Autism spectrum disorder (asd)

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1. A utism spectrum disorder (ASD). Presented by : Suaad Saleh

2. Out line Introduction of autism disorder. Detention of autism disorder. Etiology of autism disorder. Epidemiology DSM-V- of autism disorder. Sign and symptoms of autism disorder. Medical management of autism disorder. Nursing diagnosis in patient with autism disorder.

3. Objective At the end of the presentation student will be able to : Define autism disorder. Identify etiology of autism disorder. Describe the DMS-V for diagnosis of autism disorder . Describe sign and symptoms of autism Describe medical management and treatment of of autism disorder. Apply nursing process for patient with autism disorder .

4. Introduction Autism spectrum disorder (ASD) is a condition that affects social interaction, communication, interests and behaviour. In children with ASD, the symptoms are present before three years of age, although a diagnosis can sometimes be made after the age of three.

5. Definition Autism is a complex neurobehavioral disorder that includes impairment in social interaction , verbal and non-verbal communication combined with retracted and repetitive behavior. Parent usually notice sign in the first two year of their child life.

6. Etiology Genetics.  Several different genes appear to be involved in autism spectrum disorder. For some children, autism spectrum disorder can be associated with a genetic disorder, such as Rett syndrome or fragile X syndrome. For other children, genetic changes (mutations) may increase the risk of autism spectrum disorder. Still other genes may affect brain development or the way that brain cells communicate, or they may determine the severity of symptoms. Some genetic mutations seem to be inherited, while others occur spontaneously. Environmental factors.  Researchers are currently exploring whether factors such as viral infections, medications or complications during pregnancy, or air pollutants play a role in triggering autism spectrum disorder.

7. Epidemiology A study by the Autism and Developmental Disabilities Monitoring (ADDM) Network and funded by the Centres for Disease Control and Prevention (CDC) determined the prevalence of ASD in the United States to be about 11.3 per 1,000 (1 in 88) children (CDC, 2012b). It occurs about 4.5 times more often in boys than in girls. Onset of the disorder occurs in early childhood, and in most cases it runs a chronic course, with symptoms persisting into adulthood.

8. DSM-V- for A)  An autistic disorder diagnoses requires six or more characteristics from the following lists, with at least two from list 1, and one each from lists 2 and 3:   1- Impairment in social interaction (must show at least 2 items from this list) Impairment in the use of multiple nonverbal behaviours Failure to develop peer relationships appropriate to developmental level Lack of attempts to share enjoyment, interests, or achievements with others Lack of social or emotional reciprocity   2- Impairments in communication (must show at least 1 item from this list) Delay in, or lack of, the development of spoken language (not accompanied by an attempt to compensate through other types of communication, such as gestures or mime) Impairment in the ability to initiate or sustain a conversation with other, for those with adequate language ability Stereotyped and  repetitive use of language or idiosyncratic language Lack of make-believe play or social imitative play appropriate to developmental level  

9. 3- Restricted, repetitive, or stereotyped patterns of behaviour, interests, or activities (must show at least 1 item from this list) Encompassing preoccupation with stereotyped and restricted patterns of interest that is abnormal either in intensity or focus Inflexible adherence to specific, non-functional routines or rituals Stereotyped and repetitive motor mannerisms Persistent preoccupation with parts of objects (B) Show delays or abnormal functioning in at least one of the following areas before 3 years of age: Social interaction Language as used in social communication Symbolic or imaginative play (C) Not better meet the criteria for by Rett's disorder or childhood disintegrative disorder

10. Sign and symptoms Social interactions and relationships .   Significant problems developing nonverbal communication skills, such as eye-to- eyegazing , facial expressions, and body posture. Failure to establish friendships with children the same age. Lack of interest in sharing enjoyment, interests, or achievements with other people. Lack of empathy. People with  autism may have difficulty understanding another person's feelings, such as pain or sorrow. Verbal and nonverbal communication.   Delay in, or lack of, learning to talk. As many as 40% of people with autism never speak . Problems taking steps to start a conversation . Stereotyped and repetitive use of language. People with autism often repeat over and over a phrase they have heard previously (echolalia). Difficulty understanding their listener's perspective. For example, a person with autism may not understand that someone is using humor . They may interpret the communication word for word and fail to catch the implied meaning.

11. Limited interests in activities or play.   unusual focus on pieces. Younger children with autism often focus on parts of toys, such as the wheels on a car, rather than playing with the entire toy. Preoccupation with certain topics. Ex( older children and adults may be fascinated by video games, trading cards, or license plates. A need for sameness and routines. Ex (a child with autism may always need to eat bread before salad and insist on driving the same route every day to school. Stereotyped behaviours Ex.. body rocking and hand flapping

12. Medical management and treatment There's no 'cure' for autism spectrum disorder (ASD), but there are a range of specialist interventions that aim to improve communication skills and help with educational and social development.

13. Pharmacotherapy • CNS stimulants: Dextroamphetamine , methylphenidate, pemoline • Tricyclic antidepressants • Antipsychotics • Serotonin specific re-uptake inhibitors • Clonidine Psychological therapies • Behavior modification techniques • Cognitive behavior therapy • Social skills training

14. Nursing diagnosis: 1) Risk for self-mutilation related to neurological alterations ; history of self- mutilative behaviors ;hysterical reactions to changes in the environment Short-Term Goal • Client will demonstrate alternative behaviour (e.g., initiating interaction between self and nurse) in response to anxiety within specified time . ( Length of time required for this objective will depend on severity and chronicity of the disorder.) Long-Term Goal • Client will not harm self. 2) Impaired social interaction related to inability to trust; neurological alterations, evidenced by lack of responsiveness to, or interest in,people Short-Term Goal • Client will demonstrate trust in one caregiver (as evidenced by facial responsiveness and eye contract) within specified time (depending on severity and chronicity of disorder). Long-Term Goal • Client will initiate social interactions (physical, verbal, nonverbal) with caregiver by time of discharge from treatment .

15. Risk for self-mutilation 1. Work with the child on a one-to-one basis . One-to-one interaction facilitates trust. 2. Try to determine if the self- mutilative behavior occurs in response to increasing anxiety, and if so, to what the anxiety may be attributed. 3. Try to intervene with diversion or replacement activities and offer self to the child as anxiety level starts to rise . Mutilative behaviors may be averted if the cause can be determined and alleviated .

16. Impaired social interaction 1. Assign a limited number of caregivers to the child. Ensure that warmth, acceptance, and availability are conveyed. Warmth, acceptance, and availability, along with consistency of assignment, enhance the establishment and maintenance of a trusting relationship. 2. Provide child with familiar objects, such as familiar toys or a blanket. Support child’s attempts to interact with others . Familiar objects and presence of a trusted individual provide security during times of distress. 3. Give positive reinforcement for eye contact with something acceptable to the child (e.g., food, familiar object ).Gradually replace with social reinforcement(e.g ., touch, smiling, hugging ). Being able to establish eye contact is essential to the child’s ability to form satisfactory interpersonal relationships.

17. SUMMARY Autism is a brain disorder that often makes it hard to communicate with and relate to others . Most people with autism will always have some trouble relating to others. But early diagnosis and treatment have helped more and more people who have autism to reach their full potential.

18. Reference http://readingroom.mindspec.org/? page_id=6805 Essentials of Psychiatric Mental health nursing 6th edition https:// medlineplus.gov/autismspectrumdisorder.html#cat_95 https:// www.nhsinform.scot/illnesses-and-conditions/brain-nerves-and-spinal-cord/autistic-spectrum-disorder-asd#adults-living-with-autism