Autism Nursing Diagnosis and Nursing Care Plan

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

• 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
• Seizure
• 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.

• 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

• 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 18 th 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.

• 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.

  Autism Awareness

  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 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 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.

  Desired Outcomes:

  • 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 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 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.

  Nursing References

  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

  Disclaimer:

  Please follow your facilities guidelines, policies, and procedures.

  The medical information on this site is provided as an information resource only and is not to be used or relied on for any diagnostic or treatment purposes.

  This information is intended to be nursing education and should not be used as a substitute for professional diagnosis and treatment.

  Anna Curran. RN-BC, BSN, PHN, CMSRN I am a Critical Care ER nurse. I have been in this field for over 30 years. I also began teaching BSN and LVN students and found that by writing additional study guides helped their knowledge base, especially when it was time to take the NCLEX examinations.