Autism Spectrum Disorder: Case Study Analysis and Nursing Interventions

This paper highlights a case study analysis of a child with Autism Spectrum Disorder (ASD) and provides nursing interventions for recovery. It discusses the two main issues faced by the child, communication problems and repetitive behavior, and suggests solutions such as parental communication and cognitive behavioral therapy. The paper also emphasizes the role of LPN in overcoming identified health priorities.

Running head: AUTISM SPECTRUM DISORDER
AUTISM SPECTRUM DISORDER
Name of the Student
Name of the University
Author Note

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Introduction
The purpose of this paper is to highlight on a case study where child is experiencing
cognitive or mental health disorder: Autism Spectrum Disorder (ASD). I a LPN, selected the
child with ASD as the main target of interest because ASD affects both mental and cognitive
skills of a child. This developmental disorder generally appears in the first two years of life
(National Institute of Mental Health, 2019). The paper will begin with a narrative overview of
the case study that will highlight my personal experience in working with an autistic child in
the paediatric ward of the hospital. After providing the background information about the
child, the paper will highlight two main issues or problems that the child is facing. This will
be followed by analysis of the issues and how it is impairing her daily living activities
(DLAs). At the end the paper will provide specific nursing interventions and will highlight
the role of a LPN in overcoming identified health priorities. Overall I would like to highlight
the main complications experienced by ASD children and nursing interventions for recovery.
ASD is a developmental disorder. According to the Diagnostic and Statistical Manual
of Mental Disorder (DSM-5) by the American Psychiatric Association, children with ASD
experience difficulty in communication and interaction with people and are found to have
repetitive behaviour or limited interests. The child with ASD has reduced ability to perform
properly in school, work and other sectors of life in comparison to a child (National Institute
of Mental Health, 2019). Thus taking into consideration about the complex mental and
cognitive needs of ASD child with autism, I preferred to work and analyze the need of ASD
child. Proper analysis of the need and the framing of the subsequent interventions for ASD
child will help to improve their overall health and well-being and at the same time will help
to assist them in their academic performance. According to the Canadian Press (2018), one

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out of 66 Canadian children is diagnosed with autism. This increased prevalence of ASD
among Canadian children is another reason behind my selection of ASD child for analysis.
Case Study Background Information
In the hospital out-patient department of the paediatric unit, I meet a girl named Ana
she was brought in order to work on her gross and fine motor skills as she was suffering from
developmental delays arising from ASD. Ana’s mother reported that, “My girl Ana I four
year old. During her birth she was born as a healthy child and her motor development was
normal hitting the major milestones of standing, sitting and walking”. Then her mother
reported that, “When Ana was 3 years old, she was identified with a low tone along with
awkward motor skills”. “The doctor says that my girl has ASD and this is the reason for her
developmental delay”. “I bought her to the hospital in order to manage her gross and fine
motor skills so that she can perform equally like her friends in school”.
At the out-patient department in the hospital, I observed Ana closely. I found that Ana
is mainly communicating by the use of the non-verbal means. I also found that she use her
communication mainly for the behavioural regulation. I also found that she communicated
requests mainly by reaching for the communication partner’s hand and placing it on the
desired object. For example, when I bought a tray of chocolates in-front of her as a welcome
gift and asked her “Which one do you like to have?”, she refused to answer, After repeated
asking, She placed my hands over a dark chocolate toffee. I understood that she wants that. I
also observed that Anna played with the toys functionally when seated and showed repetitive
behaviour like she was constantly removing the shoes of one Barbie doll and then putting it
on. She was also found opening and closing the door of the cupboards constantly that
contained toys. Her repetitive behaviour gets increased when she wants of show case her
anger. She also inconsistently responded to her name and her gaze in eyes was absent.

