autistic child essay

An official website of the United States government

The .gov means it’s official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

The site is secure. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

• Publications
• Account settings

Preview improvements coming to the PMC website in October 2024. Learn More or Try it out now .

• Advanced Search
• Journal List
• J Educ Health Promot

The experiences of families raising autistic children: A phenomenological study

Farzad faraji-khiavi.

1 Social Determinants of Health Research Center, School of Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran

2 Department of Health Services Management, School of Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran

Mansour Zahiri

Elham amiri.

3 Department of Rehabilitation Management, Rehabilitation Faculty, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran

Behnaz Dindamal

Narges pirani.

4 Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran

BACKGROUND:

Conditions and needs of autistic children have impacts on both the children and the family members who have crucial roles in raising the child. The prevalence of autism is increasing, and this fact makes it necessary to focus more on experiences of parents who have children with autism spectrum disorder (ASD). Hence, this study aimed to reflect the experiences of parents who have autistic children.

MATERIALS AND METHODS:

The present study was a qualitative research with phenomenology approach which was conducted using content analysis approach. Participants were 14 parents with ASD children in Ahvaz, and they were included based on purposive sampling method. To gather the required data, semi-structured interviews were formed. Data analysis was performed by Colaizzi's seven-step method.

Fifty-four conceptual codes were extracted from interviews of ASD children parents. Parents of these children had two main experiences: first family related and second education and treatment problems. Family problems included three categories (financial, psychological, and family relationships). Education and treatment was categorized into three (schooling, transporting, and quality in facilities).

CONCLUSIONS:

Problems mentioned by parents of autistic children highlight the need for providing training and counseling services as well as emotional supports from both society and government. Planning and implementing supportive plans empower parents to strategically face problems and eventually improve their life quality and mutual understanding.

Introduction

Autism spectrum disorders (ASDs) are a group of pervasive developmental disabilities known as the most prevalent, serious, and yet unknown disorders during childhood.[ 1 , 2 ] Children with ASD are identified by a range of problems in their emotional, physical, and interactional skills, daily routines and playing, language development and natural speech, as well as imitative ability.[ 3 ] ASD symptoms typically are apparent within the 1 st year of age; however, certain clinical diagnosis does not happen before age three.[ 4 ] Although there is little information about the certain cause of ASD,[ 5 ] some studies have found that ASD etiology is not just characterized by a unique factor instead environmental and genetic risk factors, or a combination of both factors, play roles in ASD etiology, however, just recently it is agreed that ASD is mostly caused by genetic factors.[ 6 ]

In the last two decades, the prevalence of ASD has remarkably increased.[ 7 ] It is estimated that ASD prevalence in 2014 was 2.24% which showed three times more than 2000 estimation.[ 8 ] In Iran, ASD prevalence among 5-year olds is estimated at 6.26 in 10,000.[ 9 ]

ASD can be seen among all races, ethnics and across all socioeconomic groups. The prevalence of ASD among boys is four times higher than girls,[ 10 ] but in girls, ADS is more comorbid with some diseases like epilepsy.[ 11 ] Increasing prevalence of autism requires more focus on experiences of these children's parents.[ 12 ] Special needs and conditions of autistic children influence not only the child but also family members who play roles in child development.[ 13 ] Families with ASD children are facing a wide range of stressful and challenging conditions such as unexpected disabilities, child's harmful behaviors, and behavioral disorders, difficulty in getting services, dilemmas in finding an effective treatment, and finally, restricted and dull interaction with other members of the society.[ 14 ]

The most stressful factor that parents with autistic children have experienced is limited acceptance of autistic behavior by society members and failure to receive social support.[ 15 ] Lack of such supports increases parents' stress level.[ 16 ] A fairly large number of studies confirm that mothers of autistic children face more challenges than mothers of other children with special needs, and have lower cognitive well-being[ 17 , 18 ] as well as suffer from more stress.[ 19 ]

A child with ASD may lead to several negative effects; parents feeling guilty, mothers quitting jobs to take care of the child, a low marital life quality, parents' depression and isolation feelings due to lack of time to spend for their personal needs.[ 20 ] In addition, these disorders also insert financial burden on families to cure and rehabilitate children.[ 21 ] In Asian countries, the cost of treatment and care for such children is about 70% of an officeholder.[ 22 ] It is obvious, without instructing and supporting families, their resources (money, energy, time, and spirit) may decrease day by day.[ 14 ]

Based on what went on, identifying ASD parents' problems and needs is crucial due to the impacts of ASD on children and their families, increasing prevalence of the disease, and the fact that autism is a lifetime disorder. Furthermore, Khuzestan province and its capital city, Ahvaz, is one of the autism centers in Iran, yet no comprehensive study has been done on these issues. Therefore, this study was conducted for the first time in Khuzestan province, although it was previously conducted in some other provinces of Iran. Considering multicultural context of this province, high prevalence of ASD, and scattered ASD centers, this study aimed to reflect the Experiences of families with ASD children in Ahvaz.

Materials and Methods

This study was a qualitative research with phenomenology approach which was conducted using content analysis approach.

Participants

Participants were 14 parents with ASD children in Ahvaz. Participants were included based on purposive sampling method, and they were added until data saturation point was obtained. Inclusion criteria were: living autistic child with family, the ability to speak Persian, and consent to participate in the study. Exclusion criteria also included: The family has another autistic child and the child has another physical or mental illness.

Data collection

To gather the required data, semi-structured interviews were formed. Participants answered questions such as: “Do you have financial problems because of your child's illness?” “Do have affected care of your child on marital status?” or “Do you have depressing during in this time?”. The time and place of the interviews were confirmed by the participants; in average, each interview lasted for 90 min ranging 60–120 min regarding each participant's condition. They were informed about the aims of the study, and participants' consent forms were collected. All the interviews were recorded and completed during 3 months (September 22 to December 20, 2018).

Data analysis

All the interviews were transcribed by two of the researchers; the data were analyzed through seven-step Colaizzi's method. (1) Manuscripts of interviews were read several times by research team, (2) Significant statements which were directly related to research subjects were identified, (3) Relevant meanings were extracted and formulated from significant statements, (4) Identified meanings were clustered into categories and themes, (5) An exhaustive description was developed about experiences of families with autism children (6) Fundamental structure of the studied phenomenon was produced, and (7) Fundamental structure verification was sought through asking participants about final categorizations.[ 23 ]

In addition to check the trustworthiness of the data Lincoln and Guba's four-criteria (credibility, dependability, confirmability, and transferability) was used.[ 24 ] The validity of findings increased by means of Investigator Triangulation.

Ethical issues

When the study received ethics code (IR.AJUMS.REC.1397.591) from the Research Ethics Committee of Ahvaz Jundishapur University of Medical Sciences, the researchers were introduced to associated places (ASD care centers, clinics, and households of children with ASD). The participants were informed about the aims of the study and confidentiality of interviews.

The following sections present information related to participants' related demography as well as main themes and sub-themes.

Participants' demographic information

Participants' ages ranged from 20 to 40. They all had office jobs. Half of the parents had two or three kids. Most of them had average and above-average financial status.

In this study, six subthemes were extracted from two main themes based on parents views and included family problems (financial problems and resulting obstacles, parents' psychological and mental problems, marital problems and siblings' relationships), ASD children's education and treatment (problems related to autistic children's education, parents and children transportation problems, and clinic-related problems). Codes (conceptual units) related to each theme are presented in the following table.

Family problems

Totally, parents of children with ASDs mentioned 27 problems which were classified into three subthemes of financial problems and resulting obstacles, parents' psychological and mental problems, marital problems, and siblings' relationships [ Table 1 ].

Family problems in experienced life of Autism spectrum disorder children parents

ASD=Autism spectrum disorder

Most parents mentioned high treatment prices as the most serious problem. Sometimes treatment process was negatively influenced because they could not afford to pay it. Some complain of the costs and insurance policies: “Costs are absolutely pressing us, insurances just cover some parts of the treatment cost” (Participant 3). Other parent mentions a point: “The costs are too high. We have to cut off our other costs to pay for the treatment. We do not spend any more for ourselves; we cannot” (Participant 6)! Another parent limits services as much as possible: “To tell the truth, I cannot afford to send him to speech therapy class; I do the training at home” (Participant 2).

All participants had experienced stress and anxiety feelings. Some of them believed they cannot be happy anymore due to current concerns. Such depressions affected some parents so deeply that they could not pass denial phase. In addition, suicide intention was mentioned by some other interviewees. Some parent feels he even does not have time for himself: “Most of the time I feel depressed but I never had time to visit a psychologist” (Participant 3). Other one remembers: “It is difficult for his mother to accept her child's disease. When our son was two, she was under treatment for her depression” (Participant 7). One of interviewees basically denies problem in public while worries for his wife as well as himself: “I hate the name autism. Wherever I go they say it's autism. I say no. My child has delay in language. My wife is depressed. She says “I want to kill myself.” If I had not stopped her, she could have killed herself. One of my colleagues had a sick child. She went to a psychologist. She got pills. After a while her hands had tremors. I got scared. If I go to a psychologist, I will be affected to” (Participant 5).

Respondents believed child's disorders ended in emotional distance between parents and problems in marital life. Most mothers said they spend all their time and energy for their child with ASD and they have nothing more to spend for the typically growing child such as: “Most of my time is for this child (the autistic one), I have no time to play with the other one” (Participant 3). Some forget about their simple daily jobs: “Anyway, when I am doing my child's daily routines, I lose concentration. Well, for example, after a while you cannot iron your husband's clothes” (Participant 1), While they cannot take a break: “My husband says leave one of the children with me, and you and the other one go to your mom's home for a month, but I am scared to do it” (Participant 5).

Education and treatment problems

Twenty-seven problems were identified as education and treatment problems of children with ASD including problems related to autistic children's education, parents and children transportation problems, and clinic-related problems [ Table 2 ].

Education and treatment problems in experienced life of autism spectrum disorder children parents

As children with ASD have certain stereotypes, and their learning requires more time compared to typically developed children, parents reported problems related to ASD children's education. Although some parents mentioned the need of having a school for ASD children, some parents believed that such schools prevent children from learning social communication skills. A participant says: “I registered him in a private school. After 20 day teachers asked me to go to school. They said your son does not sit on his chair in the class and distracts other students. If he has problems take him to a psychologist” (Participant 5). Other parent recalls: “Once I took him to the kindergarten, the staff didn't let him in. They said your child has stereotypical behaviors. Other children may learn negative behaviors from him. In case of other families notice this, they will not bring their children to this kindergarten; as a result, we have to close the kindergarten” (Participant 3). A mother does not believe in special schools: “In an autism school, it is not possible for children to learn how to communicate with others because all of them are autistic children. Moreover, my child will learn other negative stereotypical behaviour like screaming” (Participant 1). Finally, we can hear from some other parent: “I do not allow my child go to a school where autistic children go. I will pay more money if I have to but I take him to an ordinary private school, because public schools do not register them at all” (Participant 7).

One of the problems that parents of children with ASD suffer from is transportation. Parents were dissatisfied with school buses which are over full. Some other mentioned restlessness and disquiet of the child in the buses as the other problem. A parent mentions: “My child does not sit in the bus. He is restless. Other mothers ask me: what is wrong with your kid? I don't send my child to school by bus because I have seen how drivers are treating children, it is very improper. In addition, kids are piled in the bus about twice of its capacity. All of these kids are aggressive; and I cannot send my child with them, no way. As a result, I have to get a taxi; and it is expensive” (Participant 3). A mother has a point: “As long as his speech has not improved I won't send him with strangers, because they may mistreat him or hurt him and he cannot tell me. There are things in Tehran (the capital city) that you cannot find here. There are special advantages in parking places for parents of ASDs children. I was fined several times because of parking place” (Participant 6).

Another point that parents mentioned was improper conditions of the clinics. Almost all participants were dissatisfied with quality of services in the clinics. Some complained trainers: “His tutors shout at him, this causes the child suffer from personality problems in the future. You have to search a lot to find a good-tempered tutor” (Participant 2). And others were expecting more from related facilities: “I am not satisfied with the facilities, neither private nor public facilities provide appropriate services. They don't have dark rooms. For such children they should have at least one dark room” (Participant 3), or: “It is very crowded here and children have behavioral problems. Once I suggested them to provide a playing room. So we can stay over there with our kids, when kids are restless. As a result, our children do not make noise and cause problems for other classes (and they did nothing)” (Participant 6). At last they try to compare it with other cities: “Compared to Tehran and other cities, Ahvaz facilities are in poor conditions. Hydrotherapy and play therapy places are very limited. The child's conditions do not improve in these contexts” (Participant 5).

The first problem that parents of ASD in this study suggested was financial problems. Studies have concluded expenses of families for children with ASD are up to three times more than typically developed kids as well as mentally and physically disabled children at the same age.[ 25 ] For participants, treatment costs and lack of insurance support were the biggest financial challenges. Sharp argues in his study that even if insurance companies cover medical tests related to diagnosis, they never pay for therapies for behaviors.[ 26 ]

It is suggested that financial supports from government and charities address such families, As Koohkan et al . found in a qualitative study, the role of various charities is very significant in access to financial support for families of sick children.[ 27 ]

In addition, providing a more comprehensive insurance coverage may reduce the total financial burdens of the families. Among all mental conditions that parents mentioned depression, anger, inability, suffer, and guilty feeling were the most repeated. The results of Poretemad et al . show that mothers with autistic children experience higher parental stress levels and this increases their anger.[ 28 ] As a response, it is suggested that autism schools and clinics may help families of children with ASD to face their conditions via setting training courses for decreasing psychological pressures, training effective confrontation, training life skills, and at the end managing anger as well as stress.[ 29 ] Dadipour et al . Also considered necessary the role of training courses and counseling for the mental health of families and their coping with the problems of the sick child.[ 30 ]

One of the results of the present study about the marital conditions of parents was couples' intention to divorce. Tensions of raising autistic children, and their behavior problems, increase the possibility of divorce.[ 31 ]

In line with the results of this study, Hartley et al . found that divorce rate among parents with autistic children is twice as much as it is for parents with normal children.[ 32 ] It seems provision of family consulting can help to restore and develop parents' relation.

Going to school can be considered as the beginning of a new kind of partnership between children with ASD and their parents to deal with special needs of family.[ 33 ] The results of the present study revealed lack of enough autism schools and low educational quality in these schools are pressing problems for training autistic kids. According to Balance et al ., parents with ASD children are always concerned about lack of necessary educational and health services in autistic schools.[ 34 ]

Another identified problem for parents in this study was using public transportation systems for autistic children and their presence in public. Although parents mostly pointed that conditions in other cities, namely Tehran, the capital, are better for children with ASD, the results of previous studies done in Tehran also suggested public transportation as one of the problems.[ 15 ]

It seems that allocating school buses and experienced drivers for transporting these children would be effective if required standards were considered, so that both parents and children benefit from relatively peaceful environment in vehicle as well as safety and security of the conditions. Parents questioned the poor quality of the services presented by the clinics. Ahmadi et al . in 2011 compared the needs of families with ASD children in Iran and Canada. Based on their study, there were three most common needs in special children's families: continuous services, professional expertise, and professional understanding.[ 35 ] These three and other needs in ASD remind us the crucial role of service quality in ASD children. It seems some comprehensive clinics need to be considered and established to provide a wide range of services for special children to meet their needs. Quality development programs may drive these facilities in delivering effective services along with other aspects of quality.

It is obvious that most of the identified problems and needs are not merely related to health field but address other sections; hence, health strategies do not solve the problem by itself. That is, problems, challenges, and meeting the identified needs and expectations of parents of children with ASD require multisector communications and cooperation.

Limitations of the study

Among the limitations of the present study was unwillingness of some families to mention their experience and problems. To encourage them to interview, the interviewers explained that their cooperation and participation may greatly help to identify their problems and try to solve them. In this way, they cooperated more consciously. Furthermore, this study was done in centers of Ahvaz; hence it needs to be cautious to generalize the results. Indeed, qualitative research may not be generalized. Similar research needs to be conducted in other provinces of Iran, then through a meta-analysis reveal the experience and general problems of these families for metropolitan and health policymakers.

Conclusions

Parents of ASD children had two main experiences: first family related and second education and treatment problems. Family problems included three categories (financial, psychological, and family relationships). Education and treatment was categorized into three (schooling, transporting, and quality in facilities). Health policymakers and other stakeholders need to support these families at least in three contact points: at home, school, and ASD facilities. Problems mentioned by parents of autistic children highlight the need for providing training and counseling services as well as emotional supports from both society and government. Planning and implementing supportive plans are necessary to empower parents to strategically face problems and eventually improve their life quality and mutual understanding. Considering the wide range needs of these families, it takes a multisector cooperation in order to provide them proper services and alleviate some of the burdens for families with ASD children.

Financial support and sponsorship

This study was financially supported by “Social Determinants of Health Research Center in Ahvaz Jundishapur University of Medical Sciences in Iran (Grant No.: SDH-9717).

Conflicts of interest

There are no conflicts of interest.

Acknowledgment

The research team appreciates managers of autism centers, instructors, and parents who helped to conduct this study. This study approved by Research Ethics Committee of Ahvaz Jundishapur University of Medical Sciences (Ethics Code: IR.AJUMS.REC.1397.591).

Educating Children with Autism (2001)

Chapter: 16 conclusions and recommendations.

Below is the uncorrected machine-read text of this chapter, intended to provide our own search engines and external engines with highly rich, chapter-representative searchable text of each book. Because it is UNCORRECTED material, please consider the following text as a useful but insufficient proxy for the authoritative book pages.

16 Conclusions and Recommendations This chapter summarizes the committee’s conclusions about the state of the science in early intervention for children with autistic spectrum disorders and its recommendations for future intervention strategies, pro- grams, policy, and research. The chapter is organized around seven key areas pertaining to educational interventions for young children with autistic spectrum disorders: how the disorders are diagnosed and as- sessed and how prevalent they are; the effect on and role of families; appropriate goals for educational services; characteristics of effective in- terventions and educational programs; public policy approaches to en- suring access to appropriate education; the preparation of educational personnel; and needs for future research. DIAGNOSIS, ASSESSMENT, AND PREVALENCE Conclusions Autism is a developmental disorder of neurobiologic origin that is defined on the basis of behavioral and developmental features. Autism is best characterized as a spectrum of disorders that vary in severity of symptoms, age of onset, and association with other disorders (e.g., mental retardation, specific language delay, epilepsy). The manifestations of au- tism vary considerably across children and within an individual child over time. There is no single behavior that is always typical of autism and no behavior that would automatically exclude an individual child from a 211 

212 EDUCATING CHILDREN WITH AUTISM diagnosis of autism, even though there are strong and consistent com- monalities, especially relative to social deficits. The large constellation of behaviors that define autistic spectrum dis- orders—generally representing deficits in social interaction, verbal and nonverbal communication, and restricted patterns of interest or behav- iors—are clearly and reliably identifiable in very young children to expe- rienced clinicians and educators. However, distinctions among classical autism and atypical autism, pervasive developmental disorder-not other- wise specified (PDD-NOS), and Asperger’s disorder can be arbitrary and are often associated with the presence or severity of handicaps, such as mental retardation and severe language impairment. Identifying narrow categories within autism is necessary for some research purposes; however, the clinical or educational benefit to subclas- sifying autistic spectrum disorders purely by diagnosis is debated. In contrast, individual differences in language development, verbal and non- verbal communication, sensory or motor skills, adaptive behavior, and cognitive abilities have significant effects on behavioral presentation and outcome, and, consequently, have specific implications for educational goals and strategies. Thus, the most important considerations in pro- gramming have to do with the strengths and weaknesses of the indi- vidual child, the age at diagnosis, and early intervention. With adequate time and training, the diagnosis of autistic spectrum disorders can be made reliably in 2-year-olds by professionals experi- enced in the diagnostic assessment of young children with autistic spec- trum disorders. Many families report becoming concerned about their children’s behavior and expressing this concern, usually to health profes- sionals, even before this time. Research is under way to develop reliable methods of identification for even younger ages. Children with autistic spectrum disorders, like children with vision or hearing problems, re- quire early identification and diagnosis to equip them with the skills (e.g., imitation, communication) to benefit from educational services, with some evidence that earlier initiation of specific services for autistic spectrum disorders is associated with greater response to treatment. Thus, well meaning attempts not to label children with formal diagnoses can deprive children of specialized services. There are clear reasons for early identifi- cation of children, even as young as two years of age, within the autism spectrum. Epidemiological studies and service-based reports indicate that the prevalence of autistic spectrum disorders has increased in the last 10 years, in part due to better identification and broader categorization by educators, physicians, and other professionals. There is little doubt that more children are being identified as requiring specific educational inter- ventions for autistic spectrum disorders. This has implications for the provision of services at many levels. Analysis of data from the Office of 

CONCLUSIONS AND RECOMMENDATIONS 213 Special Education Programs, gathered for school-age children since the autism category was recognized in 1991, would support investigation of whether the dramatic increases in the numbers of children served with autistic spectrum disorders are offset by commensurate decreases in other categories in which children with autistic spectrum disorders might have previously been misclassified or whether these dramatic increases have come about for other reasons. Although children with autistic spectrum disorders share some char- acteristics with children who have other developmental disorders and may benefit from many of the same educational techniques, they offer unique challenges to families, teachers, and others who work with them. Their deficits in nonverbal and verbal communication require intense effort and skill even in the teaching of basic information. The unique difficulties in social interaction (e.g., in joint attention) may require more individual guidance than for other children in order to attract and sustain their children’s attention. Moreover, ordinary social exchanges between peers do not usually occur without deliberate planning and ongoing struc- turing by the adults in the child’s environment. The absence of typical friendships and peer relationships affects children’s motivation systems and the meaning of experiences. Appropriate social interactions may be some of the most difficult and important lessons a child with autistic spectrum disorders will learn. In addition, the frequency of behavior problems, such as tantrums and self-stimulatory and aggressive behavior, is high. The need for sys- tematic selection of rewards for many children with autistic spectrum disorders, whose motivation or interests can be limited, requires creativ- ity and continued effort from teachers and parents to maximize the child’s potential. Although general principles of learning and behavior analysis apply to autistic spectrum disorders, familiarity with the specific nature of the disorder should contribute to analysis of the contexts (e.g., commu- nicative and social) of behaviors for individual children and result in more effective programming. For example, conducting a functional as- sessment that considers contexts, and then replacing problem behaviors with more appropriate ways to communicate can be an effective method for reducing problem behaviors. Recommendations 1-1 Because of their shared continuities and their unique social diffi- culties, children with any autistic spectrum disorder (autistic disorder, Asperger’s disorder, atypical autism, PDD-NOS, child- hood disintegrative disorder), regardless of level of severity or function, should be eligible for special educational services within the category of autistic spectrum disorders, as opposed to other 

