Aspergers_ The Pediatric Series

1. ASPERGERS
Tammy Marie Baker RN
Pediatric Educational Series

2. DSM 299.80 Aspergers
An Asperger/HFA screening tool must meet all six areas defined by the DSM-IV description of Asperger Syndrome (A-F below) to qualify for a positive rating
from First Signs:
A. Qualitative impairment in social interaction, as manifested by at least two of the following:
(1) marked impairment in the use of multiple nonverbal behaviors, such as eye-to-eye gaze, facial expression, body postures, and gestures to regulate social
interaction
(2) failure to develop peer relationships appropriate to developmental level
(3) a lack of spontaneous seeking to share enjoyment, interests, or achievements with other people (e.g., by a lack of showing, bringing, or pointing out objects of
interest to other people)
(4) lack of social or emotional reciprocity
B. Restricted, repetitive, and stereotyped patterns of behavior, interests, and activities, as manifested by at least one of the following:
(1) encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus
(2) apparently inflexible adherence to specific, nonfunctional routines or rituals
(3) stereotyped and repetitive motor mannerisms (e.g., hand or finger flapping or twisting, or complex whole-body movements)
(4) persistent preoccupation with parts of objects
C. The disturbance causes clinically significant impairment in social, occupational, or other important areas of functioning.
D. There is no clinically significant general delay in language (e.g., single words used by age 2 years, communicative phrases used by age 3 years).
E. There is no clinically significant delay in cognitive development or in the development of age-appropriate self-help skills, adaptive behavior (other than in
social interaction), and curiosity about the environment in childhood.
F. Criteria are not met for another specific pervasive developmental disorder or schizophrenia.

3. what is Aspergers syndrome
Aspergers is classified as one of the Developmental Disorders:
Child with Aspergers exhibit unusual preoccupation or limited interest in a particular subject or
fascination to the point of selective preoccupation with that activity
Regimes are repetitive and ritualistic
Speech and language peculiarities including voice tones and formal inflections, literal interpretation
of speech communication and language delays
Social awkwardness with emotionally inappropriate behaviors and inability to interact with peers in
successful relationships and manor. Socially delayed in relationships
Non verbal communication is limited, facial expression is limited, peculiar and unfazed by
environmental factors or interactions. Staring gaze or unresponsive to others.
Motor movements are clumsy and uncoordinated

5. What Does Aspergers Look like?
A unique individual with a different
focal view.....
Aspergers looks like a child
struggling to be in the world...
A child wrapped up in his own world....

6. symptoms of Aspergers
Difficulties with
Difficulties with social functioning: especially outside their own environment such as school setting
Sensory issues: under or oversensitivity to environmental factors such as bright light, loud sounds and
unpleasant smells, touch, seams in clothing, water or external pressure light or deep pressure
Obsessive interests, with a focus on one subject to the exclusion of all others
Social isolation and struggles to make friends due to a lack of empathy, and an inability to pick up on or
understand social graces and cues (such as stopping talking and allowing others to speak)
A rigid Insistence on routine (unexpected changes any change can cause an emotional and physiological
meltdown)
Structural Obsession/ Dependent : needing to know when everything is happening in order not to feel
completely overwhelmed

7. treatment modalities
Treatment Modalities are not limited but include Multidimensional and Multidisciplinary
Approach
Prescribed Medications:individualized
Special Education :IEP /Advocasey
Behavioral Alterations:social skills/psychologist
Group Therapy
Occupational Therapy:Sensory Needs/tolerance/input
Speech Therapy:Communication needs.
PhysicalTherapy:motor/ trunk coordinations/core
strengthening

8. Nursing Assessment: incorporates the child's communication, social, sensory,
and behavioral skills and successful strategies for successful outcomes.
The Aspergers child has special needs that extend beyond
his acute medical diagnosis and problems which need to
be incorporated into his POC.
NOte the child's social, communication, and behavioral strengths
and limitations
DIscuss the child’s abilities with the parents and Identify the child's
strengths
utilize the child's fascination and strengths during assessment to
keep him focused
use childs favorite activity to refocus and distract child when
trying to refocus behaviors
rewards and tokens for good behavior
............Assessment Beyond the Stethoscope

