University of Pangasinan

College of Nursing
Dagupan City, Philippines

Prepared By:

Paul Christian P. Santos

Carl M. Saure
BSN III-P
RHU-I Calasiao, Pangasinan
8-4shift MT/W

Submitted to:
Ms. Rowena Balolong, RN
Clinical Instructor
Senior Divino Tesoro Health Center

Definition:
 Autistic disorder, historically called early infantile autism, childhood autism or Kanner’s
autism is characterized by deviant reciprocal social interaction , delayed and aberrant
communication skills and a restricted repertoire of activities and interests.

Epidemiology:

· Prevalence – autistic disorder is believed to occur at a rate of 5 cases per 10,000 children.
· Sex distribution- autistic disorder is four to five times more common in males

Autism is associated with several other conditions:

Genetic disorders. About 10–15% of autism cases have an identifiable Mendelian

(single-gene) condition, chromosome abnormality, or other genetic syndrome, and ASD
is associated with several genetic disorders.

Mental retardation. The fraction of autistic individuals who also meet criteria for
mental retardation has been reported as anywhere from 25% to 70%, a wide variation
illustrating the difficulty of assessing autistic intelligence. For ASD other than autism,
the association with mental retardation is much weaker.

Epilepsy, with variations in risk of epilepsy due to age, cognitive level, and type of
language disorder.

Anxiety of various types in children and adolescents with ASD, with symptoms
including generalized anxiety and separation anxiety.[142]

Several metabolic defects, such as phenylketonuria, are associated with autistic

symptoms.

Minor physical anomalies are significantly increased in the autistic population.[143]

Preempted diagnoses. Although the DSM-IV rules out concurrent diagnosis of many
other conditions along with autism, the full criteria for ADHD, Tourette syndrome, and
other of these conditions are often present and these comorbid diagnoses are
increasingly accepted.

Etiology:
· Psychosocial and family factors- mothers lack of emotional responsiveness, parental rage and
rejection etc. can contributed to development of autism. Psychosocial stressors including family
discord, the birth of a new sibling, or a family move. Some children with autistic disorder may be
excruciatingly sensitive to even small changes in their families and immediate environment.

· Biological factors-the high rate of mental retardation among children with autistic disorder and
the higher than expected rates of seizures disorders suggest a biological basis for autistic
disorder.

· Genetic factors-in several surveys, between 2 and 4 percent of sibling of autistic children also
had autistic disorder, a rate 50 times in the general population. The concordance rate of disorder
in the two largest twin studies was 36 percent in monozygotic pairs versus 0 percent in dizygotic
pairs in one study and 96 percent in monozygotic pairs versus about 27 percent in dizygotic pairs
in the second study.

· Immunological factors- several report have suggested that immunological incompatibility may
contribute to autistic disorder.

· Exposure to teratogens (agents that cause birth defects)

>infectious diseases
>heavy metals
>solvents
>diesel exhaust
>PCBs
>phthalates and phenols used in plastic products,
>pesticides,
>brominated flame retardants,
>alcohol,
>smoking,
>illicit drugs,
>vaccines (MMR) preservative thiomersal –theoretical

Clinical features:
1. PHYSICAL CHARACTERISTICS
●children with autistic disorder are often described as attractive and , on first glance , do not
show any physical signs indicating autistic disorder . these children do have high rates of minor
physical anomalies , such as ear malformations.

2. BEHAVIORAL CHARACTERISTICS

●Qualitative impairment in social interaction

(+) lacks a social smile and anticipatory posture for being picked up as an adult approaches.
(+)Less or poor eye contact.
(+) Social development is impaired.
(+)Do not acknowledge or differentiate the most important persons in their lives –parents,
siblings, and teachers and may show extreme anxiety when their usual routine is disturbed.
(+)Deficit in the ability to play with peers and to make friends.

●Their social behavior is awkward and inappropriate.

(+)Disturbance of communication and language— deficit in language development and difficulty

using language to communicate ideas. Autistic children have significant difficulty in putting
meaningful sentences together.

(+)Stereotyped behavior—spontaneous exploratory play is absent. Do not show imitative play

and they are often rigid, repetitive, or monotonous. Children often spin, bang, and line up objects
and may exhibit an attachment to a particular object. Stereotypes, mannerisms and grimacing are
most frequent.

(+)Instability of mood and affect—exhibits sudden mood changes, with burst of laughing or
crying without an obvious reason

(+)Response to sensory stimuli— over response to some stimuli and under response to some
other stimuli. Heightened pain threshold or an altered response to pain. Enjoys music.

(+)Associated behaviors— hyper kinesis is common behavior problem in young autistic children.
Aggression and temper tantrums are observed. Self injurious behavior are observed like head
banging, biting, scratching, pulling hairs.

(+)Associated physical illness— higher incidence of upper respiratory tract infections, gastric
signs and symptoms like diarrhea, constipation, and febrile seizures.
3. INTELLECTUAL FUNCTIONING

About 30 % of children with autistic disorder exhibit mild to moderate range of mental
retardation and about 45-50 percentage of children are severely to profound mental retardation.

Differential diagnosis:
The major differential diagnosis are schizophrenia with childhood onset, mental retardation with
behavioral symptoms, mixed receptive expressive language disorder, congenital deafness, severe
hearing disorder and disintegrative psychosis.

Course and prognosis:

Autistic disorder are generally a life long disorder with a guarded prognosis. Autistic children
with IQs above 70 and those who use communicative language by ages 5 to 7 tend to show better
prognosis. Children with grandmal seizures in the late childhood or early adolescence have poor
prognosis.

Treatment :
· The GOALS of treatment for autistic disorder are:
>to increase socially acceptable and prosocial,
>to decrease odd behavioral symptoms,
>to improve verbal and non verbal communication,
>to lessen associated deficits and family distress,
>to increase quality of life and functional independence

Both language remediation and academic remediation are often required. Children with mental
retardation need intellectually appropriate behavioral interventions to reinforce socially
acceptable behavior and encourage self-care skills. Educational and behavioral interventions are
currently considered the treatment of choice.

· Careful training of parents in the concepts and skills of behavior modifications and resolution of
the parents concerns may yield considerable gains in children’s languages, cognitive and social
areas of behavior.

· There are no specific medications to treat the core symptoms of autistic disorder. Medications
have been reported to improve associated symptoms including aggression, severe temper
tantrums, self injurious behavior, hyperactivity and obsessive-compulsive behavior and
stereotypes. SSRIs , olanzapine, quetiapine, risperidone, clozapine, ziprasidone etc are the
common drugs use for the treatment of autism.

Source:
http://www.nursingplanet.com Nursing Management of Autism
by Jincy Jose, MSc.N, Manipal Colege of Nursing, Manipal University