214 EDUCATING CHILDREN WITH AUTISM terminology used by school systems, such as other health im- paired, social emotionally maladjusted, significantly developmen- tally delayed, or neurologically impaired. 1-2 Identification of autistic spectrum disorders should include a for- mal multidisciplinary evaluation of social behavior, language and nonverbal communication, adaptive behavior, motor skills, atypi- cal behaviors, and cognitive status by a team of professionals experienced with autistic spectrum disorders. An essential part of this evaluation is the systematic gathering of information from parents on their observations and concerns. If the school system cannot carry out such an assessment, the local education author- ity should fund the assessment through external sources. Early diagnosis should be emphasized. Because of variability in early development, younger children with autistic spectrum disorders should receive a follow-up diagnostic and educational assess- ment within one to two years of initial evaluation. 1-3 Professional organizations, with the support of the National Insti- tutes of Health (NIH) and the Department of Education’s Office of Special Education Programs (OSEP), should disseminate infor- mation concerning the nature and range of autistic spectrum dis- orders in young children to all professionals who have contact with children, particularly those who work with infants, toddlers, and preschool children. This information should include the vari- able presentations and patterns of behavior seen in autistic spec- trum disorders from toddlers to school age children. Members of “child find” teams within the early intervention systems, as well as primary care providers, should be trained in identifying the “red flags of autistic spectrum disorders” and the importance and means of early referral for comprehensive diagnostic evaluation. Advocacy groups and relevant federal agencies, as well as profes- sional organizations, should use effective media resources, in- cluding the Internet, to provide information concerning the range of behaviors in autistic spectrum disorders. ROLE OF FAMILIES Conclusions Having a child with an autistic spectrum disorder is a challenge for any family. Involvement of families in the education of young children with autistic spectrum disorders can occur at multiple levels, including advocacy, parents as participating partners in and agents of education or 

CONCLUSIONS AND RECOMMENDATIONS 215 behavior change, and family-centered consideration of the needs and strengths of the family as a unit. Nearly all empirically supported treat- ments reviewed by the committee included a parent component, and most research programs used a parent-training approach. More informa- tion is needed about the benefits of a family-centered orientation or com- bined family-centered and formalized parent training in helping parents. It is well established that parents can learn and successfully apply skills to changing the behavior of their children with autistic spectrum disorders, though little is known about the effects of cultural differences, such as race, ethnicity, and social class, nor about the interactions among family factors, child characteristics, and features of educational interven- tion. For most families, having a child with an autistic spectrum disorder creates added stress. Parents’ use of effective teaching methods can have a significant effect on that stress, as can support from within the family and the community. Parents need access to balanced information about autistic spectrum disorders and the range of appropriate services and technologies in order to carry out their responsibilities. They also need timely information about assessments, educational plans, and the avail- able resources for their children. This information needs to be conveyed to them in a meaningful way that gives them time to prepare to fulfill their roles and responsibilities. In the last ten years the widespread availability of the Internet and media attention to autistic spectrum disorders have increased parents’ knowledge but often conveyed perspectives that were not balanced nor well-supported scientifically. Of crucial importance is the question of how to make information available to parents and to ensure their active role in advocacy for their children’s education. Recommendations 2-1 Parents’ concerns and perspectives should actively help to shape educational planning. Specifically: a. In order for a family to be effective members of the Indi- vidualized Education Plan (IEP) team that plans a child’s educa- tion, the local school system should provide to the parents, at the beginning of the assessment process, written information con- cerning the nature of autistic spectrum disorders and eligibility categories, the range of alternatives within best practices in early education of autistic spectrum disorders, sources of funding and support (e.g., a support guide and bibliography), and their child’s rights. b. Prior to the IEP meeting, the local school system should provide to each family the written results of their child’s assess- 

216 EDUCATING CHILDREN WITH AUTISM ment, and a contact person to explain the findings if they wish, and should indicate that they will have the opportunity to present their concerns. Early during the IEP meeting, parents should be given an opportunity to voice their questions, concerns, and per- spectives about their child’s development and educational pro- gramming. 2-2 As part of local educational programs and intervention programs for children from birth to age 3, families of children with autistic spectrum disorders should be provided the opportunity to learn techniques for teaching their child new skills and reducing prob- lem behaviors. These opportunities should include not only di- dactic sessions, but also ongoing consultation in which individu- alized problem-solving, including in-home observations or training, occur for a family, as needed, to support improvements at home as well as at school. 2-3 Families that are experiencing stress in raising their children with an autistic spectrum disorder should be provided with mental health support services. Under Part C of the Individuals with Disabilities Education Act (IDEA), which addresses family sup- port and service coordination, including private service provid- ers, services should be extended to include families of children at least up to age 8 years. GOALS FOR EDUCATIONAL SERVICES Conclusions At the root of questions about the most appropriate educational inter- ventions lie differences in assumptions about what is possible and what is important to give students with autistic spectrum disorders through edu- cation. The appropriate goals for educational services are the same as those for other children: personal independence and social responsibility. These goals imply continuous progress in social and cognitive abilities, verbal and nonverbal communication skills, adaptive skills, amelioration of behavioral difficulties, and generalization of abilities across multiple environments. In some cases, reports have suggested that particular treat- ments can foster permanent “recovery”. However, as with other develop- mental disabilities, the core deficits of autistic spectrum disorders have generally been found to persist, to some degree, in most individuals. Research concerning outcomes can be characterized by whether the goal of intervention is broadly defined (e.g., “recovery” or “best out- 

CONCLUSIONS AND RECOMMENDATIONS 217 come”) or more specifically defined (e.g., increasing vocabulary or peer- directed social behavior); whether the design involves reporting results in terms of group or individual changes; and whether the goals are short term (i.e., to be achieved in a few weeks or months) or longer term (i.e., over years). A large body of single-subject research has demonstrated substantial progress in individual responses to specific intervention tech- niques in relatively short periods of times (e.g., several months) in many specific areas, including gains in social skills, language acquisition, non- verbal communication, and reductions in challenging behaviors. Studies over longer periods of time have documented joint attention, symbolic play, early language skills, and imitation as core deficits and hallmarks of the disorder that are predictive of longer term outcome in the domains of language, adaptive behaviors, and academic skills. Many treatment studies report postintervention placement as an out- come measure. While successful participation in regular classrooms is an important goal for some children with autistic spectrum disorders, the usefulness of placement in regular education classes as an outcome mea- sure is limited, because placement may be related to many variables other than the characteristics of the child (e.g., prevailing trends in inclusion, availability of other services). The most commonly reported outcome measure in group treatment studies of children with autistic spectrum disorders has been changes in IQ scores, which also have many limita- tions. Studies have reported substantial changes in large numbers of chil- dren in intervention studies and longitudinal studies in which children received a variety of interventions. Even in the treatment studies that have shown the strongest gains, children’s outcomes are variable, with some children making substantial progress and others showing very slow gains. The needs and strengths of young children with autistic spectrum disorders are very heterogeneous. Although there is evidence that many interventions lead to improvements and that some children shift in spe- cific diagnosis along the autism spectrum during the preschool years, there does not appear to be a simple relationship between any particular intervention and “recovery” from autistic spectrum disorders. Thus, while substantial evidence exists that treatments can reach short-term specific goals in many areas, gaps remain in addressing larger questions of the relationships between particular techniques, child characteristics, and outcomes. Recommendations The IEP and Individual Family Service Plan (IFSP) should be the vehicles for planning and implementing educational objectives. 

218 EDUCATING CHILDREN WITH AUTISM 3-1 Appropriate educational objectives for children with autistic spec- trum disorders should be observable, measurable behaviors and skills. These objectives should be able to be accomplished within 1 year and expected to affect a child’s participation in education, the community, and family life. They should include the devel- opment of: a. Social skills to enhance participation in family, school, and community activities (e.g., imitation, social initiations and re- sponse to adults and peers, parallel and interactive play with peers and siblings); b. Expressive verbal language, receptive language, and non- verbal communication skills; c. A functional symbolic communication system; d. Increased engagement and flexibility in developmentally appropriate tasks and play, including the ability to attend to the environment and respond to an appropriate motivational system; e. Fine and gross motor skills used for age appropriate func- tional activities, as needed; f. Cognitive skills, including symbolic play and basic con- cepts, as well as academic skills; g. Replacement of problem behaviors with more conven- tional and appropriate behaviors; and h. Independent organizational skills and other behaviors that underlie success in regular education classrooms (e.g., complet- ing a task independently, following instructions in a group, ask- ing for help). 3-2 Ongoing measurement of educational objectives must be docu- mented in order to determine whether a child is benefiting from a particular intervention. Every child’s response to the educational program should be assessed after a short period of time. Progress should be monitored frequently and objectives adjusted accord- ingly. CHARACTERISTICS OF EFFECTIVE INTERVENTIONS Conclusions In general, there is consistent agreement across comprehensive inter- vention programs about a number of features, though practical and, some- times, ethical considerations have made well-controlled studies with ran- dom assignment very difficult to conduct without direct evaluation. Characteristics of the most appropriate intervention for a given child must 

CONCLUSIONS AND RECOMMENDATIONS 219 be tied to that child’s and family’s needs. However, without direct evalu- ation, it is difficult to know which features are of greatest importance in a program. Across primarily preschool programs, there is a very strong consensus that the following features are critical: • entry into intervention programs as soon as an autism spectrum diagnosis is seriously considered; • active engagement in intensive instructional programming for a minimum of the equivalent of a full school day, 5 days (at least 25 hours) a week, with full year programming varied according to the child’s choronological age and developmental level; • repeated, planned teaching opportunities generally organized around relatively brief periods of time for the youngest children (e.g., 15- 20 minute intervals), including sufficient amounts of adult attention in one-to-one and very small group instruction to meet individualized goals; • inclusion of a family component, including parent training; • low student/teacher ratios (no more than two young children with autistic spectrum disorders per adult in the classroom); and • mechanisms for ongoing program evaluation and assessments of individual children’s progress, with results translated into adjustments in programming. Curricula across different programs differ in a number of ways. They include the ways in which goals are prioritized, affecting the relative time spent on verbal and nonverbal communication, social activities, behav- ioral, academic, motor, and other domains. Strategies from various pro- grams represent a range of techniques, including discrete trials, incidental teaching, structured teaching, “floor time”, and individualized modifica- tions of the environment, including schedules. Some programs adopt a unilateral use of one set of procedures, and others use a combination of approaches. Programs also differ in the relative amount of time spent in homes, centers, or schools, when children are considered ready for inclu- sion into regular classrooms, how the role of peers as intervention agents is supported, and in the use of distraction-free or natural environments. Programs also differ in the credentials that are required of direct support and supervisory staff and the formal and informal roles of collateral staff, such as speech language pathologists and occupational therapists. Overall, many of the programs are more similar than different in terms of levels of organization, staffing, ongoing monitoring, and the use of certain techniques, such as discrete trials, incidental learning, and struc- tured teaching. However, there are real differences in philosophy and practice that provide a range of alternatives for parents and school sys- tems considering various approaches. The key to any child’s educational program lies in the objectives specified in the IEP and the ways they are 

220 EDUCATING CHILDREN WITH AUTISM addressed. Much more important than the name of the program attended is how the environment and educational strategies allow implementation of the goals for a child and family. Thus, effective services will and should vary considerably across individual children, depending on a child’s age, cognitive and language levels, behavioral needs, and family priorities. Recommendations The committee’s recommendations for effective treatment are made on the basis of empirical findings, information from selected representa- tive programs, and findings in the general education and developmental literature. In particular, it is well established that children with autism spend much less time in focused and socially directed activity when in unstructured situations than do other children. Therefore, it becomes crucial to specify time engaged in social and focused activity as part of a program for children with autistic spectrum disorders. 4-1 Based on a set of individualized, specialized objectives and plans that are systematically implemented, educational services should begin as soon as a child is suspected of having an autistic spec- trum disorder. Taking into account the needs and strengths of an individual child and family, the child’s schedule and educational environment, in and out of the classroom, should be adapted as needed in order to implement the IEP. Educational services should include a minimum of 25 hours a week, 12 months a year, in which the child is engaged in systematically planned, develop- mentally appropriate educational activity aimed toward identi- fied objectives. Where this activity takes place and the content of the activity should be determined on an individual basis, de- pending on characteristics of both the child and the family. 4-2 A child must receive sufficient individualized attention on a daily basis so that individual objectives can be effectively implemented; individualized attention should include individual therapies, de- velopmentally appropriate small group instruction, and direct one-to-one contact with teaching staff. 4-3 Assessment of a child’s progress in meeting objectives should be used on an ongoing basis to further refine the IEP. Lack of objec- tively documentable progress over a 3 month period should be taken to indicate a need to increase intensity by lowering stu- 

CONCLUSIONS AND RECOMMENDATIONS 221 dent/teacher ratios, increasing programming time, reformulat- ing curricula, or providing additional training and consultation. 4-4 To the extent that it leads to the specified educational goals (e.g., peer interaction skills, independent participation in regular edu- cation), children should receive specialized instruction in settings in which ongoing interactions occur with typically developing children. 4-5 Six kinds of interventions should have priority: a. Functional, spontaneous communication should be the pri- mary focus of early education. For very young children, pro- gramming should be based on the assumption that most children can learn to speak. Effective teaching techniques for both verbal language and alternative modes of functional communication, drawn from the empirical and theoretical literature, should be vigorously applied across settings. b. Social instruction should be delivered throughout the day in various settings, using specific activities and interventions planned to meet age-appropriate, individualized social goals (e.g., with very young children, response to maternal imitation; with preschool children, cooperative activities with peers). c. The teaching of play skills should focus on play with peers, with additional instruction in appropriate use of toys and other materials. d. Other instruction aimed at goals for cognitive develop- ment should also be carried out in the context in which the skills are expected to be used, with generalization and maintenance in natural contexts as important as the acquisition of new skills. Because new skills have to be learned before they can be general- ized, the documentation of rates of acquisition is an important first step. Methods of introduction of new skills may differ from teaching strategies to support generalization and maintenance. e. Intervention strategies that address problem behaviors should incorporate information about the contexts in which the behaviors occur; positive, proactive approaches; and the range of techniques that have empirical support (e.g., functional assess- ment, functional communication training, reinforcement of alter- native behaviors). f. Functional academic skills should be taught when appro- priate to the skills and needs of a child. 

222 EDUCATING CHILDREN WITH AUTISM PUBLIC POLICIES Conclusions The Individuals with Disabilities Education Act (IDEA) contains the necessary provisions for ensuring rights to appropriate education for chil- dren with autistic spectrum disorders. However, the implementation and specification of these services are variable. Early intervention for young children with autistic spectrum disorders is expensive, and most local schools need financial help from the state and federal programs to pro- vide appropriate services. The large number of court cases is a symptom of the tension between families and school systems. Case law has yielded an inconsistent pattern of findings that vary according to the characteristics of the individual cases. The number of challenges to decision-making for programming within school systems reflects parents’ concerns about the adequacy of knowledge and the expertise of school systems in determining their children’s education and implementing appropriate techniques. The treatment of autistic spectrum disorders often involves many disciplines and agencies. This confuses lines of financial and intellectual responsibility and complicates assessment and educational planning. When communication between families and school systems goes awry, it can directly affect children’s programming and the energy and financial resources that are put into education rather than litigation. Support sys- tems are not generally adequate in undergirding local service delivery programs and maximizing the usefulness of different disciplines and agencies, and transitions between service delivery agencies are often prob- lematic. A number of states have successful models for providing services to children with autism, and mechanisms are becoming increasingly effi- cient and flexible in some states. In most cases, existing agencies at state and federal levels can develop appropriate programs without restructur- ing—with the possible addition of special task forces or committees de- signed to deal with issues particular to children with autistic spectrum disorders. Recommendations The committee recommends that a variety of steps be taken to ensure that policies are effectively carried out at the state and local levels. 5-1 At the federal level, the National Institutes of Health’s Autism Coordinating Committee and the Federal Interagency Coordinat- ing Council should jointly appoint a clinical research oversight 

CONCLUSIONS AND RECOMMENDATIONS 223 task force of professionals knowledgeable in the field of autistic spectrum disorders, to review and periodically report on basic and applied research programs to the parent agencies and to track program implementation through the State Interagency Coordi- nating Councils or relevant state agencies. Administrative sup- port for these efforts should be provided by the appropriate de- partment of the Secretary’s office. 5-2 States should have regional resource and training centers with expertise in autistic spectrum disorders to provide training and technical support to local schools. States should also have a mechanism to evaluate the adequacy of current support systems to local schools and recommend ways for improvement. One such mechanism could be an autistic spectrum disorders support systems task force that would examine the relevant provisions for personnel preparation, technical assistance, and demonstration of exemplary programs and would make recommendations as to what would be needed to bring a state’s support systems into alignment with quality education for children with autistic spec- trum disorders. States should monitor coordination among and transitions between service delivery systems and should develop ways to facilitate these processes. 5-3 Families should have access to consultation and legal knowledge such as provided by an ombudsman who is independent of the school system and who could be a standard part of Individual- ized Educational Plan planning and meetings. The ombudsman should be knowledgeable about autistic spectrum disorders and about relevant law and court decisions. The ombudsman’s role should include attending IEP meetings, interpreting the school system’s communications about a child to parents, and propos- ing, at the parents’ request, alternatives to those presented by the school system. Professional and advocacy groups should work together to provide this service, with the Governor’s Council for Developmental Disabilities or the Autistic Spectrum Disorders Support Systems Task Force responsible for ensuring funding for training and support of this service. 5-4 State and federal agencies should consider ways to work with and support professional and advocacy groups to provide up-to- date, practical, scientifically valid information to parents and practitioners. 

224 EDUCATING CHILDREN WITH AUTISM 5-5 States should have clearly defined minimum standards for per- sonnel in educational settings for children with autistic spectrum disorders. For example, at a minimum, teachers should have some special preparation (e.g., preservice course work, equiva- lent inservice training, workshops, and supervised practice in re- search-based practices in autistic spectrum disorders) and should have well-trained, experienced support personnel available to provide ongoing training and additional consultation. 5-6 States should develop a systematic strategy to fund the interven- tions that are necessary for children with autistic spectrum disor- ders in local schools, so that this cost is not borne primarily by the parents or local school systems. State education departments should develop interagency collaborations to pool support for local systems. A state fund for intensive intervention, or more systematic use of Medicaid waivers or other patterns of funding currently in place in some states, should be considered. Families should not be expected to fund or provide the majority of educa- tional programming for their children. 5-7 An updated, accurate summary of case law, consultation services, and mediation mechanisms in autistic spectrum disorders should be made accessible by the Office of Special Education Programs so that schools and parents can understand the options available to them when conflicts arise. 5-8 Since levels of information about autistic spectrum disorders vary greatly within the groups and agencies that make funding and policy decisions about autistic spectrum disorders, including state task forces in education and review panels in federal agencies, it is crucial that persons knowledgeable in the range of needs and interventions associated with autistic spectrum disorders be in- cluded in those decision-making activities. PERSONNEL PREPARATION Conclusions The nature of autistic spectrum disorders and other disabilities that frequently accompany them has significant implications for approaches to education and intervention at school, in the home, and in the commu- nity. Approaches that emphasize the use of specific “packages” of mate- rials and methods associated with comprehensive intervention programs 

CONCLUSIONS AND RECOMMENDATIONS 225 may understate the multiple immediate and long-term needs of children for behavior support and for instruction across areas. Teachers are faced with a huge task. They must be familiar with theory and research concerning best practices for children with autistic spectrum disorders, including methods of applied behavior analysis, naturalistic learning, assistive technology, socialization, communication, inclusion, adaptation of the environment, language interventions, assess- ment, and the effective use of data collection systems. Specific problems in generalization and maintenance of behaviors also affect the need for training in methods of teaching children with autistic spectrum disorders. The wide range of IQ scores and verbal skills associated with autistic spectrum disorders, from profound mental retardation and severe lan- guage impairments to superior intelligence, intensify the need for person- nel training. To enable teachers to adequately work with parents and with other professionals to set appropriate goals, teachers need familiar- ity with the course of autistic spectrum disorders and the range of pos- sible outcomes. Teachers learn according to the same principles as their students. Multiple exposures, opportunities to practice, and active involvement in learning are all important aspects of learning for teachers, as well as stu- dents. Many states and community organizations have invested substan- tial funds in teacher preparation through workshops and large-audience lectures by well-known speakers. While such presentations can stimulate enthusiasm, they do not substitute for ongoing consultation and hands- on opportunities to observe and practice skills working with children with autistic spectrum disorders. Personnel preparation remains one of the weakest elements of effec- tive programming for children with autistic spectrum disorders and their families. Ways of building on the knowledge of teachers as they acquire experience with children with autistic spectrum disorders, and ways of keeping skilled personnel within the field, are critical. This is particularly true given recent trends for dependence on relatively inexperienced assis- tants for in-home programs. Providing knowledge about autistic spec- trum disorders to special education and regular education administra- tors, as well as to specialized providers with major roles in early intervention (e.g., speech language pathologists) will be critical in effect- ing change that is proactive. Findings concerning change in educational and other opportunities suggest that administrative attitudes and sup- port are critical in improving schools. Recommendations The committee recommends that relevant state and federal agencies institute an agenda for upgrading personnel preparation for those who 

226 EDUCATING CHILDREN WITH AUTISM work with, and are responsible for, children with autistic spectrum disor- ders and their families. These efforts should be part of a larger effort to coordinate and collaborate with the already established infrastructure of special education, regional resource centers, technical assistance pro- grams, personnel preparation, communication sharing, and other relevant aspects of the existing infrastructure. Professionals aware of the special nature of these children are already carrying out many of these recom- mendations in a limited fashion. The committee urges agencies to pro- vide the personnel preparation resources needed for intensified efforts to build a viable support structure for educating children with autistic spec- trum disorders. 6-1 The Office of Special Education Programs should establish a 5- year plan to provide priority funds for preservice and inservice preparation for teachers, paraprofessionals, and other personnel providing services for children with autistic spectrum disorders, including children under age 3 years. 6-2 The need for a team approach involving many professions should be addressed by personnel preparation and practicum work within multidisciplined organizations and teams. 6-3 A special emphasis should be placed on training of trainers. There is a short supply of expertise and experience in the field of educa- tion for children with autistic spectrum disorders, and special attention should be paid to rapidly increase the capabilities of the trainers, who may have experience in special education or related fields, but not in the special skills and practices for children with autistic spectrum disorders. 6-4 The existing support systems that provide short-term training (e.g., technical assistance systems, resource centers, etc.) should include people with special expertise in autistic spectrum disor- ders on their staff. 6-5 The content of the curriculum for children with autistic spectrum disorders should be based on sound research. A continuing pro- gram should be established from such agencies as the National Institute of Mental Health and the National Institute of Child Health and Human Development to translate their research into usable information for practitioners. Work on family research is particularly relevant. 