9. Nursing management
Skilled nurse will provide the child a safe environment. Limit external stimuli and be aware of child
sensory concerns. Remove noxious stimuli from child's environment if it causes him discomfort.
( smells, tastes, texture sensitivities)
Give child notice prior to change or event , do not abruptly change routines. Child will not handle abrupt
changes well.
Administer medications as prescribed ,educate family on meds ,report and adverse reactions or
medication concerns to the Physician
Reward child with praise and use Behavioral incentives per Behavioral intervention plan.
Allow child to make choices within safe limits
utilize therapeutic techniques as prescribed to assist child's tolerance of medical procedures.
Provide consistent schedule and let the child know if changes will occur so that the child can modulate
the change. These children do not tolerate abrupt changes and behaviors may escalate

10. STRATEGIC THERAPEUTIC TECHNIQUES
Imitation/role-modeling paired with reinforcement: SN /PCGT demonstrates the
desired action to the child. When the child imitates the action, the parent and/or
nurse gives a "reinforcer" such as verbal praise.
High-Probability requests/ low-probability requests: Requests that have a high
likelihood of compliance; low probability requests (low-p) are those with less
expectation of compliance.
Rewards :positive reinforcer presented immediately following a behavior, causes
the behavior to increase in frequency and reoccur
Token systems. A token is a stimulus . It is paired or associated with another
reinforcer and is sometimes called a back-up reinforcer. Reinforcers that can be
accumulated and exchanged for a back-up reinforcer is called a token system
Shaping: a newer behavioral technique. Shaping involves rewarding a small stride
and slowly increasing the expectation before reward is given. ( extending tolerance
time for procedures such a nebulizer or suctioning)

11. therapeutic Strategies continued
Differential reinforcement: reinforcing desirable behaviors while ignoring
unacceptable one
Choices: It is important for children with ASD to express preferences and make
choices to increase personal autonomy. Allow child to make choices.
Visuals; Children who have ASD are usually visual learners .Present information
with a visual as opposed to verbal cues. Visuals create a higher success rate with
Children with ASD when used to foster accomplishing the presented task.
Distraction techniques: role-playing and distraction techniques are used to
manage behavior and task goals foster better outcomes and decrease anxiety in
Autistic children.

12. treatments
Communication and social skills training
Children with Aspergers syndrome are taught to learn the unwritten rules of socialization and communication .
Techniques are taught in an explicit and rote fashion. Social skills can be like learning a foreign language to
these Children with Aspergers syndrome may also learn how to communicate more effectively speak in a
more natural rhythm, as well as how to interpret communication techniques, such as gestures, eye contact,
tone of voice, humor and sarcasm.
Cognitive behavioral therapy:
Techniques aimed at curbing problem behaviors, such as interrupting, obsessions, meltdowns or angry
outbursts, and developing skills such as recognizing feelings and coping with anxiety. Therapy usually
focuses on training a child to recognize a troublesome situations; change in environment such as a new place
or an event with more social demands. Strategies are taught and learned to navigate and to cope with the
situation.

13. Medications used to treat Aspergers
Medications may improve specific symptoms such as anxiety,
depression or hyperactivity that can occur in many children with
Aspergers syndrome.
1 Aripiprazole (Abilify). may be effective for treating irritability related to Asperger's syndrome. Side effects may
include weight gain and an increase in blood sugar levels.
2 Guanfacine (Intuniv). may be helpful for the problems of hyperactivity and inattention in children with Asperger's
syndrome. Side effects may include drowsiness, irritability, headache, constipation and bedwetting.
3 Selective serotonin reuptake inhibitors (SSRIs). Drugs such as fluvoxamine (Luvox) may be used to treat
depression or to help control repetitive behaviors. Possible side effects include restlessness and agitation.
4 Risperidone (Risperdal). may be prescribed for agitation and irritability. It may cause trouble sleeping, a runny
nose and an increased appetite. This drug has also been associated with an increase in cholesterol and blood
sugar levels.
5 Olanzapine (Zyprexa). Olanzapine is sometimes prescribed to reduce repetitive behaviors. Possible side effects
include increased appetite, drowsiness, weight gain, and increased blood sugar and cholesterol levels.
6 Naltrexone (Revia). may help reduce some of the repetitive behaviors associated with Asperger's syndrome.
However, the use of low-dose naltrexone — in doses as low as two to four mg a day — has been gaining favor
recently. But, there's no good evidence that such low doses have any effect on Asperger's syndrome.

14. the end...