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Case Study Analysis: Identification of the Two Main Issues and Respective Solutions
The main identified issues with Anna apart from the fine and gross motor skills are
communication problem and repetitive behaviour in response to emotional explosion.
Communication Problems
National Institute of Deafness and Other Communication Disorder (NIDCD) (2019)
highlighted that children with ASD in the majority of the times are self-absorbed and at times
seem to exist in their private work under which they have limited ability of successfully
communicate and interact with others. I also found Anna engrossed in her own world as when
she is called on by her name, she rarely responds and mainly remain indulge in playing with
toys or starting out of the windows. Øien & Eisemann (2016) reported that ASD children
experience difficulty in communicating and understanding what others want to say. Like even
after repetitive asking which chocolate he wants she gave me a blank stare and after a while
drag my hand over the dark chocolate toffee. This might be due to the fact that ASD children
seems more interested in environmental sounds like whirring of a fan or vacuum than that of
individual’s voice and thus taking time in recognising and understanding the question.
Berggren, Engström and Bölte (2016) highlighted that running out of words or gap in the
communication skills is the reason why the ASD child provides blank gaze and refuse to
indulge in active conversation. Williams, Siegel and Mazefsky (2018) argued that ASD
children have trouble in communicating non-verbally. However, Anna can effectively use
non-verbal communication skills like use of hands gestures to highlighting her needs or
choice.
Øien and Eisemann (2016) reported that impaired speech and language development
and difficulty in communication skills hampers the academic performance of the child and at
the same time impairs active participation in the social activities with other peers and thereby
hampering overall process of health and well-being. Kao et al. (2015) reported that there is a

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strong association between the communication impairment and function in the daily living
activities. I identified Ana is having communication problem when I saw that she is using
gestures to communicate her thoughts or needs. I also found that she is only communicating
verbally during emergency situations like when she wanted to go washroom, she
communicated with her mother in single word like “Loo”. I also observed that when other
children in the ward approached her for play or for friendly interactions, she ran away inside
the lap of her mother. I realized that her communication problem or difficulty in
communicating is generating a sense of fear or a sense of shame that is making her to run
away from any kind of social activities. Deckers, Muris and Roelof (2017) highlighted that
communication gap or delayed development of communication among the ASD children
creates a sense of poor self-esteem and fear that lead to social isolation. The fear of being
bullied among the peers is also a reason why ASD children fail to take active initiatives in
starting a conversation or take part in group activities.
Solution: Parent communication for improvement in communication skills
Teaching ASD children to work on their communication skills is important for
assisting them to achieve their full potential. There are different approaches for
communication skill training among ASD children, but the best treatment program deals with
parental communication. Gulsrud et al. (2016) reported that joint attention, symbolic play,
engagement, and regulation (JASPER) parent‐mediated intervention helps to improve the
communication skills of the autistic children. As a Licensed Practitioner Nurse (LPN) it is my
duty to assist the registered nurse (RN) in framing parental education strategies so that Ana’s
parents understand the importance of communicating with Ana. I will make the initial
conversation with Ana’s parents through effective communication skills in order to explain
why they must continuously communicate with her like on her way to school and during the
bed-time. Effective communication helps in the development of therapeutic relationships

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such that Ana’s parents will feel connect with the approach the care plan in a holistic manner
(Pickles et al., 2016). After my preliminary education, the paediatric RN nurse will educate
Ana’s parents about the strategies to indulge in communication process with Ana. Gulsrud et
al. (2016) highlighted that involvement of communication board with symbols and pictures,
or even a Smartphone app and help to attract child’s attention in the communication process.
Bearss et al. (2015) are of the opinion that effective parent training program must also be
conducted with ASD parents. In the parent training program, parents are trained about the
strategies to control the outburst of the children with ASD. Sudden outburst mainly occurs
due to sudden change of the routine. Thus I along with the RN will train and educate Ana’s
parents regarding gradual implementation of the change in household or daily routine
activities so that the emotional outburst of Ana is not strong and she gets adequate time to
cope with the change. Iadarola et al. (2018) further highlighted that it is the duty of the
paediatric nursing professional to educate the parents of ASD children to prepare their
children for the change in routine like make a single in a sequential and in a chronological
manner. This kind of behaviour helps to reduce the disruptive behaviour of the children and
at the same time helps to improve the parental compliance while helping to decrease parents’
stress and strain.
Repetitive behaviour and emotional explosion
According to Berry, Russell and Frost (2018), restricted and repetitive behaviours
(RRBs) are hallmark symptoms among the children with ASD. RRBs mainly results from
core deficit in the level of attention. RRBs for ASD children include flicking fingers in front
of eyes or rolling of eyes constantly, constantly moving objects or spinning in circles. The
constant moving of subjects is exhibited by Ana as she is constantly opening and closing the
door of the toy cupboards or opening and then fixing the shoes of the Barbie dolls. Uljarević
and Evans (2017) reported that RRBs mainly results of a core deficit in attention and problem