CONCLUSIONS AND RECOMMENDATIONS 227 NEEDED RESEARCH Conclusions There are several distinct and substantial bodies of research relevant to young children with autistic spectrum disorders. One body identifies neurological, behavioral, and developmental characteristics. Another body of research addresses diagnostic practices and related issues of prevalence. Another has examined the effects of comprehensive early treatment programs on the immediate and long-term outcomes of chil- dren and their families. These treatment studies tended to use some form of group experimental design. An additional body of research has ad- dressed individual instructional or intervention approaches, with many studies in this literature using single-subject experimental methodology. Altogether, a large research base exists, but with relatively little integra- tion across bodies of literature. Highly knowledgeable researchers in one area of autistic spectrum disorders may have minimal information from other perspectives, even about studies with direct bearing on their find- ings. Most researchers have not used randomized group comparison de- signs because of the practical and ethical difficulties in randomly assign- ing children and families to treatment groups. In addition, there have been significant controversies over the type of control or contrast group to use and the conditions necessary for demonstrating effectiveness. Al- though a number of comprehensive programs have provided data on their effectiveness, and, in some cases, claims have been made that certain treatments are superior to others, there have been virtually no compari- sons of different comprehensive interventions of equal intensity. Across several of the bodies of literature, the children and families who have participated in studies are often inadequately described. Stan- dardized diagnoses, descriptions of ethnicity, the social class, and associ- ated features of the children (such as mental retardation and language level) are often not specified. Fidelity of treatment implementation has not been consistently assessed. Generalization, particularly across set- tings, and maintenance of treatment effects are not always measured. Though there is little evidence concerning the effectiveness of discipline- specific therapies, there is substantial research supporting the effective- ness of many specific therapeutic techniques. Recommendations 7-1 Funding agencies and professional journals should require minimium standards in design and description of intervention projects. All intervention studies should provide the following information: 

228 EDUCATING CHILDREN WITH AUTISM a. Adequate information concerning the children and fami- lies who participated, and who chose not to participate or with- drew from participation, including chronological age, develop- mental assessment data (including verbal and nonverbal IQ levels), standardized diagnoses, gender, race, family characteris- tics, socioeconomic status, and relevant health or other biological impairments; b. description of the intervention in sufficient detail so that an external group could replicate it; detailed documentation is crucial especially if no treatment manual is available; c. fidelity of treatment and degree of implementation; d. specific objective measures of expected outcomes, assessed at regular intervals; and e. measures of outcome that are independent of the interven- tion, in terms of both the evaluators and the measures, and in- clude broad immediate and long-term effects on children and families, particularly generalization and maintenance effects. 7-2 Funders and performers of research should recognize that valu- able information can be provided by a variety of approaches to research in intervention, including group experimental and single-subject designs. 7-3 In order to help educators and consumers make informed deci- sions about appropriate methods of intervention for particular children, federal agencies involved in autistic spectrum disorders initiatives (including the Office of Special Education Programs, the Office of Educational Research and Improvement, the Na- tional Institute of Child Health and Human Development, the National Institute of Mental Health, the National Institute of Neu- rological Disorders and Stroke, and the National Institute on Deaf- ness and Other Communication Disorders) and nonprofit agen- cies with similar national missions (such as Autism Society of America Foundation, Cure Autism Now, and National Alliance for Autism Research) should form a research task force and spe- cifically allocate federal responsibilites for recruiting and funding a comprehensive program of research related to intervention and treatment. This program should include: a. development of more specific, precise measures of impor- tant areas of outcome, such as social functioning, peer relation- ships, spontaneous communication and language, and the acqui- sition of competence in natural contexts (e.g., classroom, home); 

CONCLUSIONS AND RECOMMENDATIONS 229 b. definition of appropriate educational skills and sequences in social and cognitive development, informed by normal devel- opmental literature; c. measurement of the effects of the interactions between fam- ily variables (e.g., family structure, family supports, socioeco- nomic status), child factors (such as degree of language impair- ment), and responses to educational interventions (including family-centered, parent training, and other approaches) on out- comes. d. longitudinal treatment studies, where feasible, built on a clinical model with randomly assigned samples of sufficient size to assess the effectiveness of differing modes of treatment. 7-4 Treatment studies should recognize the common components of many comprehensive programs (e.g., standardized curriculum, family training, presence of typically developing peers) and should target and measure, longitudinally when feasible, “active ingredients” and mediating variables that influence the effects of intervention (e.g., communication and interaction opportunities for engagement, levels of interaction and initiation, specific teach- ing techniques, proportion of time in close proximity of peers). The concomitant development of innovative treatments building on these “active ingredients” should be supported. 7-5 In response to amendments in IDEA to make education more outcome oriented, a federal initiative should solicit and fund stud- ies in the following areas, not easily supported under the current review system: a. the development of instruments for measurement of diag- nosis and critical aspects of development, particularly tools for early screening of autistic spectrum disorders and for measure- ment of response to interventions; b. the development and application of sophisticated statisti- cal methods of analysis of change and growth, particularly multi- variate designs and those applicable to small samples; and c. the development and dissemination of novel research de- signs that combine individual and group approaches in ways that minimize biases and maximize the power of small samples. 7-6 Competitively funded initiatives in early education in autistic spectrum disorders should require plans and contain sufficient funding for short- and long-term assessment of child outcomes and measures of program efficacy. 

Autism is a word most of us are familiar with. But do we really know what it means?

Children with autism are challenged by the most essential human behaviors. They have difficulty interacting with other people—often failing to see people as people rather than simply objects in their environment. They cannot easily communicate ideas and feelings, have great trouble imagining what others think or feel, and in some cases spend their lives speechless. They frequently find it hard to make friends or even bond with family members. Their behavior can seem bizarre.

Education is the primary form of treatment for this mysterious condition. This means that we place important responsibilities on schools, teachers and children's parents, as well as the other professionals who work with children with autism. With the passage of the Individuals with Disabilities Education Act of 1975, we accepted responsibility for educating children who face special challenges like autism. While we have since amassed a substantial body of research, researchers have not adequately communicated with one another, and their findings have not been integrated into a proven curriculum.

Educating Children with Autism outlines an interdisciplinary approach to education for children with autism. The committee explores what makes education effective for the child with autism and identifies specific characteristics of programs that work. Recommendations are offered for choosing educational content and strategies, introducing interaction with other children, and other key areas.

This book examines some fundamental issues, including:

• How children's specific diagnoses should affect educational assessment and planning
• How we can support the families of children with autism
• Features of effective instructional and comprehensive programs and strategies
• How we can better prepare teachers, school staffs, professionals, and parents to educate children with autism
• What policies at the federal, state, and local levels will best ensure appropriate education, examining strategies and resources needed to address the rights of children with autism to appropriate education.

Children with autism present educators with one of their most difficult challenges. Through a comprehensive examination of the scientific knowledge underlying educational practices, programs, and strategies, Educating Children with Autism presents valuable information for parents, administrators, advocates, researchers, and policy makers.

READ FREE ONLINE

Welcome to OpenBook!

You're looking at OpenBook, NAP.edu's online reading room since 1999. Based on feedback from you, our users, we've made some improvements that make it easier than ever to read thousands of publications on our website.

Do you want to take a quick tour of the OpenBook's features?

Show this book's table of contents , where you can jump to any chapter by name.

...or use these buttons to go back to the previous chapter or skip to the next one.

Jump up to the previous page or down to the next one. Also, you can type in a page number and press Enter to go directly to that page in the book.

To search the entire text of this book, type in your search term here and press Enter .

Share a link to this book page on your preferred social network or via email.

View our suggested citation for this chapter.

Ready to take your reading offline? Click here to buy this book in print or download it as a free PDF, if available.

Get Email Updates

Do you enjoy reading reports from the Academies online for free ? Sign up for email notifications and we'll let you know about new publications in your areas of interest when they're released.

• Infertility
• Miscarriage & Loss
• Pre-Pregnancy Shopping Guides
• Diapering Essentials
• Bedtime & Bathtime
• Baby Clothing
• Health & Safety
• First Trimester
• Second Trimester
• Third Trimester
• Pregnancy Products
• Baby Names By Month
• Popular Baby Names
• Unique Baby Names
• Labor & Delivery
• Birth Stories
• Fourth Trimester
• Parental Leave
• Postpartum Products
• Sleep Guides & Schedules
• Feeding Guides & Schedules
• Milestone Guides
• Learn & Play
• Beauty & Style Shopping Guides
• Meal Planning & Shopping
• Entertaining
• Personal Essays
• State of Motherhood
• Home Shopping Guides
• Work & Motherhood
• Family Finances & Budgeting
• Viral & Trending
• Celebrity News
• Women’s Health
• Children’s Health
• It’s Science
• Mental Health
• Health & Wellness Shopping Guide
• What To Read
• What To Watch
• Mother’s Day
• Memorial Day
• Summer prep
• Single Parenting
• Blended Families
• Community & Friendship
• Marriage & Partnerships
• Grandparents & Extended Families
• Stretch Mark Cream
• Pregnancy Pillows
• Maternity Pajamas
• Maternity Workout Clothes
• Compression Socks
• All Pregnancy Products
• Pikler Triangles
• Toddler Sleep Sacks
• Toddler Scooters
• Water Tables
• All Toddler Products
• Breastmilk Coolers
• Postpartum Pajamas
• Postpartum Underwear
• Postpartum Shapewear
• All Postpartum Products
• Kid Pajamas
• Play Couches
• Kids’ Backpacks
• Kids’ Bikes
• Kids’ Travel Gear
• All Child Products
• Baby Swaddles
• Eco-Friendly Diapers
• Baby Bathtubs
• All Baby Products
• Pregnancy-safe Skincare
• Diaper Bags
• Maternity Jeans
• Matching Family Swimwear
• Mama Necklaces
• All Beauty and Style Products
• All Classes
• Free Classes By Motherly
• Parenting & Family Topics
• Toddler Topics
• TTC & Pregnancy
• Wellness & Fitness
• Please wait..

I’m the mom of a child with autism. Here are 3 things I want people to know

Like most mothers, I will fight to create opportunities for my son to thrive.

By Jane Kim Updated March 26, 2024

My son is autistic. He received an autism spectrum disorder (ASD) diagnosis when he was three years old, which opened the door for a plethora of covered therapies, a rigorous therapy schedule and—on my part—excessive anxiety.

The early years were incredibly difficult , and I do not look back on them fondly. There was too much unknown, too much stress and way too much silence. My son met many milestones shakily, and I tortured myself with whether or not they counted. 

When many toddlers were asserting their independence, he was quite passive. Speech and fine motor delays made independence more challenging. He seemed content to have things done for him. During that time, aside from “I love you,” the words I wanted to hear the most were, “I can do it.” 

Related: This stranger’s kindness to a child with autism is a lesson in compassion

It isn’t easy being the mom of a child with autism, and surely not everyone will understand my experience. But here are a few things I’d like for people to understand.

3 things I want people to know about parenting a child with autism

1. my kid’s milestones probably look a lot different than other kids’.

Apple TV’s “Becoming You” examines the first five years of children’s lives from across the globe and how those experiences shape each child. Episode one focuses on a long-standing culture in Japan where families send their three-year-olds out in the world to perform a task. The three-year-old goes to get sushi for dinner, armed with money and a list. After picking up dinner, he stops at some machines to get a toy, squats on the floor and plays—in no rush to get home. He no longer has any fear. As the show narrates, he is now a different kid. 

It triggered something in me, as it had been gnawing at me for some time: My son just turned 10 and I occasionally still cut up his food, brush the back of his teeth and check if his sneakers are on securely. Am I stunting his independence? 

Humans are creatures of habit. It’s natural to grow accustomed to having people do things for us. For my son, it often takes longer to acquire a new skill. Every parent wants their child to be independent, but the reality is that in the busyness of everyday life, parents often don’t have the time to nurture a particular skill if it takes some time to acquire. It’s a slippery slope of dependency—but the consequences of not nurturing and supporting independence are serious. 

Related: Why teaching your kids independent play is actually self-care

Nurturing independence is even more crucial for kids on the autism spectrum. The statistics are sobering, with 2% attending college , 15% being employed and 1 in 5 living independently since leaving high school. 

With my son turning double digits, it was a wakeup call for both of us to start stepping outside our comfort zones. Suddenly, every small step toward independence mattered. As a younger child, he never wanted to be left alone—I needed to be within eyesight, or he would come looking for me. Today, he still prefers that I’m somewhat nearby, but he has progressed to within an earshot. 

After some discussion and experimentation, I was able to do short bouts of yard work (with his face sporadically pressed against the window), leave him in the car as I sprinted into Starbucks to pick up my coffee and then he even rode his bike solo around the neighborhood, which gave me a high that lasted close to a week. That bike ride was a milestone on his journey to increased independence for a variety of reasons: following the rules of the road, navigating any chance encounters with strangers and neighbors and returning home within a certain period of time.   

Related: 10 things I’ve learned as a mom to an autistic child

After these successes, he was ready for his “first errand”: walking to a mailbox about eight minutes away to drop off (ironically) my life insurance payment. Another reminder of one’s mortality, that I won’t be around for him in perpetuity. I timed this errand so my partner could surreptitiously be in the parking lot nearby to ensure he got there safely. My partner hit some unexpected traffic so never made it in time, but the errand was successful. 

When I saw him appear from down the street (this time with my face pressed against the window), I got a feeling I wish I could bottle: that feeling that everything is as it should be, and it will be OK.

The next day, we were at one of our favorite restaurants and he announced he needed to go to the bathroom. As I got up from my chair to escort him, he said, “I can go by myself.” I was shocked and tried to play it cool as he had never done that before. Was it a coincidence that he decided to go on his own after running his first errand? I’ll never know for sure, but I think not. 

Related: The loneliness of being a ‘special needs’ parent is real

I share this because achieving independence is something much of the general population takes for granted. I’ve learned that fostering independence takes planning, effort, patience and additional time. My family has made conscious adjustments in our daily lives to build confidence and decrease dependence.

With every success and step forward, it’s easier to imagine what he’ll be doing in the next couple of years. He adores trains, so we have spoken about him taking the train when he gets older. Today, neither of us are ready for that. I’ve realized it’s OK if he takes a bit more time to establish independence as long as he’s making strides to get there—and I’m encouraging it. 

2. My experience as a mom is vastly different than yours

When my son was a toddler and I was still reeling from his ASD diagnosis , I tentatively asked one of his therapists that I had grown close with if it was obvious he was autistic. She looked me in the eyes and said without hesitation, “Jane, we all know when a child is different.” 

Looking back, I cringe thinking about that moment in time because I desperately wanted him to fit in and be a part of the neurotypical majority. In my mind, life would be easier and more predictable. Today, as a mom squarely in midlife, I know how naïve that mindset was: nothing is guaranteed for any of us—with or without a diagnosis. 

Sometimes, in an effort to avoid being uncomfortable, people resort to platitudes about raising kids and make empty predictions about my son’s future. A few that I’ve received over the years: “He’s got good language. My so-and-so’s son was autistic and never spoke. I’m sure he’ll be fine.” Or “Have you tried Therapist X? She did wonders for my neighbor’s child and now you can’t even tell he’s different.” 

Related: What moms of kids with invisible disabilities want you to know

Some moms have even tried to one-up me and share their experience of when their kid broke a bone and then summed it up with something like “ All kids are hard to raise. It takes a village. ” Although these comments may be well-intended, they don’t have that effect. I’ve most appreciated when other moms have asked questions rather than make assumptions about my son and his future. I value humor, support and an effort to understand—similar to most moms. 

When you’re uncertain of what to do or say, err on the side of being inclusive . Ask for a playdate. Encourage your child to get to know the kid that’s different. Take an extra minute to introduce yourself to the mom sitting alone at a school concert because the other moms already know each other from past playdates. This stuff matters, and I speak from experience. 

My son’s early years were some of the loneliest: dealing with all the uncertainty that comes with autism, balancing a full-time career and my son’s therapy schedule, and figuring out my new identity as a mom was overwhelming. On difficult days, I would have welcomed these because one simple gesture can change the trajectory of the day. Trust me.

3. It should be easier to provide meaningful experiences for a child with autism to engage with neurotypical children—outside the school setting

Like most mothers, I will fight to create opportunities for my son to thrive . This can be challenging when it comes to group activities if one’s social skills are not at the same level as peers or if there’s some behavioral unpredictability. As a result, group activities or team sports have not been an active part of my son’s life until late last year (ironically) during the pandemic. Neurotypical humans are a majority in this world—and I’ve always felt it important for my son to understand and get along with them, too. 

But how can one develop this important skill if opportunities are limited and kids remain siloed? In my search for meaningful experiences for my son outside the school setting, I’ve primarily come across group activities specifically for kids with disabilities and ones that will consider a child with a disability if an aide or therapist is present. Neither are a good fit for him, as they do not provide the organic real-life experience.  

We need more organizations that specialize in kid activities that embrace inclusivity . We need those leading kid activities to be creative and flexible in accommodating a range of different needs alongside neurotypical kids. Whenever this happens, it creates a pathway for understanding and acceptance. That is real life. Without all types of kids contributing to a shared experience, silos will remain. 

Related: My child isn’t rude—they have autism

As I mentioned earlier, my son joined a choir and group swimming lessons late last year and it has given him a sense of belonging and confidence that every child should experience. At first, I was hesitant to approach the music and swim schools. Even after a decade of raising my son, I still get emotional advocating for him and explaining his specific needs and ultimately hope others listening will understand and be open to making any necessary accommodations. 

As a parent of a child with a disability , you simply want to hear, “OK, let’s try it and we’ll go from there.” In the disability community, it doesn’t happen enough. When I told a colleague that my son enrolled in choir, she called him a “trailblazer.” She was referring to the fact that he was the only obviously autistic kid in the group, and his participation would (hopefully) pave the way for others to join.

We need to get to a point in our society where it’s commonplace for all kids—with or without a disability—to participate in extracurricular activities together. My preference is he be a kid above all else—trailblazer status optional.

A version of this post was published June 28, 2022. It has been updated.

Our editors also recommend...

Motherly Stories

Dr. oakley, yukon vet on building a career you love—and modeling that for your kids.

The secret to true supermom status

7 essential money lessons to teach your kids

I used to wish for ‘healthy kids’—then my son was diagnosed with type 1 diabetes

Ready for the solar eclipse? Here’s how to make it exciting for kids of all ages

Autism and writing: how to teach your child to write

by Jessica Millis

Research has shown that students with autism experience specific challenges regarding the learning process. Learning to write is a critical skill in order for a child to succeed in an academic environment. Writing is a challenge for many autistic students because it involves coordination, muscle strength, motor planning, language skills, organization, and sensory issues.

Autistic children may display these symptoms: • Marked deficit in communication • Complete or partial delay in spoken language • Repetition of words • Deficit in receptive language • Deficit in social language and social behavior • Self-stimulatory behavior such as finger flipping or hand flapping

Some children with autism benefit from augmentative communication devices, such as letterboards, IPADS, and Facilitated Communication (FC).

The importance of writing

Writing allows an individual to translate thoughts into text. It allows non-verbal children to communicate their needs. Writing is an important skill for graduation from high school.

Tips on how to teach children with autism to write

Many autistic children have some level of fine and gross motor difficulty which is manifested through poor handwriting and problems with coordination.

Hand Therapy

Hand therapy is recommended for those with fine motor skill deficits. The purpose of hand therapy is to help the child build muscle tone. An occupational therapists can assist with this therapy and offer professional consultation. Many schools have such therapists. In some cases, the child may be given a pencil grip which can be used to build stamina.

Other hand therapy activities may include but not limited to: • Involve vertical surfaces – you can further build the muscle tone by asking your autistic child to paint on a vertical surface. As they paint up and down the surface, they’ll develop muscles in their wrist. There is magnetic wallpaper you can purchase that allows children to write on walls.

• Squeezing – this can greatly help build muscle tone. Incorporate stress balls and play-dough until the muscles in the fingers strengthen. Start with something soft then you can increase the hardness as the therapy progresses. • Stretchy bands – you may also consider getting a stretchy rubber that will help with tension strengthening around the arms and the wrist area.

All these practices are aimed at strengthening the muscle tone which is critical to writing. If they are done correctly, in no time you should have the hand and fingers ready to start practicing.

What activities encourage writing?

Thinking outside the box is important. Get creative! Consider tag team learning where the child copies what you write. When beginning, it’s best to start with shapes. Draw a vertical line and then have your child copy it. Then do the same with a horizontal line and a circle. Create thick lines that make it easy for your child to trace over. It may be necessary to place your hand over your child’s hand. This type of hand-over-hand support can be faded as the child progresses in skills.

When learning how to write letters, big papers with lines is suggested. Again write the letters with fat lines and have your child trace them.

Since the point of all the exercises is to get your child to write, do not limit them to pencils and worksheets alone. Encourage them to write anywhere and with other tools, such as crayons and brightly-colored markers. There are some markers which are fat and shaped like animals.

Art can help with writing

Invest in watercolors and paints! Art can help develop a child’s fine-motor skills and assist with motor planning and the skills needed for writing.

Be aware of sensory issues regarding writing

Many autistic people have sensory issues. Bombardment of sights, sounds, smells and movements surrounding the activity can cause a meltdown when the child is being challenged to learn something new. Many autistic children have trouble sitting for extended periods of time. Make sure you alternate the sitting activity with movement breaks.

Be flexible

Remember writing should be fun! If your child is not in the mood, listen to her and do not push things because you may just end up risking it all.

Every child is unique in their own ways. Not everyone can fit in a cookie-cutter. Forcing a child to do something they are not comfortable with can only create more resistance. Approach a child in a positive manner while still considering their individual needs.

Jessica Millis, freelance writer, editor on EssayMama writing agency and educator at JMU writing courses. Find her on Twitter and Google+

You may also like

College and #Asperger’s

Using LEGOs to teach autistic students

Using Art and Creativity to Engage an Autistic Child in the Classroom

Life – the new educational curriculum

A Harvard graduate speaks: For inclusion to work education systems need to change

Monarch Center for Autism for Teens and Young Adults Helps Students Learn to Fly

For my son, his writing is exponentially improved by being in a quiet, visually non-stimulating environment… Thanks for the tips!

I posted this on my Pinterest account. Penmanship is important.

My son had other sensory issues that were not immediately recognized. He didn’t like having his fingernails trimmed because he didn’t want to feel the paper on his fingertips as he wrote. He also had a hard time tolerating writing with pencils–the lead dragging across the paper gave him the chills like fingernails on a chalkboard. This is extremely important to consider since many young children are given pencils to write with in the primary grades.

Thank you for that insight. How did you resolve the sensory issues and writing?

This article is ridiculous. To the author: Your child does not need to be “taught” how to write. They don’t need fun animal toys or squeezy adaptation devices. Your child has motor planning issues and possibly dyspraxia, not stupidity! Instead of treating him like an infant, give him a computer keyboard to type and let him be free to be himself. What is this obsession with handwriting?

Dear Henny, I think u have never worked with autistic kids. Please read to understand not to reply.

She is right….why are obsessed with making a child write when they hate it and it’s hard for them. Functionally in life as adults we barely sign our name these days! However if you can not operate a keyboard or electronic device to co.minicate you are basically not employable…not at the gas station, burger joint, or Walmart will you see employees writing but using electronic devices. In an office setting you must be able to communicate by email….let’s set them up for the future not the pasture!

In some places like ours the skill of properly handling a pencil is a requirement for children even with special needs to be included in schools.

Thanks Jessica for sharing this post. This helps parents like us to be equipped with info on how to assist our children in their needs. God bless!

