ASDs in Hospitals

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Adapting What We Already Know NY Presbyterian/Weill Cornell Medical Center Child Life In-Service April 28, 2011 Laura Marie Romeo, Child Life Assistant

Transcript of ASDs in Hospitals

Page 1: ASDs in Hospitals

Adapting What We Already Know

NY Presbyterian/Weill Cornell Medical CenterChild Life In-Service

April 28, 2011Laura Marie Romeo, Child Life Assistant

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Autism Spectrum Disorder•Autistic Disorder•Asperger’s Disorder•Childhood Disintegrative Disorder•Rett’s Disorder•Pervasive Developmental Disorder (PDD)

•Diagnosis:-impairments in social interaction-communication challenges-limited range of interests and behaviors

http://www.ninds.nih.gov/disorders/autism/autism.htm

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Aggression in ASDs•Children with ASDs tend to be 4-5 years

behind in social maturity

•Aggressive behaviors emerge because:-Rigidity-Resistance to deviations-Poor executive functioning—emotional control-Sensory overload-Confusion over verbal and non-verbal cues-Expect the worst and paranoid thinking

-Fear and anxiety

Geller (2011)

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ASD in the Hospital•About 560,000 children in the US have an ASD•Children with ASD are more likely to have: -cancer -Down syndrome

-spina bifida-seizures-sleep disturbances-GI disorders-psychiatric disorders

Scarpinato et al. (2010)

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Our Role•Research shows that members of the

healthcare team often find children with ASD to be awkward and inappropriate

•Therefore they often get avoided at the hospital

•But we already have the tools to make sure that this doesn’t happen!

Hudson (2006)

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At Admission•As usual, assess the following: -developmental level

Where are they at cognitively? Do they go to school? -somatosensory level

What senses are the most active? -emotional disturbances

What triggers fear and anxiety? -effective interventions

What has worked in the past to overcome fears? -effective communication

What method is best…not eye-to-eye, using puppet? -personal interests

Scarpinato et al. (2010), Verzosa (2009), Hudson (2006)

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Familiarize Child to Floor•Walk around ward•Show staff picture board

• If have digital camera, let child take pictures of different parts of floor and people

•Show the playroom and treatment room when it is empty and clean

Scarpinato et al. (2010), Sounder (2002), Verzosa (2006), Worth (2008)

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Set Up Schedule•CONSISTENCY!!• Break down routine into simple steps and procedures -utilize pictures and drawings -write a social story about the child’s day at the hospital• Review any changes that might occur in the schedule

•Language-numbered lists-simple sentences-simple pictures-calm voice-easier to answer closed questions

Help Autism Now Society (2011), Hudson (2006), Scarpinato et al. (2010)

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Procedures• Use the treatment room• Prepare, prepare, prepare leading up to feared event!!• Use lidocaine based topical creams or Versed• Limit number the people in room• Introduce people in room (preferably before

procedure)• Bring along favorite objects• Set up award system (sticker for every step), Praise!!• Keep voices and lights as low as possible• Debrief afterwards

Hudson (2006), Moffitt (2011), Sounders (2005), Scarpinato et al. (2010), Worth (2008)

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Distractions

Hudson (2006), Sounders (2005)

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Do What We Do Best•ADVOCATE!• For a consistent schedule• For thorough preparation• For sensitivity• For simplicity• For understanding

Case Study: 12yr old autistic male in the hospital for trauma. Is physically aggressive at moments. Has started to make sexual comments to women. Nurses openly talk about him and mother in hallways. What do you do?

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• Autism Society. (2008). About autism. Retrieved March 11, 2011, from http://www.autism-society.org/

• Geller, L. (2011, Apr 11). Powerpoint lecture on Demystifying aggression: Developing effective interventions. Bank Street College of Education, NY, NY.

 • Grandin, T. (1995). Thinking in pictures: And other reports from my life with

autism. NY, NY: Vintage Books. • Help Autism Now Society. (2011). Today I am going to have my blood drawn.

Retrieved March 11, 2011, from http://www.helpautismnow.com/blood_draw.html

 • Hudson, J. (2006). Prescription for success: Supporting children with autism

spectrum disorders in the medical environment. Shawnee Mission, KS: Autism Asperger Publishing Co.

 • Moffitt, S. (2011). Hospital preparedness lacking for children with autism. Autism

Key. Retrieved March 11, 2011, from http://www.autismkey.com/hospital-preparedness-lacking-for-children-with-autism/

 • National Institute of Neurological Disorders and Stroke. (2011). NINDS autism

information page. Retrieved March 11, 2011, from http://www.ninds.nih.gov/disorders/autism/autism.htm

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• Scarpinato, N., Bradley, J., Kurbjun, K., Bateman, X., Holtzer, B., & Ely, B. (2010). Caring for children with an autism spectrum disorder in the acute care setting. Journal for Specialists in Pediatric Nursing, 15(3), 244-254.

 • Senator, S. (2005). Making peace with autism: One’s family story of

struggle, discovery, and unexpected gifts. Boston, MA: Trumpeter Books. • Sounders, M. C., Freeman, K. G., Depaul, D., & Levy, S. E. (2002). Care for

children and adolescents with autism who require challenging procedures. Pediatric Nursing, 28, 555-562.

• Verzosa, Maryanne. (2009). Lu-lu goes to the hospital: Caring for a child with autism spectrum disorder in the healthcare setting. (Masters’ thesis). Retrieved from Bank Street College of Education.

 • Worth, T. (Dec 2008). Tips for treating children with autism: To minimize

patients’ acting out, rely on careful planning and consistency. Today’s Hospitalist. Retrieved March 11, 2011, from http://www.todayshospitalist.com/index.php?b=articles_read&cnt=731