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CHAPTER 37 • Mental Disorders of Childhood and Adolescence

on a spectrum and vary from very little needs to major care needs. Each child and family is unique with their own level of symptoms and needs. RECOGNIZING CUES: RELEVANT ASSESSMENT INFORMATION A comprehensive nursing assessment of a child with ASD includes evaluation of developmental history, communi cation abilities, social interactions, behavior patterns, and sensory sensitivities. It is important for the nurse to also review relevant medical history and co-occurring disor ders and medications. Physical Health Physical symptoms may result from ASD-associated disorders as well as from adverse effects of frequently prescribed medications. Individuals with ASD are at an increased risk for concurrent neurologic disorders such as cerebral palsy, macrocephaly, and epilepsy. They are also at greater risk for psychiatric disorders, including ADHD (28%), anxiety (20%), sleep disorders (13%), and depression (11%). Individuals with ASD are three times more likely to develop gastrointestinal (GI) symptoms such as chronic constipation, diarrhea, gastroesophageal reflux, and inflammatory bowel disease than their peers without ASD. Physical health assessment should include a review of physical health and neurologic status, giving particular attention to coordination, childhood illnesses, hospitalizations, and injuries. Self-injurious behavior may result in bruising to the forehead or nasal bridge (from head banging); marks from biting, scratching, slapping, or pinching; or injury to eyes (from eye poking). The nurse should assess sleep, appetite, and activity patterns because they may be disturbed in affected children. Lack of adequate sleep can increase irritability and contribute to poorer outcomes with therapy. Children with comor bid disorders may require the care of several providers and may be receiving multiple medications. Assessment should include a careful review of current medications and complementary therapies, paying special attention to potential interactions (Kaye et al., 2024). Psychosocial Cues Communication, behaviors, and flexibility are criti cal assessment areas. Direct behavioral observation is important to evaluate the child’s ability to relate to oth ers, to verify the selection of age-appropriate activities, and to watch for stereotypic behaviors. Assessment of the child with ASD can be based on the following categories: • Communication • Verbal and nonverbal • Use of picture cards, writing, or drawing

Teamwork and Collaboration: Working Toward Recovery Patients with ASD require long-term care at various levels of intensity. The total costs per year for children living with ASD in the United States is estimated to be between $11 billion and $61 billion due to a culmination of direct and indirect costs, exceeding the costs associated with stroke and hypertension. Medical costs for children and adolescents with ASD to address impairments and comor bidities are 4.1 to 6.2 times higher than those without ASD (Yenkovan et al., 2024; Zuvekas et al., 2021). Treatment consists of designing academic, interpersonal, and social experiences that support the child’s development. Children with autism, even those who are severely affected, may be able to live at home and attend special schools that use behavioral techniques. Other outpatient services may include family counseling, home care, and medication. As the child moves toward adulthood, living at home may become more difficult given the appropriate need for greater independence. The level of structure required depends primarily on IQ and adaptive functioning. EVIDENCE-BASED NURSING CARE FOR CHILDREN WITH ASD As the nurse begins caring for a child with ASD, it is important to remember that the symptoms and care are BOX 37.3 Mental Health Inequities: Experiences of Racism and Racial Disparities in Health Care Among Youth With Autism Spectrum Disorder (ASD) and Their Caregivers A systematic review of six databases included 37 studies of experiences of racism and racial disparities. The studies included over 733,000 children and youth with autism spectrum disorder (ASD) and 533 caregivers. A narrative synthesis revealed four themes: 1. Experiences and aspects of racism and disparities, including language and cultural barriers, poor-quality health care interactions, stereotypes and discrimination, family and community stigma, and indirect barriers. 2. Racial disparities in health care, including screening and referral, diagnosis, health care services, and care coordination. 3. Facilitators to accessing services, including advocating and taking action, building community networks, and strong provider-caregiver relationships. 4. Recommendations from caregivers, including cultivating a trusted relationship between caregivers and care pro viders, increasing training and education, and improved care coordination for different systems of care. Source: Lindsay, S., Li, Y., Joneja, S., & Hsu, S. (2024). Experiences of racism and racial disparities in health care among children and youth with autism and their caregiv ers: A systematic review. Disability and Rehabilitation, 12, 1061–1080. https://doi.org/10.1080/09638288.2024.2364823

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