I agree with deepak. Please be an outside of the box thinking. Autism is not a cookie cutter experience. Each autistic child, youth, or adult especially non verbal has their own unique challenges. Computers are great tools, there is also the over stimulation component, as well as ipads etc do not have the ability to take outside or to a store to partake in social components, which many autistic non verbal teens and adults want to to. They too want to be accepted. Sometimes it has to do with the the emotions within their environment and sensitivity to change.

I know Henny personally. She is deeply autistic — AND she is a teacher, who teaches autistic children every day.

Handwriting has been shown to have a range of benefits for children, so while assistive writing techniques of various kinds may be useful, why not also find effective, innovative ways to learn handwriting? And why be so MEAN, Henny? Someone wrote a heartfelt piece on handwriting struggles and tips and you call then “ridiculous”???

I agree with deepak. Please be an outside of the box thinking. Autism is not a cookie cutter experience. Each autistic child, youth, or adult especially non verbal has their own unique challenges. Sometimes it has to do with the the emotions within their environment and sensitivity to change

In the reality world, they don’t care how good hand writing you are. They only care how fast you type .Unless hand writing is beneficial for autistic sensor or something, I would not encourage them to do hand writing.

So my child can type and does some writing she fatigues easily, but is unable to express her feelings, thoughts, and expressions. When this is mentioned she totally shuts down. Any ideas school can’t figure it out. Thanks Cindy

I have an older autistic son. We saw the autism, but back in the day many doctors didn’t understand it and refused to. He reads wonderfully and can write. His spelling isn’t the best, unless he’s typing on a computer. The processing of thinking of how the letters are formed, how the word is spelled and putting them on paper is a greater task than just typing it out. However, he is very grateful today that he was given the chance and opportunity to learn how to write as it has been useful to him during certain times in life, especially when he has to sign his name too. These kids aren’t dumb at all. They’re very brilliant. They just need to be taught in different ways and we should never deny them the access to learning everything others are taught, including writing by hand!

I have found this article very enlightening. My 8 yr. old, moderate autistic, verbal granddaughter can read very well, but will not hold a pencil, marker or other writing instruments. She can type with two fingers, but is not a great speller. I think this may be worth a try, grateful for any suggestions that may help.

My grandson is struggling to hold the pen/pencil/crayon/texta. I am looking for any tips to encourage this as he starts prep next year and will struggle as the curriculum is difficult let alone having ASD. He loves books but doesn’t want anything to do with writing!

My son is 5+ and reading in an inclusive school. He has mild autism. He know the alphabet very well and his memory is very sharp. He always used to ask about the new thing like what is it…and he never forget the name of item/people….but the problem is that still he dont want to write…

Maybe he just has a hard time leaning a bit forward. You could try playing with him airplane, where you hold his body, he is facing the floor and you imitate an airplane while you help him “fly”. Kind of like a swing but facing down. Try this but if you see he is very uncomfortable, then try to fly him in a different position and very slowly after each day try to slowly get to the “facing down” position. This will help him in leaning forward while writing. Also, you could use colored paper but not yellow. Yellow and white background might irritate him….too contrasting. These could be reasons why he doesn’t want to try writing. They need constant praise even if things don’t go well. If he is trying even for a few seconds, praise him. Good luck and I hope these suggestions help a little.

hi am amira pls my son have problem with names of people like calling me mummy , instead he will just say i want to eat or i want to pee. please how do i get to learn how to call people by their names. thanks,

Hi Amira, My suggestion is: teach him with pictures, real pictures of people you want him to recognize. Facial recognition is hard for many atypical people. Ask him: who is this? And help him answer. Use the same pictures in the beginning, then use different ones with the same people to see if he can transition. Hope this help, good luck!

Thanks Claudia Torok

My 9 year old daughter is considered to be high functioning. Her reading skills are high. She loves to draw but still lacks the skills to write. I have tried the tag team method and had little success but after reading this I see where I may have gone wrong. I am going to try the shapes first then move to actual letters. Thanks for such great ideas.

An a Therapist, I work with a mild Autistic child. He can communicate his needs and also says No to things he don’t like, he can sound all the letters well and we have even improved in the aspect of blending three letter words. He can now read but my problem is, he hate to write. I have worked on his pincer grip and is very good. His letter formation are also my concern too. When is time to write on the schedule board. He will say “I don’t want to write, I hate writhing”. Please what other thing can I do to improve his writing skills.

My 7 year old grandson is in 2nd grade and we are in tears every night by the time he finishes his homework. On top of 2-4 work sheets, they send any worksheets home that he did not finish in school. Since school only started 2 weeks ago, we have not had his IEP meeting yet. I plan to insist that they implement a keyboard into his day instead of insisting he do all thie writing these worksheets require. He has always hated writing, coloring and painting because he gets scolded when he writes too big and messy. I do not understand why these special ed teachers aS WELL AS ALL OTHERS NOT BE MADE AWARE OF the struggles these kids have trying to write. If they are going to have inclusive classes they need to attend workshops in regards to autism and these kids wellbeing.

I think there are a lot of ways make learning effective but the most effective way is to make it fun. Learner will sometimes find the topic too boring that their brain might never grasp it or it will just be forgotten right away. So to make the learning stick to the mind of the learner is to make it fun and memorable. Appealing to the emotion makes it memorable. If the teacher could find a way to make this strategy works, then the learner will really learn a lot.

I saw nothing wrong with this article. It all made sense to me , coming from a parent of a child on the spectrum.

There are even more autism-friendly aids to Handwriting then you have mentioned in this piece. I wonder if you would like to take a look at these two, both offered by National Autism Resources:

https://www.nationalautismresources.com/trion-grips-set-of-4

https://www.nationalautismresources.com/search.php?search_query=Stage%20write&section=product

Comments are closed.

More Stories

Ashan Fernando, City of Toronto Councillor Ward 25, a Voice for the Disability and Mental Health Community

• Current Issue
• Back Issues
• Article Topics
• ASN Events Calendar
• 2023 Leadership Awards Reception
• Editorial Calendar
• Submit an Article
• Sign Up For E-Newsletter

Improving the Written Expression of Children with ASD

• By: Kristie Asaro-Saddler, PhD University at Albany
• January 1st, 2013
• children , students , writing
• 12810    1

Writing has become an increasingly important element across curricular areas. However, many young children, including children with autism spectrum disorders (ASD), struggle with this key literacy skill. While it has […]

Writing has become an increasingly important element across curricular areas. However, many young children, including children with autism spectrum disorders (ASD), struggle with this key literacy skill. While it has been well-documented that many children with ASD have handwriting deficits, difficulties in the writing process, including planning, content generation, and revising text, are also pervasive. Therefore, it is essential to examine the writing of children with ASD, determine how their characteristics impact their writing ability, and discuss how parents and teachers may foster improvement in writing outcomes.

Writing is a foundational skill that can support and extend student learning across the curriculum. It allows the sharing of opinions, the demonstration of critical thinking skills, and the display of content knowledge. Writing is critical for school success, as it is the primary means by which students demonstrate their knowledge in school, and the major instrument that teachers use to evaluate academic performance (Graham & Harris, 2005). Beyond school, students need to be able to write well to succeed in society and to obtain and maintain employment.

Writing presents a unique challenge, as it requires putting thoughts on paper in such a way as to transmit a message to another person who may not have knowledge of what you are writing. While developing these thoughts, writers must coordinate the processes of planning, text production, and revision, while also self-monitoring their work. In addition, they must consider the conventions of the language, and the constraints of the topic and the genre, along with the audience needs and perspectives.

  Why Writing is Difficult for Children with ASD

Deficits in writing have been well-documented in ASD research. In one study (Mayes & Calhoun, 2008), for example, 63% of students diagnosed with ASD also exhibited a writing disability. It can be difficult for these students to think of ideas, organize their writing, and physically write their ideas. So what is it that makes writing so difficult for children with ASD?

Children with ASD characteristically exhibit a range of impairments that make written expression difficult. Among these characteristics are:

• An inability to use imagination, engage in abstract thinking, consider perspectives of others, and imagine future events or possible scenarios (Harbinson & Alexander, 2009; Myles, 2005; Myles & Simpson, 2001). These characteristics can lead to a literal interpretation of a writing task and an inability to comprehend or use metaphors, idioms, or rhetorical questions, and may hinder the exploration of counter-arguments and various perspectives.
• Deficits in theory of mind, or the ability to take another’s perspective or believe that others think differently from you (McCoy, 2011), which makes it difficult for students with ASD to recognize that their work will be read by someone else with different views and opinions. This unawareness of an “absent audience” may result in writings that are not well-developed, or that lack elaboration.
• Weak central coherence, or a tendency to focus on small details, which can lead to an inability to understand context or see the “big picture,” causing difficulty with distinguishing important from unimportant details.
• Deficits in the areas of language and communication, which make compiling, expressing, and recording thoughts a challenge, resulting in a composition that lacks a clear, central focus, or that is poorly organized.
• Motor/coordination issues that can contribute to difficulty with handwriting and composing, resulting in brief writings that students are unwilling to revise or elaborate because it is physically “too difficult.”
• Deficits in several executive function components, including planning, cognitive flexibility, inhibition, and self-monitoring (Hill, 2004), which directly impact an individual’s ability to maintaining his/her focus on the process of developing a main idea and details to support the topic, and to encourage engagement and continuous motivation throughout the writing process.

How Can You Help?

  There are several steps that parents and teachers can take to help students with ASD improve their writing skills and allow them to be more successful in school and in their everyday functioning. Here are five simple tips that you can use to help increase the motivation and written performance of children with ASD:

Make the environment conducive to writing. The home or classroom environment can impact a child’s willingness to write. Be sure that the lighting and noise level are acceptable for your child, given his/her sensory needs. Surround the child in a print-rich environment by posting model letters, book reviews, and other types of writing around the home or classroom. Teachers and parents may also consider providing alternatives to the typical pencil and paper. Vary writing implements to include items such as markers, stamps, stickers and magnetic letters, and allow students to work in a comfortable setting for them, as long as it is appropriate for writing (i.e. has a flat surface).

Create an audience and purpose. Since deficits in theory of mind my impact children with ASD’s ability to write for an absent audience, it is helpful to create an audience for them. It is beneficial for students to know before beginning the writing process that there will be an authentic audience, besides just their parent or teacher, viewing their writing. Different genres of writing offer different options of potential audiences. For example, persuasive letters can be written to a principal, a parent, or the head of a company, whereas fictional stories can be written and shared with younger siblings or students in younger grades. Online blogs for people with ASD provide a natural context for writing, in addition to social and emotional support, and may be used by young adults with ASD and younger students who are supervised by parents or teachers.

Use interests and fascination . In school, students must eventually learn to write in response to a prompt their teacher gives them. However, in order to increase students’ motivation and fluency with writing, it may help to allow them to start writing about things in which they are interested. These are topics in which children usually have a desire to share information, along with a great deal of background knowledge. For example, a child with ASD who has an interest in digital cameras may write a “how-to” piece about how to take a picture with a digital camera, or a child with a fascination with trains may write a persuasive piece on why trains are a better method of transportation than cars.

Provide supports. Students with ASD may require various types of supports in the classroom or at home. Graphic organizers and semantic maps (visual tools designed to organize thoughts and represent relationships between them) may aid in the planning process (Sansoti, Powell-Smith & Cohan, 2010). Framed paragraphs, which are partially completed paragraphs with a number of blanks strategically placed for the student to fill in, may also be used to scaffold students’ writing (Kluth & Chandler-Olcott, 2008), along with word banks or drawings/pictures (Hillock, 2011) and story starters, which provide a statement to start the story, such as, “I went for a walk in the woods and I found…” that the student has to continue. Siblings or other students in the class can also act as a support for children with ASD through scribing (writing down what the student says aloud) or shared writing, where students take turns making a contribution to the written product. Peers can also help students with the revising process after their first drafts have been completed.

Use technology. Sometimes the physical act of writing makes it difficult for children with ASD to create written products. Allowing the students to use a keyboard or speech-to-text software may reduce the physical burden and allow students to express themselves in another way. Technology can also be used to help children organize their writing. Software programs such as Kidspiration® and Inspiration® and iPad apps such as Popplet™ for example, can be used in the planning stages to help students organize their thoughts before beginning to write.

While writing can be a challenge for many students with ASD, providing support may prove beneficial. The basic tips offered here can help increase students’ motivation to write, resulting in more frequent writing with less resistance, and ultimately, better written products.

Kristie Asaro-Saddler, PhD is Assistant Professor of Special Education at The University at Albany. For more information, please contact Dr. Asaro-Saddler at [email protected] or visit www.albany.edu/special_education .

Graham, S., & Harris, K. R. (2005). Writing better: Teaching writing processes and self-regulation to students with learning problems . Baltimore, MD: Brookes.

Harbinson, H., & Alexander, J. (2009). Asperger Syndrome and the English curriculum: Addressing the challenges. Support for Learning, 24 , 10-17.

Hill, E. L. (2004). Evaluating the theory of executive dysfunction in autism. Developmental Review, 24 , 189-233.

Hillock, J. (2011). Written expression: Why is it difficult and what can be done? In K. McCoy (Ed). Autism from the teacher’s perspective . Denver: Love Publishing Company.

Kluth, P., & Chandler-Olcott, K. (2008). A land we can share . Baltimore: Paul H. Brooks Publishing.

Mayes, S., & Calhoun, S. L. (2008). WISC-IV and WIAT-II profiles in children with high functioning autism. Journal of Autism and Developmental Disorders, 38 , 428–439.

McCoy, K. M. (2011). Autism from the teacher’s perspective: Strategies for classroom instruction. Denver: Love Publishing Co.

Myles, B. S. (2005). Children and youth with Asperger syndrome . Thousand Oaks, CA: Corwin Press.

Myles, B. S., & Simpson, R. L. (2001) Effective practices for students with Asperger Syndrome. Focus on Exceptional Children, 34 , 1-14.

Sansoti, F., Powell-Smith, K., & Cohan, R. (2010). High-functioning Autism/Asperger syndrome in schools: Assessment and intervention . New York: Guilford Press

Related Articles

The power of sensory integration: enhancing communication for non-speaking individuals.

Communication is complex and extends beyond verbal expression. This is especially important to understand in non-speaking individuals. Non-verbal cues such as facial expression, body language, and sensory experiences play crucial […]

Rights and Challenges for Autistic People with Communication Disabilities in the Legal System

Police should be the last resort…. I shouldn’t have to call the police if my son is having a meltdown. When I get up in the morning, I say, “Thank […]

Enhancing Communication and Accessibility: Assistive Technology for Individuals with Autism

What do a wheelchair, closed captioning on a television screen, and a visual schedule all have in common? They are part of an extensive list of products or services that […]

How to Advocate for Your Nonspeaking or Minimally Verbal Child or Adult

Over the last decade, there has been an increase in autistic self-advocates coming into the public eye through their incredible means to advocate for themselves – and others like them. […]

Language Development and Communication for Nonverbal Autistic Children

Autism spectrum disorder is one that has a broad range of symptoms, but many with its diagnosis have similar “core” symptoms. Difficulties with language and communication is a shared struggle […]

Have a Question?

One response.

[…] https://www.autismspectrumnews.org/improving-the-written-expression-of-children-with-asd/ […]

Have a Comment?

You can use these tags: <a href="" title=""> <abbr title=""> <acronym title=""> <b> <blockquote cite=""> <cite> <code> <del datetime=""> <em> <i> <q cite=""> <s> <strike> <strong>

Individuals, Families, and Service Providers

View our extensive library of over 1,500 articles for vital autism education, information, support, advocacy, and quality resources

Reach an Engaged Autism Readership Over the past year, the ASN website has had 550,000 pageviews and 400,000 unique readers. ASN has over 55,000 social media followers

View the Current Issue

ASN Winter 2024 Issue "Understanding and Accommodating Varying Sensory Profiles"

What is autism spectrum disorder? How to support the community this Autism Acceptance Month

April marks Autism Acceptance Month with World Autism Day occurring on April 2 every year. The month is meant to be a time for uplifting autistic voices and sharing in the community's joy. But for Samantha Edwards, an autistic content creator and neurodivergent life coach, the month also signifies an influx of harmful myths about autistic people. 

"April is a wonderful month to crack down on that and listen to autistic voices and their stories and listen to their struggles," she says. "Acceptance, at the end of the day, is going to promote more inclusivity."

Here’s how you can uplift the neurodivergent community this April and all year long.

​​​What is autism? 

Autism is a developmental disability that affects the way people experience the world . This may include differences in processing senses, thinking, physically moving, communicating, socializing and going about daily living. 

“We’re born autistic and we’re autistic our whole lives,” says Zoe Gross, the director of advocacy at Autistic Self Advocacy Network . “It affects everything about the way we interact with and perceive the world.”

Autism affects every autistic person differently, and there isn’t one way to be autistic. Gross describes it as an ice cream sundae bar: The traits of autism can be mixed and matched from person to person. 

Here’s what autism isn’t, Gross says – something to be scared of or pity.

“In truth, autism is just a neutral fact about us, it’s not necessarily a good or a bad thing,” she says. “It’s just the way our brains are.”

Another misconception is that autistic people don’t have empathy. Gross recalled a time when a teacher asked her if she loved her parents. Of course she loves them, she responded, but the question itself was a symptom of a larger myth about autistic people and emotions. 

“Where that comes from is that we may not know what other people are feeling if they don’t tell us because autistic people may not be good at reading body language or other kinds of subtle social cues,” Gross says. “But that doesn’t mean we don’t care what people are feeling.”

World Autism Day: A love letter to parents of a newly-diagnosed child

How common is autism? 

About one in 36 children have autism spectrum disorder, the Centers for Disease Control and Prevention states. This number is on the rise, especially as children of color receive more diagnoses after being largely overlooked throughout history. 

Edwards started her online autism advocacy journey to combat the misconceptions about autism. As an autistic person and a parent of two autistic children, she says she wants to make the world a more accessible place for future generations. 

A large part of her work is advocating for the self-diagnosed community, which she says “are very welcome and included in the autistic community.”

One of the more harmful narratives is that people, especially teenagers, are self-diagnosing after watching a handful of TikTok videos with captions like “Signs you may be autistic” or “10 things that are actually traits of autism.” But that’s “really not the case,” says Edwards. Online platforms like TikTok give the autistic community, like other marginalized communities, more visibility than ever before. 

“It is harmful for all of these self-diagnosed autistics that really did put in the research – some have years, even a lifetime of research – to be told, ‘Oh, you watched a couple TikTok videos so you’re not valid,'” Edwards says. 

Some medical professionals push back against self-diagnosing, especially when it comes to social media. But there’s also the nuanced issue of access to healthcare services that may lead to a professional diagnosis, which can be limited for some autistic individuals . 

What is Autism Acceptance Month?

April is Autism Acceptance Month but many, especially those outside of the autism community, used to refer to the month as " Autism Awareness Month." Autistic advocacy organizations have been using “acceptance” rather than “awareness” for over a decade, and the Autism Society of America shifted the terminology in 2021.

According to ASAN, Autism Acceptance Month was created by and for autistic people to respect the rights and humanity of all autistic people and center “the perspectives and needs of autistic people with intellectual disabilities, nonspeaking autistic people, and autistic people with the highest support needs.”

Using “acceptance” instead of “awareness” is an intentional choice because, as Edwards says, “we’re just moving on.”

“It’s 2023, I do believe most people are aware of what autism is,” she says. “We’ve got the awareness and now we need the resources, we need the advocacy.”

Awareness campaigns have historically focused on how many people have autism or a search for a “cure.” A now-removed  2009 campaign  from advocacy organization Autism Speaks opened by saying “I am autism. I’m visible in your children, but if I can help it, I am invisible to you until it’s too late.”

The “awareness” approach, Gross says, further stigmatizes autism as something scary.

“That’s not the way we want to approach giving people information about autism, we want people to view autism as a part of human diversity and autistic people as part of their community,” Gross says. 

How to support the autistic community

Don’t speak over autistic voices

“ Nothing about us without us ” is a disability rights slogan that’s top of mind during Autism Acceptance Month. 

When it comes to research, policy and advocacy, the most important thing is that autistic people are “in the driver’s seat,” Gross says. It means that decisions about autism need to be made by or with autistic people. It also means centering the stories and experiences of autistic people.

Avoid harmful labels and language

“Low-functioning” and “high-functioning” are labels often ascribed to autistic people. These are harmful ,  ASAN says, because “we all have things we are good at and things we need help with.”

“People will say, ‘How can I do without the terms low-functioning and high-functioning?’ And what I want to ask is like ‘What are you doing with them now?’” Gross says. “What I encourage people to do is just say what they mean. If they mean this person can’t speak, (say) ‘I’m talking about someone who can’t speak.’ If they mean this person has a job, just say ‘I’m talking about an autistic person who has a job.’”

Neurotypical people may also wonder what’s more appropriate to say – person with autism or autistic person? 

Many self-advocates prefer identity first language  because it works against the stigma that being autistic is something bad or something that makes you less than. Identity first language (“autistic person”) recognizes and validates that identity. 

“Autism is something that you are and not something that you have, you’re not carrying autism around in a bag,” Edwards says. “It’s something that makes your brain different.” 

But it’s a personal preference . For example, Gross says people with intellectual disabilities may use person-first language ("person with autism") because “they feel they’ve been so dehumanized and people only see their disability and don’t see them.” 

The bottom line: How someone refers to their autism is personal based on what makes them feel the most affirmed and validated.  

Support autistic-run organizations and businesses

Edwards recommends supporting organizations that center autistic voices and are run by autistic people, like ASAN and the Autistic Women and Nonbinary Network.

This month, Edwards says she’ll be using her platform to uplift other autistic and disabled creators.

“There’s so many of us that are … trying to make a really big difference in this movement, so I’m really proud of everyone this past year,” she says. “I just want to uplift each other and get the right message out.”

Organizations with primarily neurotypical leadership have led autistic advocates to move away from their symbols  (like Autism Speaks’ signature blue color and puzzle piece) in favor of new ones created by autistic self-advocates. The first puzzle piece logo in 1963 featured a crying child in the center and was designed to show autism as a “puzzling condition.” A 2018 study found the general public has a negative implicit bias against the imagery of a puzzle piece, which participants associated with “imperfection, incompletion, uncertainty, difficulty, the state of being unsolved, and, most poignantly, being missing.”

“We recognize discord within the community, including those who dislike the puzzle piece symbol or prefer a different symbol, but there are also many who embrace it and want to continue to see it associated with autism,” Autism Speaks told USA TODAY in a statement.

The organization says it is regularly seeking feedback from those within the autistic community on whether or not to continue its use and encouraged feedback at [email protected] .

Many favor a rainbow or gold infinity symbol and use “ Red Instead ,” which Edwards says symbolizes the passion autistic people have. 

Don’t perpetuate myths about autism 

Edwards recommends neurotypical people support the neurodiverse community by staying up to date on  current research  and taking a second glance before sharing something that furthers stereotypes about autistic people. 

“We all deserve our human rights, and we all deserve respect,” Gross says. “We all deserve to be able to make choices in our lives, we deserve to live free from neglect and abuse, we deserve to have services that are truly person-centered and individualized for us and that meet our needs. Those aren’t optional, fancy things that you get by being mildly impacted.”

