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Chapter 34.2

NURS 3122 Chapter 34.2: Clinical Therapy

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Mount Royal University
NURS 3122
Robert Catena

Clinical Therapy - Early intervention assists in maximizing the child’s potential by improving developmental skills and behaviors, as well as establishing helpful support for parents. - Treatment focuses on behavior management to reward appropriate behaviors (known as applied behavior analysis or ABA), foster positive or adaptive coping skills, and facilitate effective communication. The goals of treatment are to reduce rigidity or stereotypy repetitive, obsessive, machinelike movements) and other maladaptive behaviors. - Often the child must be physically restrained from aggressive or self-destructive behaviors. - Speech therapy is an essential part of treatment. - Instruction in social skills and occupational therapy to improve fine motor dexterity and sensory integration are provided. Some parents choose to use complementary therapies such as vitamin supplements and dimethylglycine or trimethylglycine. - Foods such as sugar, aspartame, milk products, and wheat are sometimes eliminated from the diet. - Medications are used with some children to treat associated disorders but are not effective in treatment of autistic syndrome itself. - Medications used for associated conditions include stimulants, selective serotonin reuptake inhibitors (SSRIs), and mood stabilizers. - The overall prognosis for children with autism to become functioning members of society is guarded. Successful adjustment is more likely for children with higher IQs, adequate speech, and access to specialized programs. Nursing Assessment The infant or toddler often displays signs of autism at an early age. Since communication abnormalities are red flags for autism, what speech would you normally expect in a 12-month- old, 16-month-old, or 24-month-old? Require immediate evaluation: ■No babbling or communication gestures by 12 months ■No single word by 16 months ■No spontaneous two-word phrases by 24 months ■Loss of language or social skills previously achieved Planning and Implementation Nursing care focuses on stabilizing environmental stimuli, providing supportive care, enhancing communication, maintaining a safe environment, and offering the parents anticipatory guidance. 1. Stabilize Environmental Stimuli - Children with autism interpret and respond to the environment differently from other individuals. Sounds that are not distressing to the average person may be interpreted by children with autism as louder, more frightening, and overwhelming. The child needs to be oriented to new settings such as a classroom or the hospital room and may adjust best to a small classroom or a hospital room with only one other child. Encourage parents to bring the child’s favorite objects from home, and try to keep these objects in the same places, because the child often does not cope well with changes in the environment. 2. Provide Supportive Care - Developing a trusting relationship with the child who has autism is often difficult. Adjust communication techniques and teaching to the child’s developmental level. Ask parents about the child’s usual home routines, and maintain these routines as much as possible if the child is not in the home setting. Because self-care abilities are often limited, the child may need assistance to meet basic needs. When possible, schedule daily care and routine procedures at consistent times to maintain predictability. Encourage parents to remain with the hospitalized child and to participate in daily care planning. Parents are integral parts of the treatment team when the child’s learning goals are e
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