Thesis: Autism Has Grown Considerably in Recent Years

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¶ … autism has grown considerably in recent years. The medical and healthcare profession has become more aware of this problem and the number of cases of autism has increased, largely as a result of greater awareness of the problem and earlier diagnosis.

However, research on specific areas of the treatment of autism is not as prolific and this includes the focus on nursing care, treatment and management of the autistic child. While this is an area that is still in need of more in research it is also growing in terms of academic breadth and depth. The following literature review was drawn from a number of resources, including journals and other offline sources, as well as sources and data from verified online databases and journals.

The focus in this review will be on the area of nursing competence in terms of communication in dealing the autistic child; as well as on the question of the hospital environment as an adequate area for treatment. A third area of concern in this review will be the role of the parent and parental stress factors in relation to nursing.

1. General studies

There are many general studies and overviews of autism. Valuable data relating to the main themes of this review can be gleaned from these sources. An example is, Autism: recognizing the signs in young children by Jennifer Humphries. The study stresses that early diagnosis of autism is important, and that this has implications in terms of the role of the nurse. Another general but valuable resource is AUTISM: Assessment and Management ( 2007). This overview discusses the various aspects of autism, including different treatment modalities. Among the modalities that are discussed are pharmacotherapy, special education, speech, communication therapy, and behavior modification. The discussion on communication therapy is particularly pertinent to the present study. (Azeem and Imran, 2007) Another general overview of autism and nursing is Autism Spectrum Disorders by Hollander ( 2003).

2. The problems: communication and environment

Among the articles dealing with the problems that nurses encounter in dealing with the autistic child and pediatric or children's nursing care is Caring for Children and Adolescents With Autism Who Require Challenging Procedures (2003). The authors of the article state that, "Providing nursing care for children with autism or autistic spectrum disorders (ASD) can be challenging." (Souders, De Paul D, Freeman and Levy, 2003) This study included 62 children with autism. Their ages varied from between three and eight years of age. A multidimensional approach was employed in the assessment of the nursing requirements for these children and "…strategies were developed for providing care that incorporated theories and knowledge from the disciplines of nursing, child development, psychology, applied behavior analysis, and pain management." (Souders, De Paul D, Freeman and Levy, 2003)

The study emphasizes that with adequate research a plan of care for the autistic child can be developed but that intervention should be individualized in order to deal with the particular array of symptoms and issues encountered with each child. This is view that is echoed in many other studies and emphasizes the complexity of the task that the pediatric nurse has to deal with in assessing and treating young children with this condition. It also raises but does not answer the question as to whether the nurse is adequately trained to deal with the autistic child.

Another important finding of this study that also impacts on the central question of adequate communication training for nurses is that there has been a significant increase in the number of autistic children under nursing care. The authors stress that the "The prevalence of children with autism or autistic spectrum disorders (ASD) has increased over the past two decades." (Souders, De Paul D, Freeman and Levy, 2003) This is also supported by studies which indicate that the rate of autism may approach one percent of school age children. (Souders, De Paul D, Freeman and Levy, 2003) The reasons that are give for this increase is increased awareness of this condition as well as earlier diagnoses and intervention methods.

A revealing finding which is also echoed in a number of other studies is that children with autism present particular problems for the nurse. Normal procedures and treatments are complicated by factors such as poor communication and language skills as well as restrictive and repetitive behavior on the part of the children. Therefore the implication is that the nurse has to be more proficient in communication needs and abilities to deal with this group of children.

Other problems noted in the study include the difficulties that children with ASD have with new environments and with changes is their daily or normal routine. This points to the problem of the hospital environment and posits the question whether this environment or any new and unfamiliar environment is the best place to treat these children. Furthermore, this study makes the important observation that

Components of a health care visit can be very stressful to the child, parent, and health care professional and painful procedures can leave lasting negative memories. These memories can have a significant impact on future visits resulting in behaviors such as tantrums and aggressions toward health care personnel.

(Souders, De Paul D, Freeman and Levy, 2003)

These are all factors that the professional nurse has to be aware of in treating children with autism. The study also notes that there is a need for the development of effective interventions and management strategies that can result in a more positive healthcare experience for these children.

The problem of treating autistic children in the nursing and healthcare environment is expanded on in other studies and assessments, although it should also be noted that there is a relative paucity of in-death research in this area. Much of the available literature on the subject emphasizes that communication is a central nursing issues in dealing with the autistic child.

A study by Lesinskien? et al. entitled Aspects of nursing of the autistic children (2002) states that "Due to the behavioral and communication difficulties autistic children need individualized approaches providing them medical help…" (Lesinskien? et al. 2002, p. 412) The central purpose of this study is to "…analyze peculiarities of behavior, communication and social adaptation of children with autism disorder" in relation to the problems faced in both inpatients and outpatients in medical services. (Lesinskien? et al. 2002, p. 412) The study also includes intervention and treatment recommendations for pediatric and mental health nurses. The research included a comprehensive questionnaire that was given to mothers of children with and without developmental disorders. The age of the children concerned was between three and twelve years of age.

The study found that these children in general experienced "severe behavioral and emotional difficulties" when being examined and nursing staff. (Lesinskien? et al. 2002, p. 412) This again indicates the importance of environment and, similar to the study by Souders et al. ( 2003), questions the adequacy of the normal hospital environment in treating these children. This study stresses that, "Adaptation difficulties in medical services were very prominent, especially at the in-patient departments." (Lesinskien? et al. 2002, p. 412) These difficulties included unpredictable and impulsive behavior, as well as anxiety, decrease of appetite, and sleep disturbances. It is also suggested in this study that the hospital may not be the best environment for nursing interventions, and the suggestion is that home visits may be a more fruitful form of intervention.

This also raises another cardinal issue that is reiterated in a few other studies; namely that data from research indicates that a central area of concern in nursing is the establishment of adequate and interactive contact with these children. The study also suggests that more knowledge with regard to treating these children from a nursing perspective is needed.

Many studies indicate that the issue of nursing communication with the autistic child is a problem that includes many concomitant aspects; including the issue of creating an environment that is conducive to treatment in the first place. In order to establish more effective modes of techniques fro interaction with these children the nurse should also take into account of research in related fields and disciplines that can shed light on this problem. For example, a study entitled Caring for Children With Autism in the School Setting by Karen Galinat, Kelly Barcalow, and Barbara Krivda, provides some insight into the communicative aspects of dealing with autism that can be use fully applied in a nursing setting. All the authors have a nursing background and Galinat is a school nurse with the Mercer County Special Services School District in Mercer County, NJ.

As is the case in many other studies, the author stress that dealing with the autistic child requires an approach that is customized to cater for the particular individual aspects of that child. In other words it is difficult to administer or adhere to general protocols or strategies. "Each child with an autistic spectrum disorder (ASD) exhibits individual characteristics of the disorder." (Galinat et al.) The authors… [END OF PREVIEW]

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