Online Collection

• Explore By...
• Museum Locations
• Plan Your Visit
• Directions & Parking
• Food, Drink, & Shop
• Free Admission
• Accessibility
• Visitor Promise
• Virtual Museum
• Exhibitions & Installations
• Programs & Events
• Collections
• Support the Walters
• Corporate Partnerships
• Institutional Funders
• Evening at the Walters
• Mission & Vision
• Strategic Plan
• Land Acknowledgment

Creative Commons Zero

• arrow_forward_ios

This is a mass-produced replica of a famous miracle-working icon of the Virgin and Child, brought to Russia from Byzatium in the 12th century, known as the "Virgin of Vladimir", and currently kept in Moscow (State Tretyakov Gallery). The Virgin and Child are each identified by abbreviated inscriptions.

Provenance Provenance (from the French provenir , 'to come from/forth') is the chronology of the ownership, custody, or location of a historical object.

Henry Walters, Baltimore [date of acquisition unknown], by purchase; Walters Art Museum, 1931, by bequest.

• social-item

Geographies

Measurements.

H: 1 15/16 x W: 1 13/16 in. (5 x 4.6 cm)

Credit Line

Acquired by Henry Walters

Location in Museum

Not on view

Accession Number In libraries, galleries, museums, and archives, an accession number is a unique identifier assigned to each object in the collection.

Do you have additional information.

Notify the curator

Tooltip description to define this term for visitors to the website.

• Photography
• Film + Video
• Culture + Lifestyle
• Exhibits + Events
• Prescriptions
• Photographers
• Designers/Architects
• Organizations/Mags
• Museums/Galleries
• ANNOUNCEMENTS
• COLLECTIONS
• EXHIBITIONS
• 30/30 WOMEN
• CONTRIBUTORS
• SUBMISSIONS
• 30/30 WOMEN PHOTOGRAPHERS

I was born and raised in a working-class city, Elektrostal, Moscow region. I received a higher education in television in Moscow. I studied to be a documentary photographer. My vision of the aesthetics of the frame was significantly influenced by the aesthetics of my city – the endless forests and swamps of the Moscow region with endless factories, typical architecture and a meagre color palette. In this harsh world, people live and work, raise children, grow geranium, throw parties and live trouble, run a ski cross. They are the main characters of my photo projects.

I study a person in a variety of circumstances. We blog with friends with stories of such people. We are citizen journalists. In my works, I touch upon the topics of homelessness, people’s attitude to their bodies, sexual objectification, women’s work, alienation and living conditions of different people. The opportunity to communicate with my characters gives me a sense of belonging and modernity of life.

My photos create the effect of presence, invisible observation of people. I don’t interfere with what’s going on, I’m taking the place of an outside observer. I’m a participant in exhibitions in Rome (Loosenart Gallery), Collaborated with the Russian Geographical Community.

30 Under 30 Women Photographers 2021

• --> --> Thailand Biennale 2023 / The Open World Dec 9, 2023 – Apr 30, 2024 Thailand Biennale Mueang Chiang Rai, Thailand The first edition of Thailand Biennale was initiated by the Office of Contemporary Art and Culture, Thailand’s Ministry of Culture in Krabi in 2018, followed by Korat in 2021. By alternating the locations from various provinces throughout the country, the spirit of the Thailand Biennale decentralizes artistic activities (more…) Show Post >
• --> --> Tarek Lakhrissi: BLISS Feb 10 – May 20, 2024 Migros Museum für Gegenwartskunst Zurich, Switzerland In his solo exhibition BLISS , Tarek Lakhrissi invites the audience on a journey: in a stage-like setting, visitors become protagonists in search of dreamy moments in the midst of chaos. Over the course of three acts, they encounter immersive installations, an enchanting film work and larger-than-life sculptures. (more…) Show Post >
• --> --> Tina Berning ARTIST / ILLUSTRATOR Featured Profile Tina Berning (b. 1969 / Braunschweig, Germany) is a Berlin based artist and illustrator. After working as a graphic designer for several years, she began to focus on drawing and Illustration. (more…) Show Post > See Full Profile >
• --> --> Anish Kapoor: Unseen Apr 11 – Oct 20, 2024 ARKEN Ishøj, Denmark Anish Kapoor’s monumental sculptures and installations speak directly to our senses and emotions. Through his unique eye for materials, shapes, colours and surfaces we are drawn into and seduced by his artwork, which turns the world upside down – often quite literally. Kapoor has been shown in the largest exhibition venues in the world, and he has also created several significant pieces for public spaces. (more…) Show Post >
• --> --> Pia Arke: Silences and Stories Feb 10 – May 11, 2024 John Hansard Gallery Southampton, UK In February 2024, John Hansard Gallery, in collaboration with KW Institute for Contemporary Art , Berlin, presents the first major survey of Danish-Greenlandic artist Pia Arke (1958–2007) to be shown outside of Kalaallit Nunaat (Greenland), and the Nordic countries. Seldom exhibited outside the Scandinavian context, this exhibition of Arke’s work is both timely and long overdue. (more…) Show Post >
• --> --> Jalan & Jibril Durimel Photographers Featured Profile Twin brothers Jalan & Jibril Durimel draw inspiration through their diversified upbringing between the French Antilles and the US. Born in Paris to parents from the island of Guadeloupe, at the age of 4 they moved to Miami where they first immersed themselves in American culture. (more…) Show Post > See Full Profile >
• --> --> Boris Mikhailov Photographer Featured Profile Ukrainian born Boris Mikhailov is one of the leading photographers from the former Soviet Union. For over 30 years, he has explored the position of the individual within the historical mechanisms of public ideology, touching on such subjects as Ukraine under Soviet rule (more…) Show Post > See Full Profile >
• --> --> Maria Sturm: You Don’t Look Native to Me Publication Void International In 2011, Maria Sturm began to photograph the lives of young people from the Lumbee Tribe around Pembroke, Robeson County, North Carolina. Through the process of documenting their lives, Sturm began to question her own understanding of what it means to be Native American. Her new book You Don’t Look Native to Me combines photographs with interviews and texts to preconceptions and show Native identity not as fixed, but evolving and redefining itself with each generation. (more…) Show Post >
• --> --> 30 Under 30 Women Photographers / 2024 Selections Announced Artpil International Artpil proudly announces for its 15th Edition the selection of  30 Under 30 Women Photographers  /  2024 . Founded in 2010, this annual selection has helped emerging, mid-career, as well as some accomplished women photographers to gain further exposure and participate in the collective among peers. (more…) Show Post > See Full Article >

• photography
• film + video
• culture + lifestyle
• exhibits + events
• prescriptions
• photographers
• designers/architects
• organizations/mags
• museums/galleries

Turn Your Curiosity Into Discovery

Latest facts.

The Best AI Photo Editor of 2024 A Comprehensive Review

6 Facts You Didnt Know About Ecommerce Call Center Outsourcing

40 facts about elektrostal.

Written by Lanette Mayes

Modified & Updated: 02 Mar 2024

Reviewed by Jessica Corbett

Elektrostal is a vibrant city located in the Moscow Oblast region of Russia. With a rich history, stunning architecture, and a thriving community, Elektrostal is a city that has much to offer. Whether you are a history buff, nature enthusiast, or simply curious about different cultures, Elektrostal is sure to captivate you.

This article will provide you with 40 fascinating facts about Elektrostal, giving you a better understanding of why this city is worth exploring. From its origins as an industrial hub to its modern-day charm, we will delve into the various aspects that make Elektrostal a unique and must-visit destination.

So, join us as we uncover the hidden treasures of Elektrostal and discover what makes this city a true gem in the heart of Russia.

Key Takeaways:

• Elektrostal, known as the “Motor City of Russia,” is a vibrant and growing city with a rich industrial history, offering diverse cultural experiences and a strong commitment to environmental sustainability.
• With its convenient location near Moscow, Elektrostal provides a picturesque landscape, vibrant nightlife, and a range of recreational activities, making it an ideal destination for residents and visitors alike.

Known as the “Motor City of Russia.”

Elektrostal, a city located in the Moscow Oblast region of Russia, earned the nickname “Motor City” due to its significant involvement in the automotive industry.

Home to the Elektrostal Metallurgical Plant.

Elektrostal is renowned for its metallurgical plant, which has been producing high-quality steel and alloys since its establishment in 1916.

Boasts a rich industrial heritage.

Elektrostal has a long history of industrial development, contributing to the growth and progress of the region.

Founded in 1916.

The city of Elektrostal was founded in 1916 as a result of the construction of the Elektrostal Metallurgical Plant.

Located approximately 50 kilometers east of Moscow.

Elektrostal is situated in close proximity to the Russian capital, making it easily accessible for both residents and visitors.

Known for its vibrant cultural scene.

Elektrostal is home to several cultural institutions, including museums, theaters, and art galleries that showcase the city’s rich artistic heritage.

A popular destination for nature lovers.

Surrounded by picturesque landscapes and forests, Elektrostal offers ample opportunities for outdoor activities such as hiking, camping, and birdwatching.

Hosts the annual Elektrostal City Day celebrations.

Every year, Elektrostal organizes festive events and activities to celebrate its founding, bringing together residents and visitors in a spirit of unity and joy.

Has a population of approximately 160,000 people.

Elektrostal is home to a diverse and vibrant community of around 160,000 residents, contributing to its dynamic atmosphere.

Boasts excellent education facilities.

The city is known for its well-established educational institutions, providing quality education to students of all ages.

A center for scientific research and innovation.

Elektrostal serves as an important hub for scientific research, particularly in the fields of metallurgy, materials science, and engineering.

Surrounded by picturesque lakes.

The city is blessed with numerous beautiful lakes, offering scenic views and recreational opportunities for locals and visitors alike.

Well-connected transportation system.

Elektrostal benefits from an efficient transportation network, including highways, railways, and public transportation options, ensuring convenient travel within and beyond the city.

Famous for its traditional Russian cuisine.

Food enthusiasts can indulge in authentic Russian dishes at numerous restaurants and cafes scattered throughout Elektrostal.

Home to notable architectural landmarks.

Elektrostal boasts impressive architecture, including the Church of the Transfiguration of the Lord and the Elektrostal Palace of Culture.

Offers a wide range of recreational facilities.

Residents and visitors can enjoy various recreational activities, such as sports complexes, swimming pools, and fitness centers, enhancing the overall quality of life.

Provides a high standard of healthcare.

Elektrostal is equipped with modern medical facilities, ensuring residents have access to quality healthcare services.

Home to the Elektrostal History Museum.

The Elektrostal History Museum showcases the city’s fascinating past through exhibitions and displays.

A hub for sports enthusiasts.

Elektrostal is passionate about sports, with numerous stadiums, arenas, and sports clubs offering opportunities for athletes and spectators.

Celebrates diverse cultural festivals.

Throughout the year, Elektrostal hosts a variety of cultural festivals, celebrating different ethnicities, traditions, and art forms.

Electric power played a significant role in its early development.

Elektrostal owes its name and initial growth to the establishment of electric power stations and the utilization of electricity in the industrial sector.

Boasts a thriving economy.

The city’s strong industrial base, coupled with its strategic location near Moscow, has contributed to Elektrostal’s prosperous economic status.

Houses the Elektrostal Drama Theater.

The Elektrostal Drama Theater is a cultural centerpiece, attracting theater enthusiasts from far and wide.

Popular destination for winter sports.

Elektrostal’s proximity to ski resorts and winter sport facilities makes it a favorite destination for skiing, snowboarding, and other winter activities.

Promotes environmental sustainability.

Elektrostal prioritizes environmental protection and sustainability, implementing initiatives to reduce pollution and preserve natural resources.

Home to renowned educational institutions.

Elektrostal is known for its prestigious schools and universities, offering a wide range of academic programs to students.

Committed to cultural preservation.

The city values its cultural heritage and takes active steps to preserve and promote traditional customs, crafts, and arts.

Hosts an annual International Film Festival.

The Elektrostal International Film Festival attracts filmmakers and cinema enthusiasts from around the world, showcasing a diverse range of films.

Encourages entrepreneurship and innovation.

Elektrostal supports aspiring entrepreneurs and fosters a culture of innovation, providing opportunities for startups and business development.

Offers a range of housing options.

Elektrostal provides diverse housing options, including apartments, houses, and residential complexes, catering to different lifestyles and budgets.

Home to notable sports teams.

Elektrostal is proud of its sports legacy, with several successful sports teams competing at regional and national levels.

Boasts a vibrant nightlife scene.

Residents and visitors can enjoy a lively nightlife in Elektrostal, with numerous bars, clubs, and entertainment venues.

Promotes cultural exchange and international relations.

Elektrostal actively engages in international partnerships, cultural exchanges, and diplomatic collaborations to foster global connections.

Surrounded by beautiful nature reserves.

Nearby nature reserves, such as the Barybino Forest and Luchinskoye Lake, offer opportunities for nature enthusiasts to explore and appreciate the region’s biodiversity.

Commemorates historical events.

The city pays tribute to significant historical events through memorials, monuments, and exhibitions, ensuring the preservation of collective memory.

Promotes sports and youth development.

Elektrostal invests in sports infrastructure and programs to encourage youth participation, health, and physical fitness.

Hosts annual cultural and artistic festivals.

Throughout the year, Elektrostal celebrates its cultural diversity through festivals dedicated to music, dance, art, and theater.

Provides a picturesque landscape for photography enthusiasts.

The city’s scenic beauty, architectural landmarks, and natural surroundings make it a paradise for photographers.

Connects to Moscow via a direct train line.

The convenient train connection between Elektrostal and Moscow makes commuting between the two cities effortless.

A city with a bright future.

Elektrostal continues to grow and develop, aiming to become a model city in terms of infrastructure, sustainability, and quality of life for its residents.

In conclusion, Elektrostal is a fascinating city with a rich history and a vibrant present. From its origins as a center of steel production to its modern-day status as a hub for education and industry, Elektrostal has plenty to offer both residents and visitors. With its beautiful parks, cultural attractions, and proximity to Moscow, there is no shortage of things to see and do in this dynamic city. Whether you’re interested in exploring its historical landmarks, enjoying outdoor activities, or immersing yourself in the local culture, Elektrostal has something for everyone. So, next time you find yourself in the Moscow region, don’t miss the opportunity to discover the hidden gems of Elektrostal.

Q: What is the population of Elektrostal?

A: As of the latest data, the population of Elektrostal is approximately XXXX.

Q: How far is Elektrostal from Moscow?

A: Elektrostal is located approximately XX kilometers away from Moscow.

Q: Are there any famous landmarks in Elektrostal?

A: Yes, Elektrostal is home to several notable landmarks, including XXXX and XXXX.

Q: What industries are prominent in Elektrostal?

A: Elektrostal is known for its steel production industry and is also a center for engineering and manufacturing.

Q: Are there any universities or educational institutions in Elektrostal?

A: Yes, Elektrostal is home to XXXX University and several other educational institutions.

Q: What are some popular outdoor activities in Elektrostal?

A: Elektrostal offers several outdoor activities, such as hiking, cycling, and picnicking in its beautiful parks.

Q: Is Elektrostal well-connected in terms of transportation?

A: Yes, Elektrostal has good transportation links, including trains and buses, making it easily accessible from nearby cities.

Q: Are there any annual events or festivals in Elektrostal?

A: Yes, Elektrostal hosts various events and festivals throughout the year, including XXXX and XXXX.

Was this page helpful?

Our commitment to delivering trustworthy and engaging content is at the heart of what we do. Each fact on our site is contributed by real users like you, bringing a wealth of diverse insights and information. To ensure the highest standards of accuracy and reliability, our dedicated editors meticulously review each submission. This process guarantees that the facts we share are not only fascinating but also credible. Trust in our commitment to quality and authenticity as you explore and learn with us.

Share this Fact:

Nursing Care of Autistic Children Essay

Being at the forefront of patient care, nurses are the ones who arrange the most comfortable conditions for individuals’ stay in the hospitals, as well as carry out the necessary procedures for speeding up patients’ recovery. Lately, more and more children are diagnosed with autistic spectrum disorder (ASD), which necessitates the nursing personnel to be able to cater to such patients’ special needs when they are hospitalized for various reasons. Research indicates that clinicians’ preparedness to care for ASD children is not sufficient (Lucarelli et al., 2018). One of the most viable reasons for this is the missing or inadequate emphasis on nursing care of ASD patients in nursing universities’ and colleges’ programs.

The Academic Setting Observed

The academic setting observed for this clinical practice experience was Western University. The university was founded at the beginning of the 1900s and has continually increased the diversity and quality of its educational programs ever since. The educational institution has a substantial alumni foundation with the help of which numerous initiatives and programs are promoted. Of particular interest for this clinical practice experience (CPE) was the College of Nursing, which is the largest program at Western University. Initially, the College of Nursing offered a BSN program in 1960, adding the MSN program in 1975 and the DNP – in 2009. The patient-centered BSN program is aimed at providing students with the necessary knowledge and skills for them to be able to practice in all areas of professional nursing.

The faculty at Western University is comprised of 36 members, 15 of them working full-time, 2 – part-time, and 19 – in adjunct positions. The average age of full-time educators is 55, with only three of them being under the age of 40. As a result, it is quite complicated to promote curriculum changes since disagreements often arise in the process. The faculty member who is willing to introduce an innovative approach must work hard to substantiate the need for change and obtain colleagues’ approval.

The Curriculum Gap Identified

In reviewing the syllabi for the BSN program, a need-gap analysis was carried out, as a result of which a curriculum gap was found. Specifically, in Psych-Mental Health Nursing I, the curriculum did not include a module on nursing care for autistic children. Since this disorder is highly prevalent, and patients identified with it require specific attention, it is recommended to include a module ‘Nursing Care of the Autistic Child’ in the curriculum.

The Proposed Course

According to the data provided by the Autism and Developmental Disabilities Monitoring (ADDM) Network of the Centers for Disease Control and Prevention (CDC, 2020a), every 54 th child in the USA has been identified with ASD. Such a high prevalence indicates an additional need for pediatric nurses to be trained in identifying children’s likelihood of having ASD in order to be able to help such patients in clinical settings. However, the lack of inclusion of the ASD topic in the nursing curriculum prevents future specialists from obtaining in-depth knowledge of ASD and, as a result, leads to complications occurring in communication and treatment. Therefore, the addition of the module on Nursing Care of the Autistic Child to the curriculum will benefit students as well as will be an overall asset of the program.

The Purpose of the Curriculum Proposal Document and Its Structure

As mentioned previously, the purpose of the proposal is to fill in the gap within the Psych-Mental Health Nursing I course by including the Nursing Care of the Autistic Child module. The rationale behind the suggested change is to make sure that nursing students are qualified for handling patients with ASD when they latter are admitted to a hospital. The proposal intends to increase future nurses’ knowledge of autistic children’s behavioral patterns and the most typical challenges in working with them. The document is structured in the following way: a review of the literature and a summary of findings, the application of the ADDIE model, and the proposal analysis, design, and development phases.

Literature Review

The importance of literature review.

Please refer to Table 1: Literature Review Summary.

The review of literature is a highly important element of research on any topic since it allows for synthesis and analysis of what has previously been done on the issue in question. Whereas in writing research papers, the use of recent studies is usually required, a literature review is not so strict concerning the publication date range. It is so due to the fact that by reviewing scholarly papers with a wider range of publication dates, one can trace the development of the question of interest. At the same time, if no changes can be noticed within a ten-year period, the need for change will be even more evident.

The search engines utilized included PubMed, Cochrane, CINAHL, ERIC, APA PsycInfo, and Google Scholar. Keywords and phrases used were autism , autism spectrum disorder , ASD , nursing education , nursing curriculum , and pediatric nurses . Only peer-reviewed articles were selected for the purpose of a literature review. The research was further refined by setting a ten-year publication date range. Although the present proposal focuses on an American-based College of Nursing, several studies selected for the analysis included findings from different geographic locations. The findings of the articles that were most suitable for the proposal’s topic were reflected in the Literature Review Summary Table.

The Curriculum Gap Observed

The curriculum gap observed in reviewed research articles concerned nurses’ knowledge of ASD and their ability to provide care for pediatric patients admitted to a hospital. As is evident from the articles, the majority of pediatric nurses experience barriers in the way of communicating with and looking after autistic patients. Potential causes of the curriculum gap are largely connected with the faculty’s composition. As it has been mentioned, the majority of full-time professors are in their fifties or sixties. At this age, it is difficult for individuals to agree to changes. Additionally, since these faculty members received their education several daces ago when no sufficient information or statistical data on ASD was available.

At the same time, many of the students feel the gap in their preparation on a daily basis. Taking into consideration this fact, the faculty should review their position on change and allow the inclusion of the suggested course in the curriculum. Since the faculty member suggesting change is the one responsible for its implementation, it is crucial to collect the most exhaustive data to show the faculty how negatively the gap influences both the nursing students and their patients. Literature Review Summary Table, thus, serves as a tool for shedding light on the problem of ASD missing from the curriculum.

Summary of Findings

The review of literature has shown that the topic of ASD is underrepresented in nursing students’ curricula, which causes difficulties both for learners and practitioners. Along with that, the analysis of scholarly sources indicates that ASD is a prevalent condition among children not only in the USA but also in other countries. All of the studies under scrutiny argued in favor of allocating more time for preparing future nurses to provide care for children with ASD. The themes identified in the reviewed articles may be grouped under three main directions: the effect of the curriculum on students, the preparation of the faculty to teach students about autistic patients, and the knowledge of practicing nurses about autism.

Theme 1: The Effect of the Curriculum on Students and Their Knowledge of ASD

The first common theme identified in the scholarly articles is that the curriculum poses challenges for future nurses due to the insufficient time allocated to studying autism. Iannuzzi et al. (2019) note that students’ insufficient level of preparation to work with autistic individuals is the main reason for their low self-efficacy levels upon starting their practice. Research by Giarelli et al. (2011) indicated that there is a lack of formal nurse preparation for taking care of patients with ASD. Major et al. (2013) remarked that those nursing students who are beginning their professional journey immediately notice a gap in their preparation concerning autistic patients. An extensive review of the content and clinical experiences in undergraduate pediatric nursing education carried out by McCarthy and Wyatt (2014) has shown that more than half of educational programs for nurses contain only two hours or less on several crucial topics, including pediatric genetics. Since autism belongs to this category, it is evident that nursing students, including those from Western University’s College of Nursing, cannot gain a sufficient level of knowledge in the conditions of the current curriculum content.

Theme 2: The Preparation of the Faculty to Teaching Students about Autistic Patients

Another highly important topic that emerged during the review of literature is the educators’ preparation for teaching nursing students about autism. A study by Gardner et al. (2016) indicates that there is a range of problems faced by nurse educators in the way of teaching students about ASD. Specifically, the faculty reported such obstacles as limited knowledge about ASD in their educational preparation, as well as a low level of knowledge about developmental disorders. Other challenges recalled by nursing educators include a low self-reported efficacy in caring for autistic patients, little to no experience of working with such patients, and poor knowledge of communication, behavioral, and safety elements of ASD care (Gardner et al., 2016; McCarthy & Wyatt, 2014). Scholars remark that an insufficient level of experience and expertise among the faculty leads to negative outcomes for nursing students and, consequently, their patients.

