Guest Author - Julie Reeser, RN
Autism rates are reaching 1% of the population, with boys being affected in 1 out of 70 births. With this growing rate, it is likely that nurses will need to understand how to effectively manage and treat this special population. Autism is a broad spectrum, ranging from Pervasive Developmental Disorder Not Otherwise Specified to Childhood Disintegrative Disorder. As with most pediatric patient populations, the parents are the best resource for their care, but not all autistics are children. The rapid growth of this population started about 20 years ago, which means that these people are now young adults facing a world unprepared for their needs.
People with autism function at their best with routine, control of their environment, and non-physical interventions. So how do you treat someone who melts down with touch and unfamiliar routine? A starting point would be to assign primary caregivers to this patient. The next step would be to collaborate with the parent(s). If this is a young adult, there will probably still be caregivers involved, and they should be consulted with the patient’s permission. Autism is often a world defined by absolutes and rules. If the staff is able to clearly articulate the rules and routine to the patient through the medium most conducive to that particular patient’s needs, then the patient feel more in control and safe. This requires that the staff not break those rules once they are set, or be prepared to deal with the anger, anxiety, and emotional outbreak that may occur.
It is important that the nurse advocate for their patient, not allowing the patient to end up medically sedated just because they have a meltdown. The meltdown is simply the way a person with autism displays their emotions. It is best to prevent the meltdown to begin with, rather than attempting to “treat” it. There are often signs of an impending meltdown that should be discussed with the patient and caregiver. Typically, autistics prefer pressure to light touch. So while we may be used to gently stroking a hand, the autistic may prefer that you squeeze a finger instead. Again, this will be very individual and should be discussed with the primary caregiver or the patient themselves, depending on where they fall on the spectrum. Other things to discuss are mealtimes, bedtime routines, self-stimulation behaviors, and what best calms the patient when they are upset.
The way a nurse verbally communicates with an autistic person can have a large impact on their cooperation and care. Many people with autism are unable to properly process non-verbal cues. They often interpret postures and facial expressions as reflecting their internal dialogue. Meaning that if they are scared or angry, they will think you are as well, regardless of your words. It is important to stay neutral, soft, and monotone with your speech. Rapid speech, rising and dropping inflections, and large motor movements can aggravate a person with autism already headed toward crisis. Stick to the facts and allow time for the patient to process what you have said. The more accurate your facts, the more trust you will build. Be careful not to take it personally if the patient has a meltdown. Be supportive, compassionate, and open as these will facilitate a faster recovery from the emotional upset. Remember to give them the physical space and safety they require. Do not assume that they do not “understand”. Autism is unrelated to IQ, and your patients will be much brighter and more creative than you may think. Be conscious of the fact that the caregivers have found the best ways to cope, and while they may do things that seem strange to you, it is important to be supportive and understanding.