 Autistic Disorder

 Autistic Disorder

 Data Base

 A. Psychopathology

 1. Many theories as to cause are being studied; however, no definitive cause

has been established

 2. Failure to develop satisfactory relationships with significant adults,

regardless of the cause, appears to be an underlying problem

 B. Behavioral/clinical findings

 1. An alienation or withdrawal from reality, usually evident before age 3

 2. A severe disturbance in the child's feeling of self-identity

 3. Inability to differentiate between self and environment

 4. Confusion in self-boundaries frequently characterized by speaking of self

only in the third person

 5. A defect in ego formation or an inadequately functioning ego system

 6. A conflict between self and reality

 7. A defect in the adaptive, inhibitory, and steering mechanisms of the

personality

 8. Interference with intellect may be so profound, child appears to be

mentally retarded

 9. Lack of meaningful relationships with outside world

 10. Use of autistic fantasy resulting in communication defects

 11. Turning to inanimate objects and self-centered activity for security

 12. Symptoms associated with severe autism include:

 a. Profound apathy

 b. Looseness of association

 c. Autistic thinking
 d. Ambivalence

 e. Absence of communication skills

 f. Poor grasp of reality

 g. Bizarre, unpredictable, uncontrolled behavior

 h. Inability to relate to others

 i. Total interference with intellectual functioning

 j. Stereotypic body movements (rocking, spinning) and same routines

 k. Increased withdrawal from reality often begins with child refusing food

 C. Therapeutic interventions

 1. Psychotherapy directed toward the developmental level of the child: play,

group, or individual therapy

 2. Medications: neuroleptics, stimulants, and lithium provide some reduction

of symptoms

 3. Removal from the home situation may be necessary, although day school
situations frequently provide enough relief so that hospitalization can be
avoided

 Nursing Care of Clients with an Autistic Disorder

 A. Assessment

 1. Behavior associated with autism

 2. Rejection of physical contact with others

 3. Preference for inanimate, spinning, shiny objects

 4. Behavior directing emotional energy inward rather than toward the

external environment

 B. Analysis/Nursing Diagnoses

 Refer to General Nursing Diagnoses for Clients with Disorders Usually First
Evident During Infancy, Childhood

 C. Planning/Implementation
  1. Refer to Fundamental Principles When Caring for Clients with Disorders
Usually First Evident in Infancy, Childhood, or Adolescence

 2. Accept child's need to push away but continue to make physical contact on
a regular basis

 3. Provide a consistent routine for activities of daily living

 4. Maintain a consistent familiar environment

 5. Use picture and letter boards to assist in communication; participate in

child's activities

 6. Set consistent and firm limits for behavior

 7. Prevent acts of self-destructive behavior

 8. Support family's decision for homecare or institutionalization

 9. Encourage verbalization of feelings

 10. Help child establish self-boundaries by using child's name and personal
pronouns and identifying belongings

 D. Evaluation/Outcomes

 1. Sits in a group

 2. Decreases self-destructive behaviors

 3. Limits inappropriate behavior

 4. Increases use of first-person speech

 5. Uses less stereotyped and repetitive motor behaviors

 Attention-Deficit Hyperactivity Disorder

 AD/HD

• Characteristics:

Inattention, impulsiveness, low-frustration tolerance, & a lot of

inappropriate activity

3% - 7% of those under 18 are affected

Drugs are short-term help

 Behavior therapy is a useful treatment along with drugs

 ATTENTION-DEFICIT AND DISRUPTIVE BEHAVIOR

DISORDERS

 Attention-Deficit Hyperactivity Disorder

 Data Base

 A. Psychopathology

 1. Diagnosis difficult, because the pathology must be separated from normal

disturbances that occur during this period of life

 2. Evident before 7 years of age; lasting at least 6 months

 B. Behavioral/clinical findings

 1. Inappropriately inattentive

 2. Excessive impulsiveness

 3. Short attention span, easy distractability

 4. Squirming and fidgeting

 5. Hyperactivity may or may not be present

 CO MORBIDITY

 Pervasive impairments associated with ADHD

across the lifespan

 C. Therapeutic interventions

 1. Psychologic counseling

 2. Psychotropic medications; methylphenidate hydrochloride (Ritalin) is

frequently used

 Nursing Care of Clients with an Attention-deficit Hyperactivity

Disorder

 A. Assessment

 1. History of child's behavior from parents and teachers

 2. Behavior reflecting impulsiveness and pattern of inattention

 3. Difficulty in following instructions

 4. Inability to sit without fidgeting or moving about

 5. Easy distractibility by extraneous stimuli

 B. Analysis/Nursing Diagnoses

 Refer to General Nursing Diagnoses for Clients with Disorders Usually First
Evident During Infancy, Childhood

 C. Planning/Implementation

 1. Refer to Fundamental Principles When Caring for Clients with Disorders

Usually First Evident in Infancy, Childhood, or Adolescence

 2. Plan activities that provide a balance between expenditure of energy and

quiet time

 3. Set realistic, attainable goals

 4. Structure situations to provide less stimulation (play with only one other
child rather than a group)

 5. Provide firm and consistent discipline; ignore temper tantrums

 6. Provide exercises in perceptual-motor coordination and balance

 7. Structure learning experience to utilize the child's ability

 8. Provide opportunities so the child can experience success and satisfaction

 9. Administer drugs such as methylphenidate (Ritalin) or dextroamphetamine

sulfate (Dexedrine)

 D. Evaluation/Outcomes

 1. Participates in school and home activities

 2. Carries tasks to completion

 3. Follows directions