Furthermore, as Garg et al. (2015) emphasize, healthcare specialists, providing care to ASD children require not only thorough preparation but also continuous education with the aim of enhancing their knowledge in accordance with the emerging trends and developments. In the reviewed articles, different suggestions were made concerning the opportunities of boosting educators’ knowledge and improving their disposition toward ASD patients (Gardner et al., 2016; McCarthy & Wyatt, 2014). However, one thing uniting all studies was that ASD should be included in the curriculum since such inclusion has the potential to help the faculty overcome numerous challenges and provide students with the best preparation for working with ASD children.

Theme 3: The Knowledge of Practicing Nurses about Autism

Finally, practicing nurses’ knowledge about autism is a crucial topic to discuss as today’s nurses are yesterday’s students, and their experience can affect the development of the curriculum in nursing colleges. Several of the reviewed studies contained information on the insufficient level of knowledge and practical skills about autism among practicing nurses (Brown & Elder, 2014; Giarelli et al., 2011; Igwe et al., 2011; Sampson & Sandra, 2018). In each of these instances, researchers emphasized the connection between poor knowledge and a gap in the curriculum. Sampson and Sandra (2018) have found that psychiatric nurses are more knowledgeable about ASD than pediatric nurses. However, these and other scholars report that overall, the level of nurses’ knowledge about autism and the ways of treating autistic patients is quite low (Igwe et al., 2011; Sampson & Sandra, 2018). Researchers emphasize that the better knowledge nurses have, the easier it is for them to identify autism in patients and to provide care for those who have already been diagnosed with this disorder.

Two of the reviewed articles contained specific pieces of advice for nurses as to how to handle pediatric patients with ASD. The most important aspect of providing ASD patients with high-quality care is the nurse’s ability to understand the diagnosis. Other crucial helpful factors, as identified by the author, include the collaboration with patients’ families and encouraging them to stay in the hospital upon admission, arrangement of a safe environment, making sure that the autistic child has consistent caregivers, and identifying the child’s emotional disturbances in order to find ways of mitigating them. Finally, researchers emphasize the utmost significance of proper communication in the process of caring for autistic children (Brown & Elder, 2014). Autistic children require special care and approaches, so teaching nurses about communication is vital for increasing changes to a successful hospital stay.

Conclusion of the Literature Review

All of the aspects identified in the process of reviewing literature require thorough preparation in the process of education, which the majority of nursing students lack. Therefore, including the course on autism in the nursing curriculum will promote the knowledge of the faculty, students, and, as a result, practicing nurses. The more knowledgeable and experienced nursing students are, the more proficient care they will be able to offer to their clients upon starting their professional journey.

Application of the ADDIE Model

The ADDIE model is the instructional design approach utilized in creating training programs. The model was first introduced in the 1970s in Florida State University’s Center for Educational Technology (Alnajdi, 2018). The model’s title is the abbreviation of its components: analysis, design, development, implementation, and evaluation. With the help of the model, educators are able to reach a high level of reliability between the learning and real-work settings (Alnajdi, 2018). The ADDIE model will be employed in the CPE to implement the Nursing Care of the Autistic Child module in the Psych-Mental Health Nursing I course in order to arrange a systematic way to conduct the revision of the curriculum.

Analysis Phase

The analysis phase involves the analysis of the current learning situation. This stage helps to obtain a clear picture of what the situation is, what gaps exist, and what can be done to improve them (Hess & Greer, 2016). Nurse educators should focus on the audience, which is composed of nursing students, and thoroughly analyze their needs. Furthermore, the faculty evaluates the learners’ readiness for curriculum change through the application of such instruments as the affinity diagram, need-gap analysis, and force-field analysis. Finally, the analysis phase involves the identification of key stakeholders who will participate in or be impacted by the curriculum change process.

Design Phase

The design phase incorporates the verification of the desired performances and suitable testing methods (Alnajdi, 2018). At this point, nurse educators decide on the instructional components that will be used to gain the established aims of the change proposal. The design stage helps the faculty to pay attention to the proposal’s details and make sure that the suggested change will promote the achievement of the desired outcomes. Nurse educators can use this stage to come up with the necessary content delivery and pedagogical methods, learning resources, and evaluation approaches that will promote students’ success in learning new course material.

Development Phase

The third phase of the ADDIE model is concerned with the development of resources that will help to meet the set objectives (Alnajdi, 2018; Hess & Greer, 2016). Nurse educators generate content and choose or create supporting materials, develop guidelines for learners and educators, and carry out formative revisions. The faculty can perform the analysis and synthesis of the materials gathered during the first two phases to create a module or program that will shed light on what students should be taught to enrich their knowledge of the identified curriculum gap. This phase also enables nurse educators to review the formative and summative assessments, as well as learning resources, activities, and lecture content.

Implementation Phase

The fourth phase of the ADDIE model involves the enforcement of the learning resources in a learning situation. At this point, students and teachers are engaged and the learning environment is prepared for change (Alnajdi, 2018). Nurse educators implement the newly created program and make the necessary alterations in the process to make sure that students obtain the maximum opportunities for successful comprehension of the new material. The implementation phase, therefore, incorporates continuous activities on analyzing, improving, and redesigning the new module. Additionally, at this stage, feedback from educators and learners is taken into account with the aim of collecting reliable data on the positive and negative aspects of the change. Such measures allow for making the program as successful as possible and beneficial for all stakeholders.

Evaluation Phase

In the model’s final stage, nurse educators thoroughly assess the newly implemented course change. To do so, the evaluation criteria are identified and evaluation tools are selected (Alnajdi, 2018). As a result, educators are able to assess to what extent the instructional needs have been met (Hess & Greer, 2016). The effectiveness of the program is evaluated with the help of both formative and summative assessments. The formative assessment occurs when students and teachers participate in the new module whereas the summative assessment takes place at the end of the new module. The main purposes of the evaluation phase are to check whether the goals of the new module have been reached and to establish possibilities for the module’s enhancement to provide maximum benefits for learners.

Proposal Analysis Phase

Academic setting description, program level.

As previously mentioned, the academic setting for this CPE is the College of Nursing of the Western University, which is accredited by the Southern Association of Colleges and Schools. The university offers a variety of nursing programs, including a traditional pre-licensure nursing program accredited by the Commission on Collegiate Nursing Education (CCNE). The educators, researchers, and clinicians working in the College of Nursing strive to prepare future nursing leaders through the implementation of innovative practices and diversification of the healthcare environment. The university has the initiative to increase the student population’s diversity by having White, Asian, Black, and Hispanic students, as well as learners of mixed parentage placed in the category of ‘two or more races.’

Knowledge and Skills

The eligibility criteria for the pre-licensure nursing program include no previous bachelor’s degree; GPA of 3.0 overall and at least 2.5 in Biology, Anatomy and Physiology, Chemistry, and Microbiology; completion of all required courses for the College of Nursing; submission of the Test of Essential Academic Skills results. A typical learner in the academic setting from the CPE has no prior nursing education or experience. The program prepares individuals to achieve the CON benchmark on the ATI Comprehensive Predictor exam on the first attempt. Students who successfully complete the course pass NCLEX at 89% or higher on the first attempt. Overall, the knowledge and skills obtained in the selected academic setting are sufficient for individuals to work as nurses in diverse practice environments.

Learning Environment and Method of Delivery

This is a blended course requiring learners to complete online activities and carry out independent study in order to pass it successfully. The course objectives can be met via an individual study by utilizing suggested resources, participating in classroom activities, exchanging ideas with classmates and colleagues both formally and informally, and applying critical thinking skills. The methods of teaching include group work, discussions, seminars, computer-assisted instruction, audio-visual aids, an independent study of texts and other resources, clinical assignments, and return demonstration. Furthermore, post-clinical conferences and check-offs of appropriate skills and assignments are held to evaluate the students’ progress. While educators offer consultation and guidance, learners are responsible for the identification of their learning needs, demonstration of course objectives, and self-direction.

Needs Assessment and Gap Analysis Creation Procedures

Please refer to Table 2: Curriculum Need-Gap Analysis.

A need-gap analysis incorporates the process of gathering and analyzing the data contributing to the decision of promoting a curriculum change. According to Keating (2018), the first step in creating or revising the curriculum should involve the evaluation of the suggested change’s relevance for the community. In the process of needs assessment, internal and external factors should be considered. The external ones include the nursing profession, the community, demographics, characteristics of the academic setting, the need for the program, financial support, regulations and accreditation, political climate and body politic, and health care system and health needs of the populace. The internal factors are the organizational structure, the mission and goals, resources within the institution, the internal economic situation, and the potential faculty and students (Keating, 2018). Based on these factors, the need-gap analysis for the current proposal was performed.

The need-gap analysis involved comparing the current curriculum to the desired one, which resulted in the identification of the need gap. Specifically, it was found that the lack of a module on ASD in the current curriculum deprives the nursing students of a comprehensive preparation to work as nurses in pediatric units or other settings providing care to children. The need-gap analysis also included the planning of the action steps that should be taken in order to meet the need gap.

Stakeholders

Nurse educators.

The role of nurse educators in the process of analyzing the course’s gaps is linked to their professional responsibilities and expertise. Being at the forefront during the implementation of any curriculum changes, nurse educators evaluate the benefits and limitations of the suggested curriculum elements. They further employ their skills and expertise to promote and support change that is expected to enhance their students’ skills and knowledge. In order to ensure the most productive outcomes, faculty members should be included in the team carrying out the need-gap analysis. Collaborative work of all faculty members on the revision of the curriculum will allow for the identification of the most evident gaps, as well as will promote valuable feedback on the course. Nurse educators at Western University’s College of Nurses acknowledged the need for paying more attention to ASD and agreed to participate in the implementation of the new module.

Learners’ role in the need-gap analysis is in providing feedback on current educational approaches and curriculum content. Since a typical learner in the academic setting from the CPE has no prior nursing education or experience, it might be hard for them to identify deficiencies in knowledge when collaborating with ASD patients. However, students regularly analyze case studies and frequently have practical sessions at hospitals. Therefore, they are capable of sharing their experience in encountering autistic children in various professional settings and reporting on the difficulties they have faced during such occasions. Students’ involvement in the need-gap analysis is crucial since they are the final consumers of the change, and if they do not consider the change to be beneficial for them, they might feel resistant to undergoing the change process. Nursing students agreed that their knowledge of ASD was insufficient due to the lack of a module in the curriculum. Learners expressed unanimous support for the suggested change as they realized how beneficial it would be for their practice.

Local Hospitals

The role of local hospitals in the need-gap analysis is valuable since they can provide objective insight into the difficulties faced by young specialists in working with autistic children. Hospitals also serve as the clinical sites for learners, so their participation in the need-gap analysis will help to arrange more suitable settings for students’ practice. During the need-gap analysis process, local hospitals reported the need for improved knowledge and skills in nursing students in relation to both learners’ and beginning practicing professionals’ low level of understanding of how to provide care to autistic children.

Current and Desired Curriculum

Based on the survey of stakeholders and analysis of the Psych-Mental Health Nursing I syllabus, the current state of the curriculum provides learners with a holistic approach to the basics of psychological disorders in adult and pediatric patients. The course covers such important topics as basic concepts, theories, and therapies; children and adolescents; legal, ethical, and cultural issues; schizophrenia, depression, anxiety, suicide, violence, sexual assault; bipolar, personality, and eating disorders. However, the topic of autism is not present in the current curriculum, which makes it incomplete in light of ADDM’s findings indicating that every 54 th child in the USA has autism (CDC, 2020a). Therefore, the curriculum should be modified to include this crucial topic.

The desired state of the curriculum is to incorporate a module on Nursing Care of the Autistic Child to the Psych-Mental Health Nursing I course. All stakeholders have agreed that the module is vital and will be beneficial for learners. The inclusion of a new module will strengthen not only students’ knowledge but also the overall structure of the course. Reports from local hospitals – external stakeholders – indicate that patients with ASD who are admitted with various diagnoses do not receive proper care and attention due to nurses’ primary focus on their physical illness, whereas their psychological state frequently remains overlooked. Therefore, the desired curriculum will eliminate such negative experiences by educating future nurses on the correct ways of communicating with ASD children and helping them to accommodate to new environments.

Curriculum Changes

Please refer to Diagram 1: Affinity Analysis and Table 2. Curriculum Need-Gap Analysis.

As previously discussed, the curriculum of the Psych-Mental Health Nursing I course did not include a module on the Nursing Care of the Autistic Child, which considerably eliminated nurse students’ preparation to manage diverse cases in practical settings. Therefore, a suggestion was made to include such a module in the curriculum, thereby enabling those taking the course to learn about the psychological challenges faced by autistic children along with the ways of coping with these barriers. First of all, the module will enable students to select the most suitable communication and treatment procedures and approaches when dealing with an ASD patient. According to research, determining the most suitable ways of communicating with autistic children and their families is a crucial aspect of arranging trustworthy relationships between the patient and nurse. As a result of positive communication, the nurse will be able to fully serve as the patient’s advocate.

Another important learner need is to understand ASD terminology and learn the types of behaviors an autistic child may have. ASD children frequently experience hypersensitivity toward different stressors, such as light, smell, or sound. Also, autistic patients may have one or several compulsions and obsessions or display some stereotypical behaviors, the knowledge of which will make it much easier for the nurse to help the patient feel comfortable in the unfamiliar environment. Therefore, adding a module on ASD o the curriculum will benefit both students and patients.

Incorporating a new module will allow students to build on their prior knowledge via the constructivist learning theory. As Shah (2019) posits, the application of the constructivist learning approach enables students to become active participants of the learning process rather than merely listeners. Hence, instead of the traditional learning approach, an innovative method of obtaining knowledge will be utilized. By doing so, students will be able to think and act creatively and take part in making decisions regarding patients’ treatment plans and other crucial arrangements. Learners will also recollect the material on other psychiatric disorders and utilize their knowledge when mastering the new module.

Collaboration with internal and external stakeholders indicated that there was a drawback in the current curriculum due to the lack of the ASD module in it. Local hospitals reported an insufficient level of nurses’ readiness to work with ASD patients. Nurse educators noted that students could significantly benefit from the detailed learning of ASD as a separate topic rather than merely mentioning it in other modules. Therefore, the curriculum changes will have a positive impact not only on learners but also on patients. As a result, Western University’s College of Nursing will gain more value among potential students and employers as they will know that learners of this institution are well-prepared to face the problems of present-day patients.

Organizational Strengths and Weaknesses

In the process of collaborating with stakeholders, a force field analysis and a thorough examination of organizational strengths and weaknesses were carried out in order to determine the situational factors that could promote or slow down the process of curriculum proposal implementation.

Please refer to Diagram 2: Force Field Analysis (Organizational Readiness for Curriculum Proposal).

Forces for the Proposal

Organizational strengths and situational factors that could support the adoption of the curriculum proposal include:

• evidence-based learning experiences,
• alignment with professional standards of pediatric care,
• improved communication skills that will enable students to successfully operate in professional settings,
• promotion of critical thinking and decision making,
• the enhancement of Western University’s reputation as a nationally ranked school for higher nursing education.

Each of these factors can be used to the suggested change’s advantage as they explain the significance and benefits offered by it.

Supporting strength 1. Evidence-based learning experiences are an indisputably valuable asset for any nursing student. With the approval of the suggested curriculum change, students will be able to obtain experience working in evidence-based settings. According to Gialloreti et al. (2019), it is easier for practitioners to manage ASD patients if the former have had sufficient evidence-based experience. The external stakeholders, local hospitals, are interested in making sure that nursing students have access to real-life and evidence-based experiences since upon graduating, they will be able to provide patients with the best care.

Supporting strength 2. A standardized and streamlined course curriculum containing a module on the care of autistic children could support the adoption of the curriculum proposal since in such cases, nurse educators would be providing learners with the most recent and valuable information. The core elements in the guidelines issued by the Council of Autism Service Providers (CASP, 2020) include the ability to make decisions regarding ASD patients and communicate with caregivers. Hence, the suggested module will make it possible for the curriculum to align with the professional standards.

Supporting strength 3. The proposal is aimed at enhancing students’ communication skills, which is a valuable feature for any nursing practitioner. By improving these skills, future specialists will be prepared to find solutions to ASD patients’ issues and opportunities to meet their needs. Additionally, communicating with autistic children’s parents will be more effective, leading to better options for young patients. As a result, the module will benefit both learners and their future clients.

Supporting strength 4. Critical-thinking and decision-making skills are some of the most vital components of a successful nursing practitioner’s personality. The suggested curriculum change aims at developing nursing students’ knowledge about ASD, which will lead to a faster way of making decisions and to a more efficient way of coming up with solutions to critical cases. Hence, the suggested change will prepare students to be self-confident and offer the best level of care to their patients, as well as become valuable members of any hospital’s nursing team.

Supporting strength 5. Both potential students and employers will express more trust and respect toward Western University once it demonstrates its intention to innovate for the sake of positive development. The university is likely to grow its rating among competitors, and its graduates will have better options in the employment market. The incorporation of the new module will, therefore, demonstrate the university’s competence and indicate a goal- and safety-oriented agenda.

Forces against the Proposal

Organizational weaknesses and situational factors that could hinder the adoption of the curriculum proposal include:

• time and resources to develop the new curriculum and master it to provide a superior learning experience for students,
• time required to compare and contrast the current curriculum to standardized, evidence-based practices,
• factoring the module into the semester time frame,
• faculty’s resistance to the adoption of innovation,
• added workload for students and faculty.

Impeding force 1. Whereas the new module poses great benefits for the program and all stakeholders, it might be complicated to develop it since its preparation requires time and resources. The developers of the module could face such challenges as the lack of resources or the need to work extra hours to have the change implemented. Learners may also feel the burden of working in unexpected time frames in regard to having a new module added to the curriculum.

Impeding force 2. Another situational factor that could hinder the adoption of the proposal is the time required to compare and contrast the current curriculum to standardized, evidence-based practices. Whereas any comparisons should be the responsibility of the persona suggesting the change, it is inevitable that all faculty members will be involved in this process. Finding time to do this may become an obstacle in the way of successful change implementation.

Impeding force 3. While all curriculum procedures have been approved for the current course, it may be complicated to factor the new module into the semester’s time frame. Naturally, some topics will be allocated fewer academic hours than before in order for the new module to fit into the curriculum. Such changes will trigger alterations in educators’ and learners’ timetables, which may not be accepted positively by many of them.

Impeding force 4. As it frequently occurs with change, the resistance of some stakeholders may impede its successful implementation. Some faculty members, especially those of advanced age, may not feel disposed toward the changes in the curriculum since it will likely pose additional complications to their work. Even despite the numerous benefits, the suggested change to the curriculum can bring, the resistance of some faculty members cannot be prevented.

Impeding force 5. The last organizational weakness and situational factor that may interfere with the successful implementation of the change is the overall added workload for students and faculty. In order to mitigate this and other impeding factors, it is necessary to create an interprofessional team where each group of stakeholders would be represented. That way, all stakeholder groups would be timely informed about the development of change and accommodate to new processes accordingly.

Syllabus Creation Procedures

In preparing the Nursing Care of the Autistic Child module to be added to the Psych-Mental Health Nursing I course, both independent and collaborative efforts with specific attention to detail were employed to make sure that learners would be provided with experiential learning activities that encouraged critical thinking and enriched professional skills.

Independent Procedures

The cultivation of the syllabus was first of all promoted with the help of research. Additionally, self-reflection was employed as a helpful method of considering one’s own philosophy of teaching and understanding the course’s importance. Self-reflection also helped to find a suitable place for the newly developed module in the existing course. Having learners’ interests as the most crucial consideration, expectations regarding the course were clearly and succinctly articulated to maximize students’ success in the course. Carrying out the research helped to provide the most up-to-date evidence-based information to learners in a well-organized manner. Upon completing research and self-reflection, collaboration with key stakeholders via meetings and emails was arranged.

Collaborative Procedures

Initially, emails concerning the intention to add the Nursing Care of the Autistic Child module to the Psych-Mental Health Nursing I course were sent to all essential stakeholders involved in the project. Emails contained a brief description of the suggested change and the rationale for its implementation. Additionally, emails contained the suggested meeting times and dates for stakeholders to gather and discuss the new module. Key stakeholders were requested and encouraged to email any concerns or address any questions they might have before the first meeting.

Meetings with stakeholders had a positive effect on the syllabus’ development. As previously mentioned, administration, nurse educators, learners, and local hospitals were all consulted to obtain multiple and versatile perspectives related to the topic of nursing care for autistic child. When working on the proposal phase, the questions received from stakeholders were taken into consideration. Before arranging the collaboration with stakeholders, meticulous drafts of the proposal were generated for every stakeholder group to find particular interest in the proposed module. At the first meeting, stakeholders’ roles and responsibilities were assigned. It was decided that two nurse educators would oversee the curriculum development project to control the alignment of the new module with the university’s vision and nurse educators’ schedules. Several meetings with stakeholders took place in order to negotiate the budget, and discuss the course content, teaching and learning approaches, time management, and resources required for the successful completion of the project.

Upon agreeing on the curriculum draft proposal, a final copy of the new syllabus, which contained the new module, was presented at the faculty meeting. A form providing all the details of the curriculum change was completed, and a rationale for the change was prepared. Upon obtaining the faculty’s approval, the syllabus was presented to the College of Nursing Curriculum Committee. Finally, the approval was obtained from the University’s Curriculum Committee, which allowed for the new module to be incorporated into the next semester’s program.

Course Description

Please refer to Appendix A: Course Syllabus.

The course description was updated to include the Nursing Care of the Autistic Child module, which was added to Week 9 of the course. The description of the course is an essential element of course materials since it explains the rationale for the module to learners, as well as contains the key concepts, activities, learning strategies, and materials. The course description was developed with the aim to communicate enthusiasm about the course, describing what students will be able to do after completing it, and outline the benefits for learners offered by the updated curriculum.

Communicating Enthusiasm

The course/module description developed for the Nursing Care of the Autistic Child module communicates enthusiasm by providing students with a holistic scope of the course and the explanation of its significance in relation to the broader scope of professional nursing practice. Furthermore, the course description communicates enthusiasm by the detailed explanation of how the course/module matches the university’s educational goals and commitment to students’ success. The description of the course/module enables learners to gain insight into the nursing care of autistic child. To enhance the effect on students, the description is presented by means of strong persuasive language, such as “Content is presented with scrupulous attention to detail and explores the psychological peculiarities of ASD children’s behavior” and “Students will be immersed in a variety of scenario-based learning activities.” The use of persuasive language offers a sense of security that implies that the course was developed with learners’ best interests in mind.

What the Learners will Be Able to Do

The course/module description outlines what the learners will be able to do upon completing the course in a clear, concise, and conscientious manner. Specifically, student learning outcomes are outlined, which include the analysis of psychological theories, the examination of various issues affecting the psychiatric health delivery system, the utilization of evidence-based practice, the comparison and contrast of mental health issues in urban and rural areas’ patients, the identification of barriers to psychological care, the selection of nursing interventions with respect for patients’ preferences, and the application of nursing research and evidence-based practices to promote mental health and provide appropriate care. The use of inspirational, logical-descriptive, and professional language in the course/module description will let the learners know that the course will be helpful in strengthening their clinical prowess. Students will appreciate the clear message in the course/module description concerning what they will learn to do.

