Translating Research to Practice for Children With Autism

Abstract and Introduction

Abstract

Introduction: Managing home and health care for children with autism spectrum disorder can be challenging because of the range of symptoms and behaviors exhibited.

Method: This article presents an overview of the emerging science related to the methods to foster family self-management of common concerns regarding activities of daily living and behaviors, as well as for the health care provider in primary and acute health care settings.

Results: Recommendations are provided to enhance the overall delivery of services, including understanding and managing a child's challenging behaviors, and supporting family management of common activities of daily living and behaviors.

Discussion: Health care providers' knowledge of evidence-based recommendations for providing care, supporting family self-management of common concerns, and referral heighten the likelihood of better outcomes for children with autism spectrum disorder.

Introduction

Behavior issues are a significant problem for children with autism spectrum disorder (ASD). Social and communication impairments, anxiety, and fear can lead to challenging behaviors in the health care setting and can be further complicated by mental health comorbidities (Mayes et al., 2012). Children with ASD have more contact with the health care environment than typically developing children, including children with chronic health conditions (Wu, Kung, Li, & Tsai, 2015). Health care expenditures have been found to be up to nine times greater for a child with ASD because of increased comorbidities, increased use of medications, challenging child behaviors, and the behavioral complexity of providing care to this population (Gurney, McPheeters, & Davis, 2006; Liptak, Stuart, & Auinger, 2006; Mandell, Cao, Ittenbach, & Pinto-Martin, 2006; Tregnago & Cheak-Zamora, 2012; Wu et al., 2015). Parents and health care providers (HCPs), including nurses and nurse practitioners (NPs), have both expressed concerns related to ineffective management of challenging behaviors in the health care setting for children with ASD (Minnes & Steiner, 2009; Rhoades, Scarpa, & Salley, 2007; Weil & Inglehart, 2010).

This review article provides an overview of the current evidence available to support HCPs. In addition, anticipatory guidance for behavior management for families of children with ASD in the home, as well as in primary and acute health care settings, is presented.

Table 1. Toilet training
Child readiness	Parent preparations	Establishing a toileting program
Dry 2 hours Coordination to pull pants up and down Able to follow simple directions Aware he or she is wet	Track child's patterns for 4 to 5 days Check for wetness every 30 to 60 minutes Develop consistent toileting "steps" Increase fluids Have rewards available Provide activity for while on toilet Have underwear, toilet insert, and step stool for feet	Goal: making it more fun to void in toilet than in pants Boys should sit to void because this is more generalizable to sitting for bowel movements later

Note. Data from Autism Speaks, (2012a); Coucouvanis, (2008); Kroeger, (2012); Kroeger & Sorensen-Burnworth, (2010).

Table 2. Mealtime strategies
Establish mealtime routines	Picky eating strategies
Have child help with shopping for food	Introduce one new food at a time, keeping the rest as accepted food
Have child help with mealtime preparation (e.g., setting the table and fixing food when appropriate)	Establish the amount of new food to be introduced (1 teaspoon may be a good start)
Establish simple rules (e.g., wash hands, sit at table, food on plate, use utensils)	Try new food more than a dozen trials before abandoning; offer different textures of the same food (e.g., chopping, blending)
Eliminate external distractions (turn off TV and put cell phones away)	The child may need to start with just having the food on the plate—then touching, smelling, and tasting food
Keep the length of mealtime consistent (15 to 30 minutes)	Referral to an occupational therapist and dietician may be necessary
Praise positive behavior (e.g., "good job touching the green bean") and ignore negative behavior such as throwing food	Offer accepted and nonaccepted food and alternate bites/licks/touches of each food using "first this, then this" instruction
Use positive language such as "we hold our fork" instead of "don't throw your fork"	Make eating fun with play such as dipping foods with sound effects, animal crackers jumping into a puddle of applesauce
The caregiver should model eating or food-exploring behaviors	Give the child choices chosen by the caregiver (two nonpreferred foods)
Use visual timers and visual schedules to communicate mealtime routines	Decrease drinks provided during mealtime to avoid being too full
Offer the same meal as the rest of the family	Offer food that is similar but different (e.g., if the child prefer apples, then try a similar fruit like a pear)