So what are some of the clinical manifestations? Well, we see impaired social interactions
and there's not just one level of the impairment, it is on a spectrum of impairment.
Some of the children are very high functioning in social interactions while others are very
isolated and incapable of having those kind of social interactions. How do we see this?
Well, we're going to notice they have difficulty forming interpersonal relationships so
if this child is a patient on your floor, what you're going to notice is they may not
connect easily with other children. They may have an aversion to affection and physical
contact. There is some difficulty they have in reading emotional cues. They have an
inability to process what another person might be feeling so they lack that ability to
emphatize if someone is getting hurt. How do we see the impairment in communication and
oftentimes also imaginative activity? Well, one maybe absent language. The child may
not have that capacity for language. They also may have immature sentence structures
or they may just have guttural utterances. Remember, this is on a spectrum so you may
have children who have ASD who have language than others who have very limited
language and others who are only making sounds. There are others who are unable to
have verbal communication at all. Their verbal capacity is absent and oftentimes with
this children we see inappropriate nonverbal communication; slapping, hitting, pushing,
screaming, tantrum-like behavior. You also might have a lack of response to the
environment or a complete overreaction to any stimuli in the environment. You cannot
make a decision that one symptom is going to apply to all of the children with ASD. Each
individual is an individual child and that child has to be assessed for his or her capacity
within their abilities to interact with their environment to learn and to connect. Sometimes
we also see that there is very restricted play where the child won't play with others or
repetitive play. Well, they want to do the same thing over and over and over again.
You can understand that if you have children in a communal room and you have one child
who only wants to do one thing and doesn't want to let anyone else do it, there is tension
that starts to increase and the situation then can turn on this child. So we want to be
able, as nurses, to assess not only the child but the environment that the child is in
and to be able to reduce stimuli if that is going to be something that activates the child
or if it is too slow a stimulation to assist that child to get to an arena where they are
able to participate. Other clinical manifestations of ASD are going to be restricted activities
and interests. For example, a child might have an attachment to a certain object and
have that attachment be a requirement for them to be able to be in the room. They may
have great resistance and sometimes agitation to any changes that might occur in their
environment or even in their routine. They might have some stereotype body movements
or ways of verbalizing themselves. What do I mean by that? They might have a body
movement like this is what helps them to feel okay or they may just need to, every once
in a while, go uhuhuhuhuh, uhuhuhuhuh. It is part of their clinical manifestation. One thing
that I want to bring up here that is really important in any disorder like ASD or IDD or
ADHD, the most important thing is to understand the child is not doing these things
on purpose, this is a clinical manifestation of a disorder and we aren't going to make it
better by having expectations of this child to be able to function at a level that they
are not able to function at. One of the things that I say to my nursing students when
I am teaching in a classroom is that if you have a person who cannot hear who is hearing
impaired, that they are totally hearing impaired with deafness that is profound, screaming
at them is not going to help them. It will only draw attention to the fact that you don't
know how to communicate with that patient. It is the same thing with these children.
Our assessment of their capacity to engage is going to help them engage at their highest
level without us demanding an engagement from which they are incapable of complying.
We want to make sure that in our assessment we understand that one of the clinical
manifestations is that this child may do self-injurious behaviors, not because the child
doesn't like themselves, not to try and upset you, not to wreak havoc in an environment.
The child may bang their head against a wall. That is self-injurious behavior. They may
punch themselves. They may scratch or dig into their arms. This is a clinical manifestation
of the disorder itself.