Care of the Patient with Autism

This is a course on caring for patients with autism spectrum disorder (ASD), also called Autism. This course is designed for Certified Nursing Assistants (CNAs) to help you understand and support patients with Autism. We will cover important topics, including what Autism is, how to communicate effectively, how to manage sensory sensitivities, how to provide structured care, and what changes you should report to the nurse.

Autism Spectrum Disorder (ASD) is a condition that affects how people communicate and interact with others. People with Autism might have different challenges and strengths, which is why we call it a "spectrum" (American Psychiatric Association, 2024). Spectrum means the subject covers a wide range of disorders associated with Autism.

The first few characteristics may appear early. Parents might see that their baby does not cuddle well or stiffen when they are held. The infant might tend to have poor eye contact and may not respond to facial expressions or surrounding people. The baby may be quite happy to sit alone in the crib for long periods, looking at their toys. As the child grows older, they may not be able to understand facial expressions or body movements as a means of communication. They may not respond to their name being called or may seem deaf. The child may not respond to hugs or smiles. They might not be able to interpret gestures or facial expressions like other children. Therefore, they may not know how to respond. The young child typically will not find friends easily and will not associate with groups of other children. For example, it might not occur to them to share the toy or something that they created with others.

Language development tends to be delayed, or the child may not speak at all. Children may also begin to develop language and then backtrack in language development. The language may be repetitive or lack meaning. They may have difficulty initiating and maintaining conversation, or they may repeat whatever they last heard. They may act as if they are in their own world and not aware of what is going on around them. They may also injure others or themselves without provocation. They may show no pain or no sensitivity to getting hurt.

Adults may find social interactions, especially in groups, uncomfortable or confusing. They may not understand or know how to respond to others appropriately. For example, they may not get the joke or why others are laughing. They may not understand why someone is sad, and they cannot respond appropriately. They may also lack eye contact and seem very meticulous and precise in everything they do.

Good communication is very important when caring for patients with Autism. Each person with Autism may have their own way of communicating, so it is important to use methods that work best for them (Autism Research Institute, n.d.). Some Autistic patients speak very well; others may not talk at all. Use Clear and Simple Language. Speak using short, easy-to-understand sentences. Avoid complicated words or phrases. Stick to direct and simple language (Mayo Clinic Staff, 2023).

Use visual supports, such as pictures, diagrams, or written schedules, to help the patient understand what they need to do. These visual tools are especially helpful for explaining daily routines and changes(Autism Speaks, n.d.). Give the patient extra time to think and respond. Do not rush them, as this can make communication harder and increase their anxiety (NIMH, n.d.). It may take a while for the patient to understand what you said and what they need to say in return.

Use positive reinforcement. Praise or small rewards can help encourage the patient to communicate and cooperate, helping build a trusting relationship (Autism Society, 2022). Nonverbal communication is important when communicating with patients with autism. Pay attention to the patient’s body language, facial expressions, and gestures. These can give you clues about how the patient is feeling or what they need (Autism Research Institute, n.d.).

Many people with Autism have heightened sensory sensitivity to things like sounds, lights, or textures. These sensitivities can make them feel overwhelmed or stressed (CDC, 2024). There are many strategies for managing sensory sensitivities. Once you identify what works with a specific patient, add that to the care plan.

Create a calm environment. Keep the surroundings quiet and calm. Lower the volume of background noises, dim bright lights, and avoid strong smells. Use soft colors and textures to make the environment more comfortable (Autism Speaks, n.d.). If the patient seems overwhelmed, provide a sensory break. This might be a quiet space or a soothing activity, like rocking or using a sensory object (Mayo Clinic Staff, 2023). A sensory object is something the patient likes to hold or stroke to comfort themselves. This may be a piece of fabric or a stuffed animal.

Respect the patient’s personal space. Be aware of the patient’s need for personal space. Some may not like being touched or have specific preferences for how they are touched. Always ask before making contact (Autism Society, 2022). Some patients with Autism do not like to be touched at all. Use sensory tools. Sensory tools such as noise-canceling headphones, weighted blankets, or fidget toys can help the patient manage sensory input. These tools can make them feel more comfortable and in control (Autism Research Institute, n.d.).

Monitor for signs of sensory overload. Look for signs of sensory overload, such as covering their ears, shutting their eyes, or showing distress. Seeing these signs helps reduce the sensory input and calms the patient (NIMH, n.d.).

Patients with Autism often do better with clear routines. Having a predictable schedule helps them feel more secure and less anxious(Autism Speaks, n.d.). These routines should be included in the care plan. Develop consistent routines. Create and follow daily routines for activities, meals, and rest. This helps the patient know what to expect and reduces their stress (Mayo Clinic Staff, 2023).