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in the fine and the gross motor skills. The study conducted by Wigham et al. (2015)
highlighted that sensory under responsiveness along with sensory over responsiveness are
potentially inter-related with the repetitive motor along with insistence on sameness
behaviours. It is also elucidated that these inherent relationship between the RRBs and the
motor skills are mediated by state of intolerance of uncertainty and anxiety. Ana has
developmental delay in the gross motor skills and fine motor skills as highlighted by her
mother for which she has paid a hospital visit. Her developmental delay in the gross motor
skills along with expression of anger is showcased in the form of RRBs.
The showcasing of the RRBs and difficulty in anger management make children with
ASD a victim of social bully and discrimination and thereby hampering their active social
participation and healthy living. I observed that RRBs is at a state of obsession. I saw her
constantly moving around the play table without any aim or projected direction. The
movement was expression less and with a fixed gaze. As per my opinion, her RRBs like
opening and closing of the doors of the cupboards and shoes of the Barbie doll as expression
of ager. This is because, the rate of repetitive behaviour increased when her mother forbade
her to take more than one chocolate. Her mother also reported that when Anna is angry her
RRBs increases. She also informed that at times when she remains engrossed within her, she
showcase repetitive behaviour. She also said that too much noise at the amusement park
increased her tantrums that followed an increased repetitive behaviour. Joyce et al. (2017)
reported that repetitive behaviour is ASD children are expression of delayed developmental
skills and also an expression of anger.
Solution: Cognitive behavioural therapy (CBT) for emotional management and
repetitive behaviour
According to Jensen et al. (2016), CBT is proved to be effective in anger management
and emotional breakdown among the children with ASD. The CBT is required to be

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implemented under the controlled supervision of the trained paediatric nursing professionals.
The implementation of the person-centered CBT is helpful in extracting the maximum
outcome (Lefèvre et al., 2016). Ana’s sessions of CBT will occur in presence of her parents,
me (LPN) and paediatric RN. Here I will assist the RN in conducting at least 5 to 20 sessions
for 30 minutes each. Since Ana is a child, I will interact with Ana in a friendly manner in
order to understand her problem and though process so that we can understand the reason
behind her RRBs. The presence of her mother will help her to feel safe. Jensen et al. (2016)
are of the opinion that implementation of CBT under group-based activities in order help the
ASD children to work on their poor-self esteem and at the same time helping them to manage
their emotions by learning from the peers. I will design group-based activities with other
ASD children for Ana. The parents of Anna will also be educated in domain of how they are
require to manage their negative emotions in order to create a positive environment in the
house so that Anna might work on her anger and thus reducing RRBs.
Medical management of ASD
Ana’ parents must be educated about the role of the anti-psychotic medication in
management of ASD. The regulated use of the antipsychotic medication helps to agitation,
irritability, physical aggression and the chances of self-injury arising out of physical
aggression (Wink, Pedapati, Horn, McDougle & Erickson, 2017). Serret, Thümmler, Dor,
Vesperini, Santos & Askenazy (2015) stated that lithium also helps to reduce the regression
and catatonia features for ASD children however, administration of lithium is associated with
sudden side-effects and thus dosage must be regulated. The medication management of the
Ana will be done under the controlled supervision of the mental health physicians. My duty
as a LPN will be to educate Ana’s parents about the importance of medication management
and taking medication on time. This will help to increase therapy adherence.

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Conclusion
Thus from the above discussion, it can be concluded that analysis of the ASD child
Anna revealed that apart from delay in the motor skills, she is also suffering from
communication problem and problem in anger management that is causing RRBs. Parent
education and implementation of the person-centered interventions can be helpful in bringing
effective outcome of care. Parent education must be given in the domain of initiating
conversation with the child while at home by designing creative strategies by use of colourful
posters or mobile based app. In order to reduce the anger and for the effective control of
RRBs, CBT therapy can be prove to be effective.

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