How to Treat Young Patients with Autism

By Deborah Mitchell

Every young patient has his or her own personality traits, which can be challenging, but are often delightful. Special challenges can arise, however, when young patients have autism or autistic spectrum disorder (ASD).  

Medical examinations, inoculations or simple procedures like receiving stitches can terrify youngsters with ASD. Margaret Souders, PhD PNP-BC at Children's Hospital of Philadelphia (CHOP) and lead author of an article on caring for children with autism published in Pediatric Nursing in 2002, says it's important that have an action plan to interact with these children. 

Step One: Understand the Child 

Souders suggests that nurses speak with the parent(s) to understand the child's physical, emotional and mental abilities. A 15- to 30-minute session with the parents before the medical visit, either in person or on the phone, is often all that is required. Souders suggests you ask the parents the following:

  • Is the child verbal or nonverbal? Does the child follow simple commands?
  • Does the child make eye contact? Respond to his/her name? Share with others?
  • How does the child behave or respond to touch? Does the child have tantrums or other problem behaviors? What initiates them?

Children with ASD often are hypersensitive to sensory stimulation and thus may lash out when having a bandage applied or become aggressive if they smell a medication. Ask the parents how they handle such behaviors.  

Step Two: Plan for the Health Care Visit  

Make sure to remove any unnecessary items from the examining or treatment area. If you know the child is aggressive, have extra staff available during his or her appointment. It's important to make sure those staff members are fully aware of the child's special needs. Don't be surprised if you run into some resistance. Radiology staff once refused to work with a patient of Souders' who spit. "I told the techs to put on goggles and gowns," says Souders. "These children have an illness. You need patience and understanding." 

Step Four: Implement Behavioral Strategies  

Once you have a sense of your patient's special needs, select some appropriate behavioral strategies to use during the visit. Be prepared to try another strategy if your first attempt fails. A few strategies include:

  • Imitation plus reward

    If you need to listen to a child's heart, for example, demonstrate on a doll with a stethoscope, and then allow the child to imitate you. Reinforce the child with praise or a predetermined reward, such as a favorite toy.

  • Token system

    Before a medical procedure begins, have the child select a desired reward. Give the child a token at certain points during the procedure, with the understanding that he/she must gather a set number of tokens to get the reward.

  • Choices

    Children who are allowed to make choices often curtail or stop negative behaviors. The offered choices must be within the context of the procedure. For example, ask the child which arm to use for a blood sample.

  • Distraction

    This strategy is often the most effective. Souders advises nurses to "give the child a good time. Get into a playful mode." Try singing songs, reciting the alphabet, playing with toys or blowing bubbles during the patient's visit. 

Step Five: Look for Physical Abnormalities 

During your examination, make sure to look for any physical abnormalities that often accompany autism. Autistic children often have gastrointestinal disorders and nutritional imbalances. The Autism Research Institute reports one of the most predominant abnormalities in children with ASD is a permeable intestinal tract or 'leaky gut.' A 'leaky gut' can cause partially digested foods, toxins and bacteria to seep into the bloodstream causing infections and allergic reactions. 

Lyn Redwood, RN, MSN and conference coordinator for the Autism Research Institute, says these medical disorders "can be easily overlooked because the child may not have language skills and these abnormalities may not be visible." 

Redwood says these abnormalities can be identified through a detailed review of the patient's history, a physical exam and laboratory testing. Once treated, an autistic child's behavior can improve significantly, leaving him or her nearly symptom-free.  

Redwood and Souders agree that the key to successful medical interventions with children who have ASD is preparation and patience. Time spent talking with parents and assessing the patient, plus patience when implementing strategies, will allow you to provide the best patient care possible to an autistic child.

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