April is National Autism Awareness Month. And considering that about 1 in 68 children has been diagnosed with Autism Spectrum Disorder (ASD) and that it is reported across ALL racial, ethnic, and socioeconomic groups, chances are that you, my dear pediatric nurse, have come across your fair share of autistic patients. Let’s get the facts straight, though. ASD is not, as the masses are wont to think, a single mental disorder. In fact, there are several conditions (think Aspergers, Rett etc.) which fall under the umbrella we call ‘autism,’ and each one presents its own unique symptoms. How to deal with these patients, though? An 8 year old with autism will present very differently than your average 8 year old and it takes knowledge and oftentimes creativity to properly care for these little people with special souls. For tricks of the trade, keep reading:)
A Non-Stimulating Environment is Key:
Should you need to perform a physical exam on an autistic child, be sure to place them in a quiet room devoid of any medical equipment, so as to diminish distractions. Dim the lights, regulate the temperature, and try to create an overall relaxing environment.
Talk to the Parents:
Once your quiet room is secured, your best bet is to have a chat with your patient’s parents. The parents will be able to tell you how the child is likely to react to the examination, as well as what works for their child. For example, they’ll tell you the best form of communication, the best soothing methods, as well as a basic outline of the patient’s medical history. Another important aspect: Let the child watch you interact with his/her parents. This is the best way to establish trust.
Use Medical Equipment on a Parent First:
New and unfamiliar medical equipment can really set off an autistic patient. To minimize any sort of outburst, use the specific tool you’ll be using on Mom or Dad first. A parent is someone the child trusts, and if they see the tool being used on a parent, they’re more likely to cooperate and allow the tool to be used on themselves.
Consistency is Key:
Children with autism NEED routine. Inconsistency will result in tantrums. That said, be sure to be consistent and very gentle with your actions, or you run the risk of stressing out the child. On the same note, try and limit the number of healthcare providers working with the patient. And if there are several types of healthcare providers during a child’s hospital stay, such as phlebotomist, therapist, nurse etc., it should be the same personnel day in and day out, if possible.
Be Mindful of Body Movement:
While providing care for your autistic patient, try and lower yourself to eye level. If the child has to look up or down there will be mistrust. Additionally, when performing a physical, start away from the child and slowly move centrally. To illustrate, you’ll want to do a visual assessment first, and if the child shows cooperation you’ll move on to the hands and feet, and eventually, the trunk. The reasoning behind all this is to avoid sudden intimate touch which can really put stress on an autistic child.
Use an Award System:
Believe it or not positive reinforcement works very well with autistic children. A simple sticker will do the trick and motivate them to be more cooperative. Plus, the positive attention being showered upon them will facilitate a greater level of trust.
Bottom line is, dealing with autistic children is a real lesson in patience and trust. The more you read up on autism, the more you’ll understand about this disorder, and the better equipped you’ll be to provide your little patients with the best care out there.
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