Benefits for Learners

The course/module description emphasizes how the course and its subject matter will benefit the learners through the variety of valuable skills that they will obtain upon its completion. Of specific importance is the explanation of the purpose that guided the inclusion of a new module. It is mentioned that the new curriculum has the aim of “simplifying nursing students’ work,” which inevitably serves as an advantage. Through the inclusion of a new module, learners will obtain the information previously lacking in the program. Hence, the new generations of nurses will be more skillful and will meet fewer obstacles once immersed in professional practice. The course/module description explains how learners’ higher cognitive thinking, autonomy, and critical thinking will be enhanced.

Course Objectives

It is crucial for nurse educators to come up with effective course objectives that will provide learners with achievable and measurable goals to gain by the end of the course. Hence, course objectives should be developed in consistency with the current difficulty of the course. Furthermore, objectives should align with the overall curriculum needs and expectations, such as promoting the enhancement of students’ higher cognitive functioning. For instance, since the Psych-Mental Health Nursing I course is designed for future nurses, the development of its objectives is aligned with the higher cognitive level of Bloom’s taxonomy. The course objectives for this course/module were conceived as follows:

• Analyze the baccalaureate-prepared nurse’s role in nursing care of the autistic child (cognitive level: analysis).
• Examine the psychological peculiarities of autistic children and develop a treatment plan in accordance with them (cognitive level: application).
• Apply knowledge of ASD to identify the issues that might hinder treatment and alleviate these issues (cognitive level: application).
• Apply a holistic approach to nursing care for the autistic child (cognitive level: application).
• Analyze how nursing can be assisted through computer-assisted instruction, group work, discussions, seminars, audio-visual aids, an independent study of texts and other resources, clinical assignments, and return demonstration (cognitive level: analysis).

Teaching Strategies, Instructional Delivery Methods, and Learning Materials

Nurse educators should ensure that the syllabus reflects the most contemporary healthcare needs in order to prepare students to operate effectively as competent baccalaureate-prepared nurses. Therefore, educators develop the syllabus by formulating course objectives, content, and outcomes that will support productive learning in the academic setting through evidence-based practice and current learning theories.

Please refer to Appendix A: Course Syllabus and Appendix B: Course Materials and Learning Resources.

Teaching Strategies

The teaching strategies suggested in the syllabus are underpinned by the constructivist learning theory. The selected theory enables learners to build upon the previously acquired knowledge by assembling new material in synthesis with the syllabus content. Participating in a scenario-based learning activity is a highly effective teaching strategy since it allows students to immerse in the settings most closely resembling real-life clinical situations. This teaching strategy enables learners to gain a deeper understanding of the issues encountered in nursing practice and consider possible solutions. According to Fitzgerald and Keyes (2019), case studies and role-plays allow for exploring students’ attitudes and interests, as well as developing their values and feelings. Furthermore, working in groups enhances students’ skills in collaboration and communication. Critical-thinking and analytical skills, which are the core of student-based learning, are likely to be promoted with the use of the selected teaching strategies. Therefore, the application of the constructivist learning theory and the use of case studies and team-based learning will support the educational process in the current academic setting.

Instructional Delivery Methods

The instructional delivery methods for this course incorporate a blend of lectures and resources, as well as independent and group activities. Learners can meet course objectives through active involvement in classroom activities, an individual study using the suggested resources, formal and informal exchange of ideas with peers, and clinical assignments. Information for these activities is presented to learners through video-recorded PowerPoint presentations, lectures, and discussion board posts. The constructivist learning theory and evidence-based practice support the listed instructional delivery methods since students are able to take an active part in classroom and individual work, construct new ideas, and increase the bulk of knowledge based on the previously gained experience. The format of delivering instructions allows learners to obtain a thorough understanding of the material both with the help of resources and through active communication with their peers.

Learning Materials

Learning materials for this course and module include textbook readings ( Hazen & McDougle, 2018; Iyama-Kurtycz, 2020), a scholarly peer-reviewed article (Lord et al., 2018), and information and statistics about ASD from the CDC (2020b) and the National Institute of Mental Health (NIMH, 2018). The mentioned materials are supported by the constructivist learning theory and evidence-based practice since textbook readings and academic articles provide the foundational knowledge for building learners’ nursing expertise. The use of a case study will enable students to apply theoretical concepts from readings to real-life situations upon evaluating, analyzing, and synthesizing the data. The scenario-based learning activity will enforce the constructivist learning theory by allowing students to experience collaboration in an environment close to a real-life one.

Student Learning Outcome Analysis

Student learning outcomes (SLOs) are academic goals set for learners at the beginning of the course/module. When generating SLOs, educators make sure that these align with the current course content, activities, and objectives. SLOs have to be specific and measurable and should correspond to the learners’ cognitive level of learning. The SLO selected for analysis states:

Upon successful completion of the course/module, learners will be able to identify competent, culturally sensitive, and compassionate nursing interventions and techniques for patients and their families that demonstrate respect for the patients’ preferences.

Bloom’s Cognitive Level of the SLO

Bloom’s cognitive levels of the SLO are remembering, understanding, and applying. At the remembering level, the learners will demonstrate memory of previously learned material by operating concepts, terms, and facts that will be incorporated in nursing interventions. At the level of understanding, students will exhibit the mastery of organizing and interpreting ideas for the successful arrangement of interventions. At the applying level, learners will find solutions to new situations by utilizing acquired knowledge and facts in new settings.

Expected Student Performance Level of the SLO

Learners will be expected to successfully develop a nursing intervention aimed at making the care of the autistic child effective and promoting positive collaboration with the patient’s family. It will be anticipated of students to explain the differences between culturally sensitive and insensitive approaches, as well as the discrepancies between compassionate and inconsiderate patterns of behavior. Students’ performance levels should demonstrate the highest level of respect for the patients’ preferences and needs.

How the SLO Can Be Measured

The educator can measure the SLO with formative, summative objective, and summative performance assessments. In the formative assessment, students’ SLO will be measured by responses to knowledge-based questions, which will determine whether students understand the topic’s key issues. In the summative objective assessment, learners will select an answer based on provided scenarios. Finally, in the summative performance assessment, students’ SLO will be measured through preparing a research paper on the topic of nursing care of autistic child.

How the SLO Aligns with the Course Objectives

The SLO aligns with the course objectives since the latter presupposes the analysis of autistic children’s peculiarities (objective 2), the development of treatment plans (objective 2), and the application of a holistic approach to nursing care (objective 4). All of these objectives prepare learners to identify effective interventions and demonstrate respect for patients’ needs and preferences.

Course and Grading Policies

Please refer to Appendix A: Course Syllabus and Appendix C: Assessments (Formative, Summative Objective, Summative Performance).

Course objectives were developed with the aim of describing what students should demonstrate upon completing the module. The grading policies and assessments offer mechanisms of evaluating students’ achievements and assessing to what extent they have mastered the set goals and objectives. The course syllabus includes a clear breakdown of the overall score and the impact of each assessment factor on the student’s grade. A minimum grade of 75 is required to pass the course. The grading policies support the course objectives and overall goals of the curriculum proposal since they enable nurse educators to evaluate the extent to which learners have mastered the appointed goals and requirements. Additionally, the precautions regarding plagiarism and other violations are aimed at ensuring that students work independently, utilize reliable sources, spend enough time on analyzing and synthesizing the materials, and carry out every task diligently and professionally.

Proposal Development Phase

During the development phase, the creation of the content and learning materials based on the design phase was completed. The following course materials were developed and included as appendices to this proposal. Please refer to Appendix B: Course Materials and Learning Resources and Appendix C: Assessments (Formative, Summative Objective, Summative Performance):

Course Unit Overview

Lecture content, learning resources, learning activities.

• Formative Assessment Quiz
• Summative Objective Assessment Test
• Summative Performance Assessment Task
• Summative Performance Assessment Rubric

Course Materials Creation Procedures

In developing the Nursing Care of the Autistic Child module to be added in the Psych-Mental Health Nursing I course, both independent and collaborative efforts were taken with particular attention to detail to ensure that students were provided with effective content, dynamic assessments, and experiential learning activities with resources promoting critical thinking and encouraging a higher cognitive order of thinking.

The major independent approaches to creating content were reflection and self-reflection, which allowed for a careful and detailed analysis of what content would be the most suitable and beneficial for the course. Based on the review of the literature and need-gap analysis, it was possible to reflect on the course materials to be included in the module, such as course content, learning resources, and assessments. Reflection resulted in determining the module and course content, including the objectives and SLOs.

Self-reflection was helpful in making sure that the content was student-oriented and that it would be not only interesting but also helpful to learners. Some of the self-reflection questions that prompted the creation of course materials included the following:

• How can one make the content more engaging?
• In what ways can students’ earning process be better facilitated?
• How can real-life situations be employed in the classroom with the greatest benefit to students?
• What resources might be the most helpful to learners in the process of understanding the topic?
• How can students’ knowledge and understanding of the topic be evaluated in an engaging and reliable way?

In addition to reflective and self-reflective processes, a review of the literature was carried out. Literature review allowed establishing evidence to support the module content and activities. Finally, the review of the whole syllabus allowed for singling out the most suitable assessments for the module, which were aimed at evaluating learners’ progress and identifying the areas of improvement. Independent procedures were rather useful in outlining the appropriate course content.

As previously mentioned, essential stakeholders received emails regarding the intention to include a new module in the Psych-Mental Health Nursing I course. These emails contained the description of the suggested module and its rationale. Key stakeholders were encouraged to express any questions and concerns about the suggested change. Further, meetings with stakeholders were held, at which the course content and materials were discussed. The meetings, as well as email communication, allowed for each stakeholder group’s expression of their suggestions on the change. Collaboration with stakeholders gave valuable feedback and presented multiple perspectives on the module and syllabus. Overall, both independent and collaborative procedures were rather beneficial in the process of creating the materials.

Learning Resources and Activities

Please refer to Appendix B: Course Materials and Learning Resources.

Learning resources for this course and module include textbook readings (Hazen & McDougle, 2018; Iyama-Kurtycz, 2020), a scholarly peer-reviewed article (Lord et al., 2018), information and statistics about ASD from the CDC (2020b) and the NIMH (2018), and a PowerPoint presentation. The combination of these resources will promote the development of students’ skills and reflective practice as the selected learning content is aimed at reaching the course objectives and SLOs.

The main textbook for the course is Varcarolis’ foundations of psychiatric mental health nursing: A clinical approach (7th ed.), specifically chapters 3, 11, and 34. This book is an excellent resource for nursing learners as it contains information about mental health and illness, relevant theories, biological basis for understanding psychiatric disorders, psychiatric care settings, cultural implications, standards of care, ethical guidelines, and others. Of special interest for this module are chapters on communication and childhood and neurodevelopmental disorders. At the end of each chapter, there are review questions with an answer key, which help students to revise the information and identify the moments to which they should pay more attention.

The book edited by Hazen and McDougle (2018), The Massachusetts General Hospital guide to medical care in patients with autism , offers a variety of helpful pieces of professional advice on how to make ASD patients’ stay in the hospital comfortable and effective. The book contains valuable insights into the nursing care of pediatric autistic patients. Such crucial topics as challenges for autistic children’s inpatient care, strategies for improving care, innovative approaches, and others are discussed by the book’s contributors.

Iyama-Kurtycz’s (2020) book, Diagnosing and caring for the child with autism spectrum disorder: A practical guide for the primary care provider , is useful for learners as it contains the explanation of diagnostic obstacles, autism screening, anxiety issues, challenging behaviors, teaching positive parenting skills, and others. These topics will be of great help for learners since they will prepare future nurses to effective communication and collaboration with autistic children and their caregivers in hospital settings.

The inclusion of a scholarly article by Lord et al. (2018), “Autism spectrum disorder,” pursues two goals: providing vital data on ASD and teaching nursing learners to work with scholarly articles, which will be needed in their summative performance assessment assignment. Data and statistics provided on CDC (2020b) and NIMH (2018) websites offer relevant information about the disorder’s prevalence, diagnostic tools, risk factors, and other important issues that nursing practitioners should know. Overall, learning resources contain essential information about ASD and prepare students to encounter autistic patients in healthcare settings and provide high-quality care to them.

The scenario-based learning activity created in the proposal is a case-based scenario with a role-play simulation followed by a group discussion. Students will be assigned randomly to a case study and will work independently on the given task. After they finish working on the case studies, learners will be placed in groups. Each group will discuss the case study and share individual experiences, which will enable making a common conclusion. The suggested scenario-based learning activity will support student skill development and encourage reflective practice in two ways. Firstly, students will engage in reflection and self-reflection in order to find answers to the case study’s questions. Secondly, learners will develop their skills both when working independently (professional nursing skills) and in groups (collaborative and teamwork skills). Furthermore, the activity will enhance students’ empathetic skills and emphatic communication skills. Learners will be able to practice nursing skills, communication, and interventions for promoting effective care of autistic child and making their stay at the hospital comfortable. The use of role-playing will facilitate students’ understanding of patients’ values and interests, as well as their parents’ concerns.

The other learning activity is a simulated role-play activity where each learner will be assigned a role and will have to utilize their knowledge of ASD. This activity will promote reflective practice since students will have to approach the ‘patient’ professionally and try to discern the ASD symptoms. Skill development will be promoted as learners will analyze the cases of ‘patients’ by applying all the skills mastered in the course and module.

Formative Assessment

Please refer to Appendix C: Assessments (Formative, Summative Objective, Summative Performance).

A formative assessment is a five-question quiz with five possible answers for each question. The purpose of formative assessment is to evaluate the effectiveness of learning materials and activities offered in the module. The quiz will assess learners’ comprehension of nursing care of autistic child. The success or failure to choose correct answers will indicate students’ progress or identify areas of improvement. For instance, if the majority of learners fail to answer the same question, the educator will analyze the course content and include more information on that topic to align with SLOs and course objectives. The scores of the formative assessment quiz will allow the nurse educator to make the necessary adjustments to the course. Students’ performance in the quiz will provide insight into the areas of strength and room for improvement.

The educator will provide feedback to students, so they will be able to see what content areas they have mastered well and which areas need to be given more attention. Learners will revisit the topics in which they failed to boost their knowledge and improve performance. By doing so, students will make sure that their SLOs have been met and course objectives have been achieved.

Summative Objective Assessment

For summative objective assessment, learners will answer a ten-question quiz based on the material presented in the module. This assessment will allow evaluating students’ abilities to analyze, synthesize, and apply their knowledge in practice. The results of the summative objective assessment will be used as reliable data for ensuring that the curriculum is meeting the intended goals since these results will give an insight into how good the earning materials and activities are at helping learners to meet course objectives. The higher the incidence of pass rates on the summative objective assessment is, the better the objectives of the curriculum proposal are met.

On the contrary, if the incidence of pass rates is low, nurse educators will need to revise and modify the module in order to improve SLOs. Summative objective assessment is, therefore, a helpful tool utilized in the process of identifying whether the curriculum change proposal is meeting its intended goals or not. The instructors will carefully review and analyze students’ results to make solid conclusions about the success of the new module’s inclusion.

Summative Performance Assessment

Summative performance assessment represents an authentic activity relevant to the selected curriculum proposal since it promotes learners’ critical thinking and clinical decision-making. Furthermore, the performance assessment is a recreation of a core professional activity corresponding to the academic setting of the curriculum proposal since it encompasses the culmination of all the skills, knowledge, and practical habits acquired by students in the form of a scholarly paper. Authenticity is justified by challenging students to employ their professional judgment rather than memorizing the material performance assessment involves research practices, collaboration, and presentation skills as important prerequisites of decision making and collaboration in real-life situations. Therefore, successful completion of summative performance assessment will signify the mastery of the course content and objectives.

Alnajdi, S. M. (2018). The effectiveness of designing and using a practical interactive lesson based on ADDIE model to enhance students’ learning performances in the University of Tabuk. Journal of Education and Learning, 7 (6), 212-221. Web.

Brown, A. B., & Elder, J. H. (2014). Communication in autism spectrum disorder: A guide for pediatric nurses. Pediatric Nursing, 40 (5), 219-225.

Centers for Disease Control and Prevention. (2020a). Data & statistics on autism spectrum disorder . Web.

Centers for Disease Control and Prevention. (2020b). What is autism spectrum disorder? Web.

The Council of Autism Service Providers. (2020). Applied behavior analysis treatment of autism spectrum disorder: Practice guidelines for healthcare funders and managers (2 nd ed.). Web.

Fernando, S., & Marikar, F. (2017). Constructivist teaching/learning theory and participatory teaching methods . Journal of Curriculum and Teaching, 6 (1), 110-122. Web.

Fitzgerald, K., & Keyes, K. (2019). Teaching methods and settings. In S. B. Bastable (Ed.), Nurse as educator: Principles of teaching and learning for nursing practice (5 th ed., pp. 459-504). Jones & Bartlett Learning.

Gardner, M. R., Suplee, P. D., & Jerome-D’Emilia, B. (2016). Survey of nursing faculty preparation for teaching about autism spectrum disorders . Nurse Educator, 41 (4), 212-216. Web.

Garg, P., Lillystone, D., Dossetor, D., Wilkinson, H., Kefford, C., Eastwood, J., & Liaw, S. T. (2015). A framework for developing a curriculum regarding autism spectrum disorders for primary care providers. Journal of Clinical and Diagnostic Research, 9 (10), SC01-SC06. Web.

Gialloreti, L. E., Mazzone, L., Benvenuto, A., Fasano, A., Alcon, A. G., Kraneveld, A., Moavero, R., Raz, R., Riccio, M. P., Siracusano, M., Zachor, D. A., Marini, M., & Curatolo, P. (2019). Risk and protective environmental factors associated with autism spectrum disorder: Evidence-based principles and recommendations . Journal of Clinical Medicine, 8 . Web.

Giarelli, E., Ruttenberg, J., & Segal, A. (2011). Continuing education for nurses in the clinical management of autism spectrum disorders: Results of a pilot evaluation . The Journal of Continuing Education in Nursing, 43 (4), 169-176. Web.

Halter, M. J. (Ed.). (2014). Varcarolis’ foundations of psychiatric mental health nursing: A clinical approach (7 th ed.). Saunders.

Hazen, E. P., & McDougle, C. J. (Eds.). (2018). The Massachusetts General Hospital Guide to medical care in patients with autism . Humana Press.

Hess, A. N., & Greer, K. (2016). Designing for engagement: Using the ADDIE model to integrate high-impact practices into an online information literacy course. Communications in Information Literacy, 10 (2), 264-282.

Iannuzzi, D., Rissmiller, P., Duty, S. M., Feeney, S., Sullivan, M., & Curtin, C. (2019). Addressing a gap in healthcare access for transition-age youth with autism: A pilot educational intervention for family nurse practitioner students. Journal of Autism and Developmental Disorders, 49 (4), 1493-1504. Web.

Igwe, M. N., Ahanotu, A. C., Bakare, M. O., Achor, J. U., & Igwe, C. (2011). Assessment of knowledge about childhood autism among paediatric and psychiatric nurses in Ebonyi state, Nigeria. Child and Adolescent Psychiatry and Mental Health, 5 (1). Web.

Iyama-Kurtycz, T. (2020). Diagnosing and caring for the child with autism spectrum disorder: A practical guide for the primary care provider . Springer.

Keating, S. B. (2018). Needs assessment: The external and internal frame factors. In S. B. Keating & S. S. DeBoor (Eds.), Curriculum development and evaluation in nursing education (4 th ed., pp. 47-66). Springer.

Lord, C., Elsabbagh, M., Baird, G., & Veenstra-Vanderweele, J. (2018). Autism spectrum disorder. Lancet, 392 (10146), 508-520. Web.

Lucarelli, J., Welchons, L., Sideridis, G., Sullivan, N. R., Chan, E., & Weissman, L. (2018). Development and evaluation of an educational initiative to improve hospital personnel preparedness to care for children with autism spectrum disorder. Journal of Developmental & Behavioral Pediatrics, 39 (5), 358-364.

Major, N. E., Peacock, G., Ruben, W., Thomas, J., & Weitzman, C. C. (2013). Autism training in pediatric residency: Evaluation of a case-based curriculum . Journal of Autism and Developmental Disorders, 43 (5), 1171-1177. Web.

McCarthy, A. M., & Wyatt, J. S. (2014). Undergraduate pediatric nursing education: Issues, challenges and recommendations . Journal of Professional Nursing, 30 (2), 130-138. Web.

National Institute of Mental Health. (2018). Autism spectrum disorder . Web.

Sampson, W.-G., & Sandra, A. E. (2018). Comparative study on knowledge about autism spectrum disorder among paediatric and psychiatric nurses in public hospitals in Kumasi, Ghana . Clinical Practice & Epidemiology in Mental Health, 14 , 99-108. Web.

Shah, R. K. (2019). Effective constructivist teaching learning in the classroom. Shanlax International Journal of Education, 7 (4), 1-13. Web.

Table 1: Literature Review Summary

Table 2. Curriculum Need-Gap Analysis

Appendix A: Course Syllabus

NAME University

College of Nursing

Psych-Mental Health Nursing I

Instructor:

Instructor Email:

Office Location: College of Nursing

Office Hours: As posted and by appointment

Phone: 000-000-0000

Course Information

Prerequisite:

Co-requisite: XXX, or permission of instructor

Course Description: (5 credit hours):

This course is designed to provide learners with an opportunity to apply theories and implement evidence-based care for clients with psychiatric/mental health issues, including psychosocial concepts; cultural, ethical, and legal influences; and wellness of individuals and family groups. Students will also be able to develop their professional role in psychiatric/mental health nursing. The process of correct treatment of autistic patients is included in the course with the aim of simplifying nursing students’ work. Based on the course, learners will be able to manage the challenges and barriers existing in communication with ASD children. As a result, nursing students will determine the best practices for managing autistic children’s needs and apply them in their work. Content is presented with scrupulous attention to detail and explores the psychological peculiarities of ASD children’s behavior, including compulsions, obsessions, and communication barriers. Students will be immersed in a variety of scenario-based learning activities promoting critical thinking, autonomy, and collaboration.

Course Objectives:

Upon successful completion of this course, learners will be able to:

• Analyze the baccalaureate-prepared nurse’s role in nursing care of the autistic child.
• Examine the psychological peculiarities of autistic children and develop a treatment plan in accordance with them.
• Apply knowledge of ASD to identify the issues that might hinder treatment and alleviate these issues.
• Apply a holistic approach to nursing care for the autistic child.
• Analyze how nursing can be assisted through computer-assisted instruction, group work, discussions, seminars, audio-visual aids, independent study of texts and other resources, clinical assignments, and return demonstration.

