Autism Nursing Care Plans Diagnosis and Interventions
Autism NCLEX Review and Nursing Care Plans
Autism is an umbrella medical term used to describe a person with a group of neurological conditions. Autism or autism spectrum disorder (ASD) is a condition related to brain development that affects how a person perceives and socializes with others which causes problems in social interaction and communication.
Autism spectrum disorder also includes limited and repeated patterns of behavior. A person with autism spectrum disorder is found in people around the world regardless of the person’s race, culture, ethnicity, and economic background.
Autism can be a minor problem or a disability that requires full-time care in a special facility. People with autism have trouble with communication and may also have trouble understanding what other people may think and feel.
A person with autism spectrum disorder may experience difficulty in expressing themselves, either in words or through gestures, facial expressions, and touch. People with autism may have difficulty learning but are unusually good at art, music, math, and memory.
Signs and Symptoms of Autism
A person with autism spectrum disorder may affect social communication and interaction skills which may be challenging for a person with this disorder. Examples of social interaction and communication characteristics related to the autism spectrum disorder include:
- Avoidance or does not keep an eye contact
- Does not respond to name by the age of 9 months
- Does not show facial expressions like happy, sad, angry, and surprised by the age of 9 months
- Usage of few or no gestures by the age of 12 months
- Does not share an interest with others by age of 15 months
- Does not point to showing something interesting by the age of 18 months
- Does not notice when another person is hurt or upset by the age of 24 months
- Does not join or notice other children when playing by the age of 36 months
- Does not sing, dance, or act like the other children by the age of 60 months
People with autism spectrum disorder have behaviors or interests that can be unusual. The following are the examples of restricted repetitive behaviors that can be seen in a person with ASD:
- Performs repetitive movements such as rocking, spinning, and flapping of the hands.
- Performs activities that may cause self-harm, such as biting, or banging of the head.
- Develops specific routines or rituals and becomes disturbed even at the slightest change.
- Has a problem with coordination and has odd movement patterns such as walking on toes or clumsiness, and presence of odd, stiff, or the exaggerated language of the body.
- Is fascinated by the object details, such as spinning the wheels of a toy car, but the person does not understand the overall function of the object.
- Unusual sensitivity to light, sound, or touch, but indifferent to pain or temperature.
- Does not engage in make-believe play.
- Fixates an object or activity with abnormal focus or intensity.
- Eats only a few foods or has specific food preferences.
Other symptoms may include:
- Delayed movement, cognitive skills, and language
- Gastrointestinal symptoms such as diarrhea and constipation
- Extreme worry or stress
- Unusual levels of fear
- Hyperactive, inattentive, and impulsive behavior
- Unexpected emotional reaction of a person
- Uncommon eating habits or preferences
- Uncommon sleep pattern
As the person matures, some children with autism spectrum disorder become more engaged with others and show fewer disturbances in behavior.
People with the least severe problems may eventually lead to normal or near-normal lives. However, others may continue to have difficulty with language or social skills, and the teen years may bring worse behavioral and emotional problems.
Children with autism might experience trouble expressing their feelings and understanding others at 36 months. Children with autism might experience difficulty talking or they may experience limited speaking skills.
When the children with autism begin talking, they might talk in an unusual tone that can range from high-pitched and “sing-song” to robotic or flat tones.
Children with autism may also show signs of hyperlexia, which occurs when the child starts reading beyond the child’s expected ability and might be able to learn to read earlier that the others.
Autism spectrum disorder begins during childhood that often causes problems in functioning in society such as in school and work.
According to the Center for Disease Control and Prevention (CDC), autism spectrum disorder is often diagnosed in boys rather than in girls. Children often show symptoms of ASD within the first year and then go through a period of regression between the age of 18 to 24 months of age.
The Diagnostic and Statistical Manual of Mental Disorders, the fifth edition is published by the American Psychiatric Association and used to identify a variety of psychiatric disorders and recognizes five different subtypes of ASD or the Autism Spectrum Disorder. They are:
- With or without accompanying intellectual problem
- With or without accompanying language problem
- Related to a known medical, environmental, and genetic condition
- Related to another neurodevelopmental, behavioral, and mental problem
- With catatonia, which refers to the lack of movement and communication which includes agitation, confusion, and restlessness
People with ASD may also have a diagnosis of:
- Autistic disorder. Autistic disorder refers to the difficulties with social interaction, communication, and play in children younger than 3 years of age.
- Asperger’s syndrome. Asperger’s syndrome refers to children who do not have problems with language and tend to score in the average or above-average range on the test of intelligence. People with Asperger’s syndrome have social problems and have a narrow scope of interest.
