The aim of this essay is to identify an individual’s situation in need of improvement and provide ways in which the situation can be improved through the use of an action plan. The client chosen for this essay has been diagnosed with ‘classic autism’ since the age of four. He is now seven years old and has been attending a special school for seven months. For the purpose of the essay the client’s parents and teacher have allowed me to observe and access confidential information needed in order to gain an understanding of the problems later identified.
Before identifying the problems it is important for nurses to understand what autism is and how the individual is affected. Autism is a spectrum developmental disorder that affects many aspects of how an individual communicates and relates to the world around them (Howlin, 1997). This means that the individual can be affected to different degrees, and no individual is the same (Legge, 2002). Currently there is no treatment available to cure autism as the cause of autism has not been fully identified. There are some medications which improve problems associated with autism such as hyperactivity behaviour.
Over the years many causes for autism have been suggested. It is evident from ongoing research that the causes of autism involve genetics, biology and neurology in combination with a number of environmental factors, such as infections, antibiotics, vaccinations, allergies and toxins that may all have a vital significance (Yapko, 2003). The physical dysfunction of the brain causes the inability to interact with other human beings and communicate their needs and not, as once thought the result of emotional disturbance caused by inadequate mothering (Yapko, 2003).
Viral encephalitis before birth or in early childhood has also been implicated as a cause of autism. Good epidemiological evidence argues that the Measles, Mumps and Rubella (MMR) vaccine is not an environmental risk factor for autism (Nursing Times, 2003). The most common explanation is that several genes appear to be involved, and the extent to which someone is affected depends on their combined effect. Ives et al, (2002) found that three to six per cent of siblings of individuals with autism also have autism or a related developmental disorder.
It was also found that upto a further twenty per cent of siblings have milder problems such as language delay or social difficulties. Recent studies suggest that parents with one child with autism are a hundred times more likely to have another child with the condition compared with other families (BBC News, 2004). Furthermore the BBC News (2004) reported that scientist Dr Buxbaum and colleagues have identified a gene that may increase the risk of developing autism. The gene involved is part of a molecule that provides the energy that cells need to function.
The children used for the study were found to have variations of this gene and this could disrupt the production of fuel needed by the cells. Obviously the condition is far more complex than this and more than one gene is involved. When all or most of these genes have been identified then new diagnostic tools and approaches to treatment can be developed. The prevalence rates have shifted over time. Autism is now thought to be relatively common (Gabriels et al, 2002). The National Autistic Society (2003) suggests that autistic spectrum disorders have been identified in five hundred thousand families in the United Kingdom.
Currently there is no central register of all people with autism. The current estimated rate of people with autistic spectrum disorders in the United Kingdom is ninety-one per ten thousand people (Shattock et al, 2001). Autism is found in families of all races, ethnic and socioeconomic background (Holmes, 1998). The condition affects four times as many boys as girls, however Yapko (2003, pg 39) states that ‘when females are diagnosed with autism, they are typically more severely affected and exhibit more severe mental retardation’.
Individuals with autism have difficulties in three areas of development, Wing (1979) called these the ‘triad of impairments’ (Gabriels, pg 69, 2002). These are verbal and non-verbal communication, social interaction and imaginative play (Gates, 2003). Difficulties such as inconsistent patterns of responses to smells, sights, sounds and abnormalities in behaviour, sleep patterns and eating and drinking patterns are also common. The causes of speech and language problems are unknown.
Watson (1989) suggests that autistic children often fail to understand the purpose and meaning of language as a means to influence their surroundings (Gabriels et al, pg 27, 2002). Those who can speak often exhibit impairments in their ability to initiate and sustain conversation. Fifty percent of autistic children never develop useful language (Yapko, 2003). The child may repeat phrases over and over again or use echolalia, repeating what others say without understanding the meaning of what is being said.
Further more, they are likely to confuse personal pronouns, for example talking about the self in the third person, and may have problems with turn taking in conversation. Many do not make eye contact and have poor attention skills making communication difficult. The National Autistic Society (2003) suggests that if a child does not want to communicate they will not explore their ability to vocalise, learn new sounds or listen. This will ultimately result in a delay in their language acquisition.
While communication problems are often a major concern, the underlying core deficit in autism is believed to be in social behaviour (Williams et al, 2000). Garfin and Lord (1986) state ‘children with autism lack social understanding’ (Gabriels et al, pg 129, 2002). They fail to develop typical peer interactions and relationships and show no understanding of how others feel or think. They have the inability to attribute thoughts, beliefs or actions and are averse to affection, particularly of a physical kind.
Self occupying behaviour and an inability to participate in group activities are usually apparent. Much of their behaviour is routine-led, and if their routine is broken they become extremely distressed. This is because they are unable to extract meaning from their experiences and therefore fail to anticipate what will happen next; routines are therefore a means of avoiding surprises which might be distressing to them. Restricted, repetitive, and stereotyped behaviours frequently represent what is most easily observed to be normal in autism.
Autistic children tend to play in repetitive ways, they have the inability to develop imaginative play like there peers and may interact with toys in an unusual way, such as arranging the same toy(s) by colour or shape. From a recent speech and language assessment the client is currently at the exploratory stage which is recognised in three to twelve month olds. It is evident from seeing him play that he is at this stage as he explores the toys rather than use them for imaginative play like his peers.
The client has ‘classic autism’ this means he has severe qualitative deficits in all three of the triads described above (Yapko, 2003). By the age of thirty-six months a small proportion of children diagnosed with classic autism have snippets of exceptional ability in areas such as drawing, music and mathematics (DfES, 2002). The client is extremely good at drawing although the pictures drawn are repetitive unless he is told what to draw.