly structured, specialized programs.” In my personal research of ASD treatment options, I have yet to come across documented “risks” associated with non-pharmacological treatment measures. However, physicians should be consulted for the risks and benefits that accompany drug therapy.

Reference:

Autism Spectrum Disorders (ASDs). (2010). Retrieved from http://www.cdc.gov/ncbddd/autism/treatment.html#types

National clinical practice guidelines for autism

by Casey Trejo

(click on image to enlarge)

Algorithm: Practice guidelines for surveillance for screening of autism

• Health care professionals (HCP) should identify autism signs early in life (preschool) through routine screening
• HCP should be well educated and have a good understanding of autistic clinical features to identify in children and associated comorbid problems
• The Checklist for Autism in Toddlers (CHAT), modified CHAT (M-CHAT), TheCommunication and Symbolic Behavior Scales Developmental Profile Infant/Toddler Checklist and many other tools can help health care professionals with identifying high risk autism characteristics Video: Autism Screening Tutorial with the use of The Checklist for Autism in Toddlers (CHAT)
• Interview the parent/guardian and obtain a health history/questionnaireand/or screening checklist
• Directly observe the child’s behavior and language development, and social interaction and play
• Direct children to receive a comprehensive evaluation of speech, language and communication skills
• The child’s intellectual, neuropsychological and adaptive functioning should be adequately assessed
• Other investigations as needed in a child: physical status, DNA analysis, audiological status and rule outs of other known etiologies of ASD
• Non Pharmacological Interventions include Communication Interventions such as Support for Early Communication Skills, Social Communication and Interaction, Behavior/Psychological Interventions, Interventions for Specific Behaviors, Auditory Integration Training and Auditory Integration Training
• Pharmacological intervention: Risperidone, Methylphenidate, Secretin, Melatonin
• Service Provisions: all facility employees involved in autism treatment or screening with children and families should receive proper and up-to-date education and skills training
• Parents and guardians should be offered training and support materials in any form absorbable such as the following:

Autism Society of Greater Phoenix (Arizona & National autistic resources)

Southwest Autism Research & Resource Center (Autism information and research)

S.E.E.K Arizona (direct care services for autism in Arizona)

Autism National Committee (Autism advocacy organization)

Autism Speaks (global biomedical research)

References:

Armstrong, Carrie. (2008). American Academy of Family Physicians: Practice Guidelines. Retrieved from http://www.aafp.org/afp/2008/1201/p1301.html

National Guideline Clearinghouse. (2010). Retrieved from http://www.guideline.gov/summary/summary.aspx?doc_id=11011&nbr=005791&string

Nursing implications

By Maria Thaiveettil

When working with autistic patients the care has to be individualized. Giving individualized care to patients can be challenging if there is a lack of knowledge of the disorder by the health care staff. Because individuals with autism fall within a wide range between high functioning and low functioning, identifying the needs of each patient can be challenging. There is a lot of variance within these levels of functioning. For example, some low functioning patients may exhibit impairment in verbal and non-verbal communication, and may have hypersensitivities to touch. Often nurses lack the specialized education and training needed to provide quality care to autistic patients. According to research conducted by the Institute of Health Research, autistic patients often received care that was limited in flexibility and lacked supportive measures. This is not simply symptomatic of a lack of resources. Despite improved funding, supportive attitudes and flexibility were still limited, which indicates that often the system works for the system, not for the patient (Power, 2009). Another issue addressed by this research is lack of time. The data shows that nurses simply do not have the additional time needed for the complex needs of autistic patients.

Power, A. (2009). 'It's the system working for the system': carers' experiences of learning disability services in Ireland. Health & Social Care in the Community, 17(1), 92-98

Conclusions: Autism research and evidence based practice

By Claire Lockwood

Autism is a spectrum disorder and thus presents with a wide range of attributes. The biggest challenge to nurses is the identification of these specialized needs. There are many myths and misunderstandings surrounding the topic, so nurses and other healthcare professionals must clarify the facts from fiction. Fortunately, profound interest surrounding neurological, genetic, and social components of this disorder have broadened and deepened research endeavors. As research sheds light on the remaining mysteries of autism, healthcare professionals will be better educated and equipped to care for patients on the spectrum.