ASDs in Hospitals
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Transcript of 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
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
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)
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)
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)
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)
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)
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)
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)
Distractions
Hudson (2006), Sounders (2005)
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?
• 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
• 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