Boyd 8e

790

UNIT VII • Care of Children and Adolescents

ASD with restricted repetitive patterns of behavior such as stereotypic or repetitive motor movement, use of objects, inflexible adherence to routine or ritualized pat terns, and fascination with lights or movement has been a subject of considerable interest and research effort since its original description more than 70 years ago. Kanner (1943) described the profound isolation of these children and their extreme desire for sameness. These children appear aloof and indifferent to others and often seem to prefer inanimate objects. Impairment in communication is severe and affects both verbal and nonverbal communication. Children with ASD may manifest delayed and deviant language development, as evidenced by echolalia (repetition of words or phrases spoken by others) and a tendency to be extremely literal in interpretation of language. Pronoun reversals and atypical intonation are also common. Other common features of ASD are stereotypic behavior, self-stimulating, nonfunctional repetitive behaviors, such as repetitive rocking, hand flapping, and an extraordinary insistence on sameness. These children may also engage in self-injurious behavior, such as hitting, head banging, or biting. In some children, their unusual interests may evolve into fascination with specific objects, such as fans or air conditioners, or a particular topic, such as transpor tation schedules. A child with ASD may have age-appropriate language and intelligence but also have severe and sustained impairment in social interaction and restricted, repetitive patterns of behavior, interests, and activities. This type of ASD was previously known as Asperger syndrome and appears to be a milder form of ASD. These children have social deficits marked by inappropriate initiation of social interactions, an inability to respond to typical social cues, and a tendency to be literal in their interpretation of lan guage (CDC, 2024c). They may also display stereotypic behaviors, such as rocking and hand flapping, and have highly restricted areas of interest, such as train schedules, fans, air conditioners, or dogs. Signs of developmental delay may not be apparent until preschool or school age, when social deficits become evident (Box 37.2). Epidemiology and Etiology Recent studies by the CDC find that approximately 1 in 36 children has been identified with ASD. It is nearly four times as prevalent among male children as among female children, and is found in all racial, eth nic, and socioeconomic groups (Maenner et al., 2023). Intellectual disability and epilepsy often occur in ASD (Assuah et al., 2023; Pinals et al., 2022). Although the annual prevalence of ASD is increasing, a broader definition and change in diagnostic criteria, changes in screening methods, and increased awareness of the dis order contribute to this increase (Talantseva et al., 2023). Additionally, racial disparities among youth with ASD

related to diagnostic processes and access to services have been found (see Box 37.3). Although research has not identified an exclusive cause for ASD, evidence has identified many likely contributing factors, including environmental, biologic, and genetic factors. There is strong evidence supporting the majority of risk for ASD is from genetic factors. In a multinational cohort study of over 2 million individuals, of whom 22,000 were diagnosed with ASD, the heritability rate was estimated to be approximately 80% (Bai et al., 2020). Other risk factors identified as possible contributors to ASD include having a sibling with ASD, being born to older parents and preterm birth, individuals with cer tain genetic or chromosomal conditions, such as fragile X syndrome or tuberous sclerosis, and experiencing complications at birth. Studies have shown that vaccines and maternal smoking and alcohol consumption are not linked to increased risk of ASD (CDC, 2024c; Yenkoyan et al., 2024). In addition to his unusual preoccupations and social deficits, Frank resisted any change in his routine, was easily frustrated, and was prone to temper tantrums. His parents sharply disagreed about the nature of and appropriate response to his issues. Building Clinical Judgment 1. What effect do you think Frank’s preoccupation may have on his family and their relationships? 2. What kind of teaching program would you develop if you were the nurse assigned to this family? BOX 37.2 Clinical Judgment Vignette: Autism Spectrum Disorder A pediatrician refers Frank, age 5 years, 6 months, for an evaluation because of Frank’s unusual preoccupation with ceiling fans and lawn sprinklers. According to his mother, Frank became interested in ceiling fans at age 3 years when he began drawing them, tearing pictures of them out of magazines, and engaging others in discussions about them. In the months before the evaluation, Frank also became fas cinated by lawn sprinklers. These preoccupations dominated Frank’s interactions with others so much that he was practi cally incapable of discussing any other topics. He remained on the periphery of his kindergarten class and had few friends. Although he tried to make friends, his approaches were not successful and he had trouble reading others. Frank was the product of a full-term uncomplicated pregnancy, labor, and delivery to his then 25-year-old mother. It was her first pregnancy, and both parents eagerly anticipated Frank’s birth. As an infant, Frank was healthy but seemed to cry a lot and it was difficult to comfort him, causing his mother to feel inadequate and depleted. His motor development was also delayed, and at age 3 years, nonfamily members had difficulty understanding his speech. His articulation, however, was within expected limits at the time of consultation. Frank received regular pediatric care and had no history of serious illness or injury. There was no family history of intellectual disability or psychiatric illness; results of genetic testing for chromosomal anomaly were negative.

Copyright © 2026 Wolters Kluwer, Inc. Unauthorized reproduction of this content is prohibited.