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UNIT VII • Care of Children and Adolescents

• Use of eye contact • Understanding of emotional cues • Presence of pain • Preoccupation with restricted interests • Behaviors • Items of fixation (how does family manage?) • Triggers for agitation • Early signs that indicate beginning of agitation • Interventions that work when child is overstimu lated or agitated • Repetitive behaviors • Flexibility or adherence to routine • Home schedule • What aggravates or irritates the child • Early warning signs of agitation • When overagitated, what interventions work best The child’s behavior, need for structure, and commu nication style may affect the functioning of the whole family unit. Social and communication deficits are bound to influence family interaction which may adversely affect family functioning and result in increased stress among the family. For example, the ability for a parent to respond to the needs of other children within the family may be limited. ANALYZING CUES AND DEVELOPING HYPOTHESES Ensuring physical safety is a priority for the nurse. The nurse will need to develop a plan of care that takes into consideration the child’s ability to communicate effec tively with others. The child may also have difficulty completing ADLs and may demonstrate poor coping and impaired skills. Determining the need for predictability and stability in routine for the child is also important. PLANNING RECOVERY AND WELLNESS OUTCOMES: GENERATING SOLUTIONS Treatment outcomes need to be individualized to the child, family, and social environment and may change with time. Planning interventions for children with an ASD consider the child, family, and community supports, such as schools, rehabilitation centers, or group homes. First and foremost, the clinicians involved in the child’s treatment should col laborate with the family toward the same general goals. As the number of clinicians and educators involved increases, the chance of fragmentation in treatment planning also increases. The nurse can serve as a case coordinator. Residential care may be necessary in some cases. After making the decision to place a child into a residential

facility, family members may experience guilt, loss, and a sense of failure concerning their inability to care for the child at home. TAKING ACTION: NURSING INTERVENTIONS Physical Health Interventions In teaching self-care skills, the nurse needs to consider the child’s current adaptive skills and language limita tions. Developing a list of activities for the child to post in their bedroom may be effective for some children. Drawings or symbols may be useful for nonverbal chil dren. Physical safety is an important concern for children who are cognitively delayed and may have impaired judgment. Medication Interventions No medication has proved effective at changing the core social and language deficits of autism. However, some atypical antipsychotics (i.e., risperidone, aripiprazole) are beneficial for the management of hyperactivity, impul sivity, agitation, temper outbursts, self-injury, or aggres sion associated with autism. Weight gain and metabolic syndrome are concerns with these agents (Iffland et al., 2023; Salazar de Pablo et al., 2023). Medications used for ADHD, both stimulants and nonstimulants, may be effective for symptoms of hyperactivity, irritability, and inattention (Martins et al., 2024). Antidepressants may be effective in treating restricted and repetitive behaviors associated with ASD (Liang et al., 2022; Maneeton et al., 2024). Evidence is unclear that anticonvulsants and tra ditional mood stabilizers are useful in managing mood lability and aggression (Sesso et al., 2023). Psychosocial Interventions When working with children with neurodevelopmental disorders, building on their strengths and using positive reinforcement are very important. If these children feel that they are constantly criticized or need “fixing,” their self-esteem may be diminished and they may be less engaged in their treatment. Developmental approaches for children with ASD often focus on improving lan guage and physical skills. Speech and language therapy will help the child improve their understanding and use of speech and language. Occupational therapy is benefi cial in promoting independence, and may include build ing skills with eating, grooming, and bathing. Sensory integration therapy may be useful for individuals who struggle with sensory input (CDC, 2024c). Cognitive behavioral therapy (CBT) and mindfulness therapy may be helpful in reducing anxiety and depression (Linden et al., 2023).

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