Prepare for transitions. When things change, moving from one activity to another can be tough. Give the patient advance notice and use visual or verbal cues to help them prepare for the change(Autism Society, 2022). Use visual schedules. A visual schedule showing the day’s activities can help the patient understand what will happen next. This makes routines clearer and less confusing (Autism Research Institute, n.d.).

Establish clear expectations and clearly explain what behaviors are expected during activities. Use simple language and visual cues to help the patient understand (CDC, 2024).

Adapt routines as needed. While routines should be consistent, they should also be flexible. Adjust routines if needed based on the patient’s mood, health, or other factors. Explain any changes calmly and clearly (NIMH, n.d.).

As a CNA, you play an important role in noticing and reporting any changes in the patient’s behavior, communication, or health. This helps ensure the patient receives the right care (Autism Speaks, n.d.). The autistic patient may be on medication or have additional medical issues. Be aware of problems with medication side effects such as diarrhea, nausea, headache, or other side effects. Remember that this patient may not be able to state exactly what is hurting or what is wrong.

Watch sleep patterns, bathroom patterns, eating habits, the ability to complete activities of daily living, and any changes in their patterns or behaviors. Any sudden changes should be reported. The parent or caregiver may be the best person to ask about any problems that are occurring. If working with an adult, use some of the techniques mentioned, such as allowing them to write down symptoms or use pictures for communication.

Be sure to report any new issues, such as aggressive behavior toward a particular person or acting out at certain times of the day. Determine the patient's anxiety level during activities or new interactions. Notice any changes in their environment. If there are, discuss with the nurse and other caregivers how to help the patient adjust to anything new that may occur.

Report behavioral changes. These are any sudden or big changes in the patient’s behavior, such as increased agitation, withdrawal, or aggression. These might indicate pain, illness, or stress (CDC, 2024). If the patient has new or worsening problems with communication, like struggling to express needs or becoming nonverbal, tell the nurse. They might need further help or evaluation (Autism Society, 2022). Report any signs of physical discomfort, illness, or injury right away. This includes symptoms like pain, fever, changes in appetite, or refusal to eat (Mayo Clinic Staff, 2023).

If the patient shows signs of sensory overload, you should implement the care plan to help calm this patient. If the signs of overload occur more often than normal, report them to the nurse. These signs may include covering their ears, closing their eyes, or becoming distressed. The care plan may need to be adjusted (NIMH, n.d.). If the patient reacts poorly to new activities or changes in routine, report this to the nurse. The care team may need to find a different approach (Autism Research Institute, n.d.).

Scenario/Situation/Patient Description

Jerrod is a ten-year-old who has been diagnosed with Autism. You are Jerrod’s home care CNA. Upon arrival, you notice that Jerrod has withdrawn and will not address you. His mother tells you he has not slept for more than two hours. As you approach Jerrod, he suddenly starts flapping his hands and yelling. His mother is upset and wants you to help him.

Intervention/Strategy

Report to the nurse that Jerrod is not sleeping well and is more withdrawn. The nurse may have strategies to share with you to help Jerrod and his mother. These may include reviewing his schedule, particularly around bedtime, or asking if there is anything new around the environment. They will probably also include parent education.

Discussion

It would be best to prevent whatever is stressing Jerrod, but in a home setting, the parents are the primary caregivers. You can review the care plan with the parents and tell them to report sudden changes to the nurse.

Strengths and Weakness

This strategy may prevent the situation from getting worse and help calm Jerrod. The weakness is that the home environment is not under the CNAs' control. You can only reinforce the care plan.

Caring for patients with Autism requires special understanding, patience, and flexibility. By learning about Autism, using effective communication, managing sensory sensitivities, providing structured care, and knowing when to report changes, CNAs can provide the best care for these patients. This course gives you the knowledge and skills to support these patients in a caring and effective way.

• American Psychiatric Association. (2024). Autism spectrum disorder. American Psychiatric Association. Visit Source.
• Autism Research Institute (ARI). (n.d.). Sensory sensitivities and autism. Autism Research Institute. Visit Source.
• Autism Society. (2022). Understanding Autism. Visit Source.
• Autism Speaks. (n.d.). What is autism?Visit Source.
• Centers for Disease Control and Prevention (CDC). (2024). Data and statistics on autism spectrum disorder. Centers for Disease Control and Prevention. Visit Source.
• Mayo Clinic Staff. (2023). Autism spectrum disorder. Mayo Clinic. Visit Source.
• National Institute of Mental Health (NIHM). (n.d.) Autism spectrum Disorder. National Institute of Mental Health (NIMH). Visit Source.