Autism and the School Nurse

Article excerpt

ABSTRACT: Until recently, treatment for children with autism involved housing them in hospitals for the developmentally disabled. Today, more states are returning children with autism to their home communities, and more parents are choosing or are being required to keep their children with autism in their homes. Laws were developed to ensure that children with autism receive some form of education, often through the local school system. School nurses, who may not have experience working with children with autism, may feel uncertain about how to provide support for the child with autism. Approximately 300,000 persons in the United States have autism or display autistic behaviors. About one-third are under age 21. People with autism come from all socioeconomic classes. Males are four times more likely to be affected by autism than females. People with autism can be expected to live a normal lifespan. (J Sch Health. 2001;71(3):96-100)

Until recently, treatment for children with autism involved housing them in hospitals for the developmentally disabled. Today, more states are returning children with autism to their home communities, and more parents are choosing or are being required to keep their children with autism in their homes. Laws were developed to ensure that children with autism receive some form of education, often through the local school system. School nurses, who may not have experience working with children with autism, may feel uncertain about how to provide support for the child with autism. Approximately 300,000 persons in the United States have autism or display autistic behaviors.[1] About one-third are under age 21. People with autism come from all socioeconomic classes. Males are four times more likely to be affected by autism than females.[2] People with autism can be expected to live a normal lifespan.[1]

DIAGNOSTIC CRITERIA

Diagnostic criteria have been established for autism (Figure 1). The child with autism may present with any one of many possible combinations of symptoms, so the school nurse may never see two identical cases of children with autism. Autism is quite different from schizophrenia, though some high-functioning children with autism may be misdiagnosed as having schizophrenia.[3] Autism is diagnosable in very early childhood whereas schizophrenia is usually associated with adolescence or early adulthood. No hallucinations or delusional thoughts occur with autism in contrast to the alterations in thought which characterize schizophrenia.

Figure 1 Diagnostic Criteria for Autism According to DSM-IV-TR[24]

A diagnosis of autism can be made when the person meets these criteria:

A. A total of six (or more) items from (1), (2), and (3) with at least two from (1), and one each from (2) and (3).

(1) Qualitative impairment in social interaction evidenced by:

a. marked impairment in nonverbal behaviors

b. lack of peer relationships appropriate to developmental level

c. absence of seeking to share enjoyment, interests, or achievements with others

d. lack of social or emotional reciprocity

(2) Impairments in communications evidenced by at least one of the following:

a. delay in, or total lack of, the development of spoken language

b. in individuals with adequate speech, marked impairment in the ability to initiate or sustain a conversation with others

c. stereotyped and repetitive use of language or idiosyncratic language

d. lack of varied, spontaneous make-believe play or social imitative play appropriate to developmental level

(3) Restricted, repetitive and stereotyped patterns of behavior, interests, and activities as manifested by at least one of the following:

a. encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus

b. apparently inflexible adherence to specific, nonfunctional routines or rituals,

c. …