AUTISM SPECTRUM DISORDER Jassin M. Jouria, MD Dr. Jassin M. Jouria is a medical doctor, professor of academic medicine, and medical author. He graduated from Ross University School of Medicine and has completed his clinical clerkship training in various teaching hospitals throughout New York, including King’s County Hospital Center and Brookdale Medical Center, among others. Dr. Jouria has passed all USMLE medical board exams, and has served as a test prep tutor and instructor for Kaplan. He has developed several medical courses and curricula for a variety of educational institutions. Dr. Jouria has also served on multiple levels in the academic field including faculty member and Department Chair. Dr. Jouria continues to serves as a Subject Matter Expert for several continuing education organizations covering multiple basic medical sciences. He has also developed several continuing medical education courses covering various topics in clinical medicine. Recently, Dr. Jouria has been contracted by the University of Miami/Jackson Memorial Hospital’s Department of Surgery to develop an e-module training series for trauma patient management. Dr. Jouria is currently authoring an academic textbook on Human Anatomy & Physiology. ABSTRACT Autism spectrum disorder is a complex brain condition characterized by difficulties in social interaction and communication, as well as a tendency toward repetitive behaviors. In its mildest form, autism spectrum disorder can present minor communication challenges in children who are at or above normal intelligence. In its most severe form, comprehensive cognitive deficits and a total lack of communication create permanent dependence. Currently, there is no cure for autism and the focus is on research to develop effective management and prevention strategies. nursece4less.com nursece4less.com nursece4less.com nursece4less.com nursece4less.com 1 Policy Statement This activity has been planned and implemented in accordance with the policies of NurseCe4Less.com and the continuing nursing education requirements of the American Nurses Credentialing Center's Commission on Accreditation for registered nurses. It is the policy of NurseCe4Less.com to ensure objectivity, transparency, and best practice in clinical education for all continuing nursing education (CNE) activities. Continuing Education Credit Designation This educational activity is credited for 6.5 hours. Nurses may only claim credit commensurate with the credit awarded for completion of this course activity. Pharmacy content is 0.5 hours (30 minutes). Statement of Learning Need Autism treatment teams are involved in the diagnosis and ongoing health care of the individual child or adult with ASD as well as their families. Clinicians in mental health and school programs are required to perform initial and ongoing evaluations and to develop a treatment plan to promote improved coping skills and development for individuals with autism. Course Purpose To provide advanced learning for clinicians interested in the diagnosis and ongoing treatment of individuals with autism, including education and support for their families. nursece4less.com nursece4less.com nursece4less.com nursece4less.com nursece4less.com 2 Target Audience Advanced Practice Registered Nurses and Registered Nurses (Interdisciplinary Health Team Members, including Vocational Nurses and Medical Assistants may obtain a Certificate of Completion) Course Author & Director Disclosures Jassin M. Jouria, MD, William S. Cook, PhD, Douglas Lawrence, MA, Susan DePasquale, MSN, FPMHNP-BC – all have no disclosures Acknowledgement of Commercial Support There is no commercial support for this course. Please take time to complete a self-assessment of knowledge, on page 4, sample questions before reading the article. Opportunity to complete a self-assessment of knowledge learned will be provided at the end of the course. nursece4less.com nursece4less.com nursece4less.com nursece4less.com nursece4less.com 3 1. The primary goals of ASD treatments are to a. lessen deficits and family stresses. b. treatment through use of medication. c. educating family and other caregivers about unique challenges of an individual with ASD. d. All of the above 2. Secondary ASD can be caused by: a. Fragile X syndrome b. Tuberculosis c. Rett Syndrome d. Answers a., and c., above 3. Rett syndrome predominantly affects a. males. b. females. c. individuals during adolescence. d. those of African descent. 