- Childhood disintegrative disorder. These children show typical development for at least 2 years and then lose their communication and social skills.
- Pervasive developmental disorder. These children show delays in social and communication skills, but do not fit into another category.
Causes of Autism
The exact cause of autism spectrum disorder is unknown and the most current research shows there’s no single cause.
Some risk factors are suspected of ASD include:
- Having an autistic immediate family member
- Genetic mutation
- Fragile X syndrome and genetic disorders
- Born by older parents
- Low birth weight
- Metabolic imbalances
- Heavy metal and environmental toxin exposure
- History of viral infection of the mother
Risk Factors to Autism
There is an increasing number of children diagnosed with an autism spectrum disorder. It’s not clear if this is due to better detection and reporting or an actual increase in the number of cases diagnosed or both.
Risk factors may include:
- The child’s gender. Males are about four times more likely to develop ASD than girls.
- Family History. When the family has one child with autism spectrum disorder have an increased risk of having another child with an autism spectrum disorder. Parents or relatives of a child with autism spectrum disorder may have minor problems with social or communication skills themselves.
- Other disorders. Children with medical conditions have an increased risk of autism spectrum disorder or autism-like symptoms. Examples of the conditions that may increase the risk of ASD include fragile X syndrome, intellectual problems due to an inherited disorder, tuberous sclerosis, a condition that causes the development of benign tumors in the brain, and Rett Syndrome, intellectual disability and loss of purposeful hand use.
- Extremely preterm babies. Babies that are born before 26 weeks of gestation have a greater risk of having autism spectrum disorder.
- Age of parents. Children born to older parents may be a risk of having a child with an autism spectrum disorder.
Complications of Autism
Problems due to social interaction, communication, and behavior can lead to:
- School problems and problems with successful learning
- Employment problems
- Failure to live independently
- Social isolation
- Stress within the family
- Victimization and bullying
Diagnosis of Autism
The diagnosis of autism involves several screenings, evaluations, and genetic examinations, which may include:
- Developmental screenings. A developmental screening will help the physician to assess whether the child is on track with basic skills, like learning speaking, moving and behavior. Experts may suggest that children should be screened for developmental delays during regular checkups at 9 months, 18 months, 24 months, and 30 months of age. Children should be checked routinely specifically for autism at their 18th month and 24th-month checkups. The Modified Checklist for Autism in Toddlers(M-CHAT) is a screening tool commonly used by many pediatric offices. The M-CHAT is a 23-question survey that should be filled out by the parents to help identify children who have an increased chance of having ASD.
It is essential to note that screening is not a diagnosis. Children that will be screened as positive for ASD do not necessarily mean he or she has ASD.
- Other screenings and tests. The physician may recommend a test for autism including:
- DNA testing for genetic diseases
- Behavioral evaluation
- Visual and audio tests to rule out issues with vision and hearing that are not related to ASD
- Occupational screening therapy
- Developmental questionnaires
Multi-disciplinary Team for the Diagnosis of Autism
Specialists typically make the diagnosis, and the team may include:
- A child psychologist. A child psychologist focuses on the mind and behavior of the children from prenatal development through adolescence and deals not only with how children grow physically, but also with their mental, emotional, and social development.
- Occupational therapists. An occupational therapist helps children with autism improve the quality of their life at home and school focusing on the child’s needs and goals.
- Speech and language pathologists. A speech and language pathologist helps to prevent, assess, diagnose and treat speech, language, cognitive communication, as well as social communication of an individual of all ages.
Treatment for Autism
There is no known cure for patients with autism spectrum disorder, for some patients with ASD, supportive therapies and other considerations can help the patient feel better and decrease certain symptoms.
Therapies for ASD include:
- Behavioral therapy. Behavioral therapy helps in treating mental health disorders and helps in identifying the self-destructive and unhealthy behaviors of a person. Behavioral therapy is based on the idea that behaviors are learned and can be changed. The focus of the treatment is frequently on the current problems and how to change them.
- Play therapy. Play therapy is a therapy used for children who are unable to process their own emotions or express problems to their parents or other adults. A trained therapist may help the child by exploring the emotions and help in dealing with unresolved trauma. The children can learn new coping mechanisms and can learn how to redirect inappropriate behaviors through play.
- Occupational therapy. Occupational therapy is a type of rehabilitation that aims to improve or prevent the worsening of the patient’s condition or the patient’s quality of life due to an illness.
- Physical therapy. Physical therapy is also a type of rehabilitation that focuses on improving the patient’s mobility, movement, and function. A physical therapist uses a variety of exercises, stretches, or other physical activities to help the patient.
