Over the last 2 decades, great advances in care have been made to meet the unique needs of individuals with autism spectrum disorder (ASD). In 2014, the CDC estimated that 1 in 68 children in the US was identified with ASD. As nurses, we must maintain a wide knowledge base and awareness of current evidence-based practice strategies to provide optimal care for this patient population and their families.
When patients with ASD are admitted into healthcare settings, their daily routines and schedules are disrupted, and we must be acutely aware of the negative impact this may have on them. If possible, caregiver staffing should be consistent each day to ensure that a familiar face is present for the patient, which may reduce anxiety. Many people with ASD find comfort in performing specific daily routines or rituals in their familiar environment. For this reason, we should ensure that we meet the agreed-upon time-specific care obligations to minimize the negative impact of the unfamiliar environment. Providing structure can help decrease the likelihood of behavioral outbursts and further reduce anxiety for the patient.
Identify special interests or tasks that are important to the patient and plan his or her care around incorporating or accommodating them. When planning or performing physical care, provide choices when possible; this can be implemented by simply offering the option of performing a required test now or in 15 minutes. Having a choice allows patients with ASD to regain some control over their new environment.
Many individuals with ASD experience communication barriers and cognitive deficits, so we need to be prepared to tailor our communication strategies to the patient's needs. Only one-third of all people with ASD are nonverbal; however, the change in normal daily routines may cause a temporary regression in communication. When providing information, utilize concrete language and avoid multistep directions that can cause confusion. As we communicate, we should assess the patient for nonverbal signs of comprehension and awareness to ensure that he or she is processing the information.
Although it's common for nurses to infuse humor into our daily communication to lighten patients' spirits, this can cause confusion for patients with ASD and increase their anxiety level in an already stressful situation. Be aware that many patients with ASD think and process communication in very concrete terms. Abstract concepts are often incorporated into our communication strategies but for our patients with ASD, these should be avoided to optimize both comprehension and trust.
If your patient is nonverbal, he or she may require alternative communication tools such as a communication board. Make sure to ask family members or caregivers what communication strategies work best for the patient. Utilize a family-centered care plan to help identify the patient's level of physical and intellectual independence.
Our goal is to return our patients to their optimal level of wellness and independence. Patients with ASD may need additional time, compassion, and patience. This requires us to be flexible with our routine workflow. For best-practice interventions, see our article “Nursing Care of Patients with Autism Spectrum Disorder” on page 28.