4. Repetitive behaviors in individuals with ASD can include a. arm and hand flapping. b. rocking or other unusual body movements. c. head banging. d. All of the above 5. True or False: Pregnancy and increased risk of ASD with a combined diagnosis of ADHD or ADHD symptoms includes use of valproic acid. a. True b. False nursece4less.com nursece4less.com nursece4less.com nursece4less.com nursece4less.com 4 Introduction The diagnosis of Autism Spectrum Disorder (ASD) encompasses a group of developmental disorders with symptoms that range on a continuum from mild to severe.1 ASD is typically present early in life, from infancy or early childhood, however, deficits from ASD may not be detected until later on, possibly due to parental or caregiver assistance and limitations placed on social exposure involving the autistic individual. The onset of ASD has been intensively studied and it is widely accepted that the diagnosis of ASD may occur far after the age of onset.2-3 From the time when a parent indicates their child has early signs or symptoms of ASD or abnormal development until when diagnosis is made may be quite lengthy. Detecting early signs of ASD is often difficult4 with diagnosis occurring only after a child is placed in situations where social awkwardness or deficits can be noticed. Autism may keep a child from forming effective relationships with other people, due in part to an inability to properly interpret facial expressions or emotions. Children with autism may be resistant to cuddling or change, and they may play alone or have delays in speech development. People with autism also frequently repeat body movements or have extreme attachments to certain objects. However, there are positive aspects to autism, such as the fact that many people with autism excel on certain mental levels, such as counting and measuring, or at art, music, or memory. The precise causes of ASD are not known. However, it is known that genetic factors play a role in ASD.5,6 It is also known that non-genetic, environmental factors play a role in the development of ASD. It is thought that ASD is the result of a combination of genetic and non-genetic factors. What basically happens is that non-genetic, environmental factors come into nursece4less.com nursece4less.com nursece4less.com nursece4less.com nursece4less.com 5 play to make those who are genetically susceptible to ASD more likely to develop ASD. Autism spectrum disorder may develop gradually, or the individual may experience what is known as regression, where he or she may lose some or all of their acquired skills. The loss of skills can happen suddenly or gradually. Overall, there are a number of risk factors for ASD, including gender (boys are more likely than girls to develop ASD) and genetics, including certain prenatal and perinatal factors, neuroanatomical abnormalities such as enlargement of the brain, and environmental factors. There is no cure for ASD. The primary goals of ASD treatments are to lessen deficits and to lessen family stresses. There are a number of ways to do these things, including applied behavioral therapy, structured teaching, speech and language therapy, social skills therapy, occupational therapy, and the use of medication. Additionally, educating parents, caregivers, and siblings and providing these individuals with ways to cope and to face the unique challenges that having an individual with ASD in the household brings helps to alleviate the inevitable resulting family stress. Disorders Included In The Autism Spectrum: DSM-5 The American Psychiatric Association has put forth a definition for autism as a part of the revisions made for the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5). Autism is seen as part of a continuum of disorders termed autism spectrum disorder, involving a range of disorders, such as autistic disorder, Asperger’s syndrome, childhood disintegrative disorder, and pervasive developmental disorder not otherwise specified. It has been proposed that the DSM-5 criteria will lead to more nursece4less.com nursece4less.com nursece4less.com nursece4less.com nursece4less.com 6 accurate diagnosis to support clinicians in the development of treatment planning.7 Autistic disorder is also known as autism or mindblindness. This disorder generally presents sometime in the first three years of life, and the child appears to live within his or her own world. The child also appears to show little interest in other people and displays poor social skills. The focus of a child with autistic disorder is on a consistent routine, with repetitive odd or peculiar behaviors. Children with autism frequently have problems communicating, and they often will avoid making eye contact with others or will avoid attaching to others. Additionally, autistic disorder may be associated with a number of infirmities, including difficulties with motor coordination and attention, intellectual disability, and physical health issues such as gastrointestinal issues or sleep issues. However, despite difficulties, some people with autistic disorder often excel in music, art, math, or with visual skills. Autistic disorder seems to have roots in the early development of the brain, although the most obvious signs and symptoms emerge between 2 – 3 years of age. Approximately 1 out of every 88 children in the United States will have an ASD; this is a huge increase in prevalence over the past 40 years. The increase is due in part to improvements made in diagnostic tools as well as disease awareness. Another reason for the increase may be environmental influence. Autistic disorder is much more common in boys than it is in girls; approximately 1 out of every 54 boys and 1 out of every 252 girls is diagnosed with an ASD in the U.S.