- Speech therapy. Speech therapy helps in treating and assessing communication problems and speech disorders of a person. Speech therapy helps the person with ASD to develop skills like comprehension, clarity, voice, sound production, and fluency.
The most effective therapies for autism spectrum disorder involve early and intensive behavioral support for the patient. The earlier a child joins in the programs, the better the outlook will be. Remember that ASD is complex, and it takes time for an autistic person to find the support program that is best suited for the patient.
April is Autism Awareness Month in the United States, and April 2 is World Autism Awareness Day.
The Autism Awareness Month is a month-long observance that focuses on raising awareness about autism spectrum disorders, what it means to be a person with autism, and how to support the people with autism during difficulties and discrimination that a person with autism spectrum disorder experiences.
Other communities’ advocates have rightly called for the need to increase awareness regarding ASD year-round, not only during the selected days.
The acceptance of autism requires empathy and understanding that autism spectrum disorder is different from the others. Awareness and acceptance are important for patients with autism.
It is important to be compassionate and most importantly, be kind. Therapies and certain approaches can work for some people. Understanding autism starts with awareness but does not end there.
Nursing Diagnosis for Autism (ASD)
Nursing Care Plan for Autism 1
Risk for Self-Mutilation
Nursing Diagnosis: Risk for Self- Mutilation related to developmental tasks that are not resolved from trust and distrust secondary to autism.
- The patient will be free of self-inflicted accidents and injury
- The patient will participate in impulse control training and coping skills training.
- The patient will ask for help when the patient experiences self-destructive impulses and will verbalize alternative ways to meet the demands of the current situation.
|Nursing Interventions for Autism||Rationale|
|1. Check the patient’s history of self-mutilation such as the type of mutilating behaviors, frequency of behaviors, and stressor preceding the behavior.||Knowing about the history of self-mutilation will help in identifying patterns and circumstances that surround self-injury that can help the nurse in planning interventions and teaching strategies that are appropriate to the patient.|
|2. Recognize the feelings experienced by the patient before and around the act of self-mutilation.||It is important to know the feelings of the patient to serve as a guide for future interventions such as rage at feeling left out or abandoned.|
|3. Maintain and establish limits on the patient’s behavior and make clear the client’s responsibilities.||It is essential to decrease negative behaviors such as clear and non-punitive limit setting.|
|4. Be consistent in maintaining and setting limits and approach the patient in a non-punitive way.||A sense of security can be achieved by consistency.|
|5. When self-mutilation occurs, use a matter-of-fact approach and avoid criticizing or giving sympathy.||Anxiety will be decreased when the nurse uses a neutral approach. Giving special attention to the patient will encourage acting out.|
|6. Make a plan to identify alternatives to self-mutilating behaviors such as anticipating certain situations that may cause increased stress, identifying actions that will modify the intensity of situations, and identifying people that the patient can contact to express and discuss the patient’s intense feelings.||It is important to review and evaluate plans and offer a chance to cope with feelings and struggles that may happen.|
Nursing Care Plan for Autism 2
Nursing Diagnosis: Chronic Low Self-Esteem related to avoidant and dependent patterns, and persistent lack of integrated self-view secondary to autism as evidenced by evaluation of self as unable to deal with the events, expressively seeking reassurance, and rationalizing away the positive feedback, and exaggerating negative feedback.
- The patient will show skills that will help him or her to meet future goals.
- The patient will show the ability to reframe and dispute cognitive distortion with assistance.
- The patient will show a willingness to work to achieve realistic goals with the nurse that the patient wishes to pursue.
|Nursing Interventions for Autism||Rationale|
|1. Check the perception of the patient and evaluate the patient’s strength and witness in performing in school and at work as well as the patient’s physical appearance, sexuality, and personality.||The patient’s strengths and weaknesses should be identified by the nurse. The nurse and the patient can work together on the realities of the self-appraisal.|
|2. Provide a neutral, calm environment and show a respectful attitude to the patient.||Showing a neutral and calm environment may help the patient to see himself or herself as a respected person even if the behavior might not be appropriate.|
|3. Assess for the presence of low self-esteem through blaming, projection, anger, passivity, and the presence of demanding behaviors because it is commonly seen in patients with a personality disorder.||Patients with personality disorders may show many different behaviors that may affect the patient’s interpersonal difficulties in the patient’s relationships with others.|
|4. Ask the patient about his or her plans for the future and work with the patient and help in setting realistic goals and identify skills that should be learned to help the patient in reaching his or her goals.||If the realistic short-term goals are met the patient will be able to gain a sense of accomplishment, direction, and the patient’s purpose in life. The accomplishment of the goals can increase a sense of control and help in enhancing self-perception.|
|5. Practice transparency and honesty when giving feedback regarding the observation to the patient about his/her strength and to the areas that needed additional skills.||Giving honest feedback helps the patient to have an accurate view of self. Therapeutic alliance may be affected by dishonesty and insincerity.|
Nursing Care Plan for Autism 3
Impaired Social Interaction
Nursing Diagnosis: Impaired Social Interaction related to genetic factors, immature interests, and unacceptable social behavior and values of the patient secondary to autism as evidenced by destructive behaviors towards self and others, dysfunctional interaction with peers, family, and others, and observed use of unsuccessful social interaction behaviors.
- The patient will show increased security and decreased suspicions.
- The patient will show decreased manipulative behavior.
- The patient will show interest and willingness to change to at least two unacceptable behaviors.
- The patient will participate with the nurse in identifying the positive behaviors that can be substituted for the patient’s unacceptable behavior.
|Nursing Interventions for Autism||Rationale|
|1. Establish limits on the undesirable behaviors such as: Arguing or beggingConstantly seeking attentionFrequently disregarding rules Angry and demanding behaviors||Setting limits for the behavior should also be done at the beginning of the interventions, because the patients may test the limits repeatedly.|
|2. Check the thoughts and feelings of the patient constantly and collaborate with the patient and establish a reward system for the patient’s compliance with clearly defined expectations.||Reinforcement for meeting the expectations may help in strengthening the patient’s positive behaviors.|
|3. Provide alternative ways that will help interpersonal relationships such as problem-solving and role-playing with the patient acceptable social skills that will help the patient to obtain his or her needs appropriately||Alternative ways of experiencing interpersonal relationships are important to assess if the patient is willing to work on and help with the goals.|
|4. Advise the patient, family, and significant others about the need for a skills training workshop.||To help the patient increase social skills through role-playing and interaction with others, skill training workshops are important. Skills training workshops will help in motivating the patient.|
|5. Document the behaviors of the patient objectively. Assess for the physical signs that will help in managing the clinical problems. Maintain the boundaries and set limits.||The patient may test another person’s limit, and once the patient understands the limits, this will help the patient to be motivated to work on other ways that will help him or her to get his or her needs.|
Nursing Care Plan for Autism 4
Nursing Diagnosis: Ineffective Coping related to the failure to change behavior, negative attitudes toward health behavior, and intense emotional state secondary to autism as evidenced by extreme distrust of others, failure to achieve an optimal sense of control, and manipulation of others.
- The patient will identify the skills that will help in facilitating functional behaviors.
- The patient will use coping skills that will help in modifying anxiety and frustration.
- The patient will verbalize his or her feelings and perception and not act on them.
|Nursing Interventions for Autism||Rationale|
|1. Recognize the behavioral limits and behaviors that are expected of the patient.||The patient needs clear structure and the nurse should expect frequent testing of limits. Maintaining limits is important to enhance feelings of being safe.|
|2. Consistently approach the patient in all interactions.||Being consistent will help to enhance feelings of security and will provide structure to the patient.|
|3. Provide a concrete and clear written plan of care that the other staff may follow.||Providing a clear and concrete plan will help in minimizing manipulation and will help to encourage cooperation.|
|4. Understand the patient’s underlying feelings that cause inappropriate behaviors.||Feelings of anger, fear, shame, insecurity, and loneliness should be assessed by the nurse. Talking about the patient’s feelings can help in problem-solving and will contribute to the growth of the patient.|
|5. Set very realistic goals and go in small steps. People with autism might take a long time to achieve their goals.||Change is always possible but it can take a long time to see a positive change in the behavior.|
|6. Instruct and encourage the patient with coping skills that will help decrease tension and trouble feelings such as anxiety, reduction and assertive skills.||Coping skills may help the patient to reduce the tension and will help in achieving the goals for the patient.|
Nursing Care Plan for Autism 5
Nursing Diagnosis: Caregiver Role Strain is related to the patient’s extreme distrust of others, patient dependency, and failure to achieve an optimal sense of control secondary to autism as evidenced by verbalization of the family about the inability to perform patient care.
- The caregiver will identify the skills that will help them in doing daily patient care.
- The caregiver will verbalize his or her willingness to assume care for the patient.
Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier. Buy on Amazon
Gulanick, M., & Myers, J. L. (2022). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon
Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2020). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier. Buy on Amazon
Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier. Buy on Amazon
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