Student Learning Outcomes:

• Analyze selected nursing and psychological theories used in psychiatric/mental health settings.
• Examine the legal, economic, sociocultural, and ethical issues impacting the psychiatric/mental health delivery system and apply them in the clinical setting.
• Discuss clinical modalities and psychiatric terminology as it relates to psychiatric/mental health nursing practice.
• Utilize principles of evidence-based practice in psychiatric mental health nursing.
• Compare and contrast the difference in mental illnesses in clients in urban and rural geographic areas.
• Identify barriers to care for patients with psychiatric illnesses in the rural setting.
• Identify competent, culturally sensitive, and compassionate nursing interventions and techniques for patients and their families that demonstrate respect for the patients’ preferences.
• Apply the nursing process, nursing research, and evidence-based practices to provide nursing care and promote health and wellness among autistic children.

Materials- Textbooks, Readings, Supplementary Readings

Textbook(s) Required:

• Halter, M. J. (Ed.). (2014). Varcarolis’ foundations of psychiatric mental health nursing: A clinical approach (7th ed.). Saunders.

Hazen, E. P., & McDougle (Eds.). (2018). The Massachusetts General Hospital guide to medical care in patients with autism. Humana Press.

Other Resources:

National Institute of Mental Health. (2018). Autism spectrum disorder. Web.

Course Requirements

Instructional / methods / activities assessments.

This is a blended course without lecture requiring students to complete online activities and independent study to be successful. Course objectives may be met through individual study using suggested resources, active involvement in classroom activities, formal, and informal exchange of ideas with classmates and colleagues regarding specific topics as well as utilizing critical thinking skills. Teaching methods include seminar, discussion, small group work, independent study of texts and library resources, computer-assisted instruction, audio-visual aids, return demonstration, clinical assignments and supervision, post clinical conferences and check-off of appropriate skills and the assignments listed. While the professor will provide guidance and consultation, the student is responsible for identification of learning needs, self-direction, seeking consultation and demonstration of course objectives.

Grades will be determined as follows:

Grading Scale:

• F = 66 and Below

A minimum grade of 75 is required to pass the course.

The Course grade will be earned as follows:

Specifics on course assignments for both class and clinical are in the assignments listed below. The HESI Psychiatric/Mental Health Exam must be passed with a score of 850 or greater. If you do not achieve this score, you will have to undergo remediation and retesting as indicated in the Student Guide.

The clinical component is PASS/FAIL and must be passed in order to pass the course. To receive a passing grade in clinical you must achieve at least 75% on the clinical assignments and receive a satisfactory clinical evaluation.

Technology Requirements

This course will be enhanced using eCollege, the Learning Management System used by NAME University. To login to the course, go to: XXXXXXXX.

You will need your WUID and password to log in to the course. If you do not know your WUID or have forgotten your password, contact Technology Services at 903.468.6000 or [email protected] .

The following hardware and software are necessary to use eCollege.

• Internet access/connection-high speed recommended (not dial up)
• Word Processor (MS Word, or Word Perfect)

Our campus is optimized to work in a Microsoft Windows environment. This means our courses work best if you are using a Windows operating system (XP, Vista, 7 or 8) and a recent version of Microsoft Internet Explorer (6.0, 7.0, 8.0, or 9.0).

Your courses will also work with Macintosh OS X or better along with a recent version of Safari (5.1 is now available). Along with Internet Explorer and Safari, eCollege also supports the Firefox browser (3.0) on both Windows, and Mac operating systems.

It is strongly recommended that you perform a “Browser Test” prior to the start of your course. To launch a browser test, login to eCollege, click on the “myCourses” tab, and then select the “Browser Test” link under Support Services.

Communication and Support

Interaction with Instructor Statement:

It is expected that you will check your eCollege course and email at least DAILY for communication from the instructor.

Communication between faculty and students is primary and taken seriously. Preferred communication methods are individualized office hours, email, or via office phone. If a phone call is not answered please leave a message and send an e-mail using the direct e-mail link on the course home page. You will be treated with collegial respect and you are expected to communicate likewise in a professional manner.

Course and University Procedures/Policies

• Class Cancellation: If a class is canceled, the student is expected to do the readings and complete the objectives for that day. The content will still be included on examinations. The material in this syllabus and dates identified in the Course Calendar are subject to change.
• Class attendance is expected. The students should notify course faculty in advance of any absence.
• Exam dates are listed in each course syllabus, and the student is expected to be present for exams. If the student will be absent, the course instructor must be notified in advance. Failure to do so will result in the student receiving a zero for the missed exam or quiz. Review NAME University catalog for excused absence criteria.
• As an adult learner and responsible professional, the student is responsible for reading and completing assignments prior to class and for being prepared to participate in discussions over the assigned material. It should not be expected that all material will be covered in class. Students are expected to come to class prepared.
• Assignments must be handed in on time. Assignments submitted late without prior arrangement with the classroom instructor will receive a zero.

Nursing Skills Laboratory

Students are responsible for assigned readings in textbooks and completing DVD and other assignments prior to lab. Participation in discussions over the assigned material is expected. Failure to prepare will result in an unsatisfactory for the lab session. All lab sessions must be completed satisfactorily to progress to the clinical setting.

Students must adhere to the clinical dress code for skills laboratory sessions. Refer to the Nursing Student Guide for policy information.

Students with Disabilities:

The Americans with Disabilities Act (ADA) is a federal anti-discrimination statute that provides comprehensive civil rights protection for persons with disabilities. Among other things, this legislation requires that all students with disabilities be guaranteed a learning environment that provides for reasonable accommodation of their disabilities. If you have a disability requiring an accommodation, please contact: Office of Student Disability Resources and Services NAME University-Commerce Gee Library Room XXX Phone (XXX) XXX-XXXX Fax (XXX) XXX-XXXX [email protected]

Student Conduct Code – Refer to the BSN Student Guide

Students must adhere to standards of professional and academic conduct Academic misconduct involves any activity that tends to compromise the academic integrity of NAME University, or subvert the educational process, including, but not limited to, cheating, plagiarism, falsifying academic records, misrepresenting facts and any act designed to give unfair academic advantage to the student or the attempt to commit such an act. Students are responsible for their own academic honesty and for reporting violations of academic honesty by others.

Course Outline / Calendar

Lecture assignments, examinations.

48% total, 16% each 2/28; 4/4; 5/2

There are a total of three examinations in this class on the dates identified. They will cover all the topics covered in class as of one week prior to the examination date. The examinations will include terminology from the applicable chapters in the textbook. The questions will be in multiple formats: multiple choice, multiple answer, matching, etc.

Online Case Studies

35% of grade, 5% each

There are seven case studies to be completed and submitted either on Evolve or in the Dropbox by 2359 on the date indicated. You will receive the score that you receive when you complete the case study:

• Evolve Case Study-Psychosis 2/14
• Evolve Case Study-Schizophrenia 2/14
• Evolve Case Study-Depression 2/28
• Evolve Case Study-Major Depression 2/28
• Evolve Case Study-ADHD 3/21
• Evolve Case Study-Autism 3/21
• Evolve Case Study-Alcoholism 4/18
• Case Study-Eating Disorders 5/02

Online quizzes

5%, 1% each 2/7; 2/21; 3/7; 3/28; 4/11

There are five quizzes on eCollege on the important terminology for the indicated modules. These are due by 2359 on the date indicated

Group Presentation 8%

4/10 or 4/24

Students will be divided into groups and each group will be assigned a theatrical movie that deals significantly with a psychiatric or mental illness. The movies are all available for rental and/or streaming. They include: The Soloist; Black Swan; Silver Linings Playbook; and Side Effects. Each member of the group is to watch the movie. As a group, describe what mental illness or illnesses were portrayed and if it was appropriate to the illness based on the accepted signs and symptoms of the condition. Analyze why you feel the changes were made or not made to the illness for purposes of the movie. Discuss how this portrayal influences society’s view of psychiatric and mental illnesses. There is no paper for this assignment.

The group will present informally to their classmates and lead a discussion with the following information on the assigned date:

• Summary of the movie, including illness in the movie
• Were the illness (es) portrayed accurately? Why and/or why not?
• Why were changes made, if any, for the movie?
• How does the movie influence society’s view of mental illness?

This presentation is a group or team project. All members of the group receive the same grade, see grading rubric on eCollege. However, a student can be removed from his/her group if the other students in the group come to the instructor and report that a student is not doing his/her fair share of the work. If that happens, the student will be notified in writing by the instructor. The student will then be responsible for doing the assignment on his/her own.

Class/Clinical Experience Paper 2%

Write a paper that includes the following: 1) Discuss at least three (3) aspects of the upcoming class/clinical experience that you are looking forward to. Analyze what factors in these experiences make you feel positive about them; 2) Describe at least three (3) aspects of the

upcoming class/clinical that you are most apprehensive or uncertain about. Analyze the factors in these experiences that are influencing your reaction; 3) Identify at least three (3) SPECIFIC actions you can take throughout the semester to reduce your apprehension or uncertainty.

The paper should be no less than two (2) and no more than three (3) pages typed double spaced in APA format. Place your name at the top of the first page. You do not have to have a title page or reference page. See grading rubric on eCollege. Submit it by 2359 on the due date on eCollege.

Class/Clinical Experience Paper Evaluation 2%

Write a paper that evaluates the results of your experience in class/clinical during the semester. Refer to the paper you wrote at the beginning of the semester. Analyze both the positive and negative experiences you were expecting.

NCLEX Review Questions

To assist in preparing students for the HESI examinations and the NCLEX examination, you are required to complete a total of 250 NCLEX questions related to psychiatric/mental health and/or therapeutic communication during the semester. NCLEX review questions must be taken via computer (CD-ROM or any other computer application) and must be completed and submitted as one grade. The printed form showing the score and the number of questions completed should be brought and shown to the classroom instructor on class days. All questions must be completed by April 24th.

HESI Psych/Mental Health Practice Examination Cr/NC

Complete online non-proctored exam by May 6th with a score of 90% or better to receive credit.

HESI Psychiatric/Mental Health Examination Cr/NC

Complete proctored exam on May 9th with a score of 850 or better to receive credit. If you receive below 850, you will have to complete remediation and re-take the examination to receive credit. For scores on the HESI of 900-949, you will receive 1 extra point for your grade; for scores of 950-999, you will receive 2 extra points and for scores of 1000 and greater, you will receive 3 extra points.

Curriculum Map

Course content outline, appendix b: course materials (including powerpoint presentation).

This course is designed to provide learners with an opportunity to explore nursing care of the autistic child using evidence-based standards across the continuum of care. The psychological peculiarities of autistic children’s behavior are reviewed along with the risk factors influencing this patient group’s health and well-being in order to determine the best nursing practices for managing these risks. Content is presented with scrupulous attention to detail, which allows for the thorough exploration of autistic children’s developmental and psychosocial characteristics associated with health promotion and maintenance. The module is focused on nursing care for the autistic child, along with the approaches to communicating with caregivers and collaborating with healthcare specialists from various disciplines. Students will be immersed in opportunities that will enable them to translate theory to practice at the baccalaureate level.

Textbook(s) Required

Other resources, scenario-based learning activity.

Overview: Students will be assigned randomly to one of two different case studies available to them via the module’s online resources. Each learner will work independently on the case study assigned to them. Upon completing their case studies, students will be placed in groups based on the case study assigned to them. Group discussions about the individual experiences and findings will promote the development of learners’ skills and encourage their reflective practice via collaborative learning with peers. Group work will enable students to engage in active collaboration that will help them to process and apply information, as well as analyze and synthesize it to facilitate a student-centered learning process.

Part 1: working independently. Work on the case study assigned to you. Complete all work independently. Analyze how the nurse in the scenario should develop a patient care plan in order to gain the best patient outcomes and serve as a patient advocate. Think about the specialists you would include in the interprofessional team to work with the patient. Consider the ways of communicating with the patient’s parents/caregivers. At the end of the scenario, there are questions that will guide your work on the case study.

Part 2: group work. Discuss your findings/assumptions/conclusions. What did your peers plan to do similarly? What did they do differently? Who do you think would have gained the best patient outcomes? Now that you have listened to your peers’ ideas, would you change yours? What have you learned from your peers’ experiences? Is there anything you would suggest to them?

Prepare a discussion board post based on your discussions. Share your post with the other groups and respond to one another’s scenarios and findings.

N. is a nine-year-old girl admitted to the hospital with sharp pain in the chest. The girl’s mother says that it is possible that N. has swallowed a small piece of a toy, so the doctor needs the girl to have an X-ray. Upon seeing the doctor and hearing that she should undergo some unknown procedure, N. starts crying and throwing tantrums, which is bad both for her physical and psychological state. The girl’s mother is devastated and says they should probably go home. However, if the girl has indeed swallowed something, it is quite dangerous to let them go.

As a nurse, what are your actions? How could the situation have been prevented? How should the doctor have presented the procedure? What can you do to make the mother stay and let the doctor have the girl examined? What communication strategies would you employ? What specialists, if any, would you engage in solving this situation?

M. is a seven-year-old boy who has been admitted to the hospital two weeks ago with pneumonia. The boy has a repetitive behavior which is manifested in ordering his toy cars in the same way on a tray that is placed in his bed. When it is time to do some procedures, the nurse waits for the boy to have the cars arranged, which makes him calm down and allows him to tolerate the necessary hospital routine. This morning, a new doctor arrives, who has not been informed about the boy’s ASD diagnosis. The doctor is in a hurry because he has an appointment planned with the hospital administration. He decides that “the boy is too old to be allowed to play during serious procedures” and takes away the tray with the cars. The boy immediately becomes enraged and pulls out all the tubes and monitors attached to him and his bed. As a nurse, what are your actions? How can you help the boy calm down and agree to continue treatment? How will you explain the situation to his parents? Do you think the doctor should continue working with this patient? If yes, how should they arrange their cooperation? If no, why, and what should the new doctor do to arrange a friendly relationship with the boy?

Overview of activity: Upon reviewing course materials, students’ understanding and knowledge of child autism will be evaluated via participating in a simulated activity. This assignment will allow learners to apply their knowledge, evaluate their readiness to work with autistic children, discern the signs and symptoms of ASD in pediatric patients, and come up with solutions to treatment.

Directions: Learners will be divided into groups of three for this assignment. Every student will assume a role of a nurse for the purpose of the activity. For each group, there will be a ‘patient’ (a student from a different group so that every student could participate in the activity not passively but actively). The patient will present some signs and symptoms, which the ‘nurses’ should carefully analyze and decide whether the ‘patient’ has ASD and what his main signs and symptoms are. Every ‘nurse’ should take notes and write down the diagnosis. Students will have two days for the activity: one day for working with the ‘patient’ and making notes, and another day for discussing them. The group should decide whether the ‘patient’ is an autistic child or not, come up with differential diagnoses, and back up their decision with scholarly resources. The educator will assess each group’s findings and evaluate students depending on such factors:

• the correctness of the diagnosis
• the ability to work in a team (quality of discussion, application of analysis and persuasion)
• the knowledge of ASD and similar disorders and the ability to discern one from the other.

Appendix C: Assessments (Formative, Summative Objective, Summative Performance)

Directions: Students will do a five-question quiz. For each question, they will choose one answer: A, B, C, D, or E. In question 4, they will choose ‘all that apply.’

SELECT ALL THAT APPLY. Which of the following is a typical behavior of an ASD child?

• avoiding eye contact
• showing a lot of interest in peers
• lining up toys in a particular order
• repeating the same words or phrases over and over
• focusing on specific parts of objects

Which of these characteristics is the most typical of autistic children?

• delayed language skills
• delayed cognitive skills
• delayed movement skills
• all of the above
• none of the above

When should autism-specific screening occur?

• at the 9-, 18-, and 24- or 30-month visits
• at the 9- and 24-month visits
• at the 18- and 24- or 30-month visits and whenever a concern is expressed
• at the 18- and 24- or 30-month visits
• at the 24- and 30-month visits and whenever a concern is expressed

SELECT ALL THAT APPLY. What social communication skills are the most typical for an autistic child?

• does not respond to his/her name by the age of 9 months
• does not use gestures such as waving goodbye by the age of 12 months
• shows the surprised face by the age of 9 months
• likes looking at what a parent is pointing by the age of 18 months
• does not play simple interactive games by the age of 9 months

Which of the following are the most typical comorbidities of ASD?

• anxiety disorders
• attention-deficit/hyperactivity disorder

Answer Key:

This objective assessment contains a total of 10 items, each of them worth 10 points, for a total of 100 points. Students must answer a minimum of 8 out of 10 questions correctly to score at a passing grade of 80% or better.

You are a nurse taking care of an autistic child. You have noticed that the child refuses to eat the food brought to the ward. What should you say to the patient to improve the situation?

• Don’t you know that you should eat to stay healthy?
• Would you mind telling me about your favorite food?
• If you don’t eat, you will need an injection of glucose to keep your organism working properly.

You are working a night shift, and an autistic child asks you to stay with them. What is the correct way of behavior in this situation?

• You tell the child you have to help all patients and cannot stay in their ward
• You tell the child you will check on him or her from time to time to make sure they are comfortable
• You make sure your beeper is working correctly in case any other patient needs you and stay in this child’s ward

A child is admitted on your shift. You notice some signs of ASD, but there is no indication of the disorder in the child’s EHR. How do you approach parents?

• You tell them their child most likely has autism and ask why it is not mentioned in the EHR.
• You notice that the child behaves in a strange way and ask whether it is a typical behavior.
• You cautiously and gently ask parents about the things that you consider ASD symptoms. E.g. “I can see that your daughter is covering her ears when I am speaking. Am I talking too loud for her comfort level?”

The head nurse announces that starting from tomorrow, rotation in the ward where an autistic child is staying will occur every 12 hours. The child has been at the hospital for a week and is scheduled to be discharged the next day. What are your actions?

• You ask the head nurse to reconsider her decision
• You prepare the schedule and inform all nurses about their shifts
• You ask the nurses to change their shifts so that the same nurses stay with the autistic child irrespective of the new order.

When making rounds, you notice that an autistic child, who had been playing with his toy cars all day long yesterday, is very sad and quiet. You still have several wards to check. What are your actions?

• You continue making rounds since it is your primary duty.
• You continue making rounds but try to find someone who will cheer the child.
• You ask your team members to continue without you and stay with the boy to inquire into the matter.

A four-year-old girl is admitted to your unit with sharp ear pain. Along with that, parents are concerned about the girl’s psychological health. What are your steps in trying to identify whether she has autism?

• You perform a thorough analysis of the child’s behavior by observing her for several minutes.
• You observe the child for several hours.
• You conduct a parent interview and interact with the child directly.

As a nurse taking care of an autistic child staying in a ward with a non-autistic child, what should you ensure?

• That the autistic child has the opportunity to engage in his routine tasks.
• That the non-autistic child does not disturb the autistic child.
• That both children have plenty of opportunities for communication.

Out of these three children, which one would you consider to have the highest risk for autism?

• The child sits in one position, becomes afraid when the bright light is on, and loves to arrange toys by size.
• The child loves reading books, is fidgety, and gets upset easily.
• The child is constantly rocking, arranges toys by size or color, and avoids the company of peers.

As a nurse, what is your position when the parents of an autistic child want to interrupt the treatment and to take the child home?

• Let them go on condition that they will continue treatment at home.
• Try to convince the parents that the child is safer at the hospital where he is under constant supervision.
• Try to persuade the parents that by disrupting the treatment process, they will deteriorate his psychological condition.

A 12-year-old boy, who was admitted yesterday, is staying in your hospital unit. You notice that some of the crucial questions were missed upon the child’s arrival, and at the moment, parents are not available. How do you obtain the crucial information?

• Ask the child since he is old enough to answer those questions.
• Call the boy’s parents and request them to come immediately.
• Wait till the parents come to visit their son and ask them everything you need.
• B (new foods can cause anxiety, so you must make sure the child receives the food he/she is accustomed to).
• C (autistic children often have trouble getting to sleep. If not supported, they may not fall asleep at all, which will deteriorate both their psychological and physical conditions)
• C (it may come as a shock to parents. You should be extremely gently and polite).
• A (you should act as a patient advocate and protect the child from excessive anxiety)
• C (routine is extremely important for ASD children. It is necessary to find out what has happened as soon as possible and return the child into his habitual environment)
• C (the most comprehensive approach should be used)
• A (the most important thing for autistic children is their routine – hence, you must make sure they have an opportunity to maintain it)
• C (these are the most typical characteristics of ASD children)
• B (you should first of all care about the patient’s interests: you need to make sure that the disease with which the child was hospitalized has been cured before discharging the patient)
• C (autistic children, when if seeming mature, are likely to develop anxiety in critical situations. The child may become afraid of questions, so it is best to wait for the parents).

Summative Performance Assessment: Care for the Autistic Child Research Paper

Directions: Throughout the module, you have had an opportunity to explore the peculiarities of nursing care for the autistic child using evidence-based standards, textbook readings and other resources, scenario-based learning activities, and other activities that enriched your knowledge of ASD and prepared you to apply it in practice. For this assignment, your task will be to conduct research and develop a scholarly paper related to an autistic child. This will help you to be prepared to encountering ASD patients when working as a nurse. In this scholarly paper, you will be investigating and discussing the signs and symptoms of ASD, clinical manifestations, and nursing interventions. You will also provide a nursing care plan and prepare a thoughtful reflection based on your knowledge, skills, and attitudes about ASD before and after completing this module. APA7 and professional communication are required for the successful completion of this assignment. Please review all learning resources and activities and refer back to the grading rubric to make sure that you have followed all the requirements. In case you need clarification on any part of the assignment, feel free to contact your nurse educator.

Description of Assessment: You will write a six-page paper on ASD following the given outline:

• Introduction/Background: Provide an introduction to the topic. Explain its significance and relevance.
• Pathophysiology: Explain the pathophysiology of ASD.
• Clinical Manifestations and Diagnostics: Describe clinical manifestations of ASD and the diagnostic tools that can help in the identification of the issue.
• Medical Management: Describe the medical approaches to managing the topic. Analyze in what cases medical management is applicable and on what occasions it is better to avoid it.
• Nursing Interventions: Suggest at least two nursing interventions that could be employed in managing an ASD child’s case. Provide a rationale for your choice of interventions.
• Reflection: Discuss your knowledge and attitudes toward ASD prior to the completion of this module versus upon completion. Analyze your self-awareness related to nursing practice with ASD children. Dwell on how your current nursing practice has changed or will change after the completion of this module. Discuss how you can be an advocate for ASD children’s and their families’ needs at your workplace. If not currently employed, discuss how you plan to advocate for change in ASD management at your future workplace.
• References: A minimum of five peer-reviewed journal articles is required. Sources must be from the past five years.
• APA Guidelines: Follow APA guidelines strictly when developing your scholarly paper. Ensure title page, font, paragraph format, page numbers, line spacing, headings, and subheadings conform to APA7 guidelines.
• Chicago (A-D)
• Chicago (N-B)

IvyPanda. (2022, August 22). Nursing Care of Autistic Children. https://ivypanda.com/essays/nursing-care-of-autistic-children/

"Nursing Care of Autistic Children." IvyPanda , 22 Aug. 2022, ivypanda.com/essays/nursing-care-of-autistic-children/.

IvyPanda . (2022) 'Nursing Care of Autistic Children'. 22 August.

IvyPanda . 2022. "Nursing Care of Autistic Children." August 22, 2022. https://ivypanda.com/essays/nursing-care-of-autistic-children/.

1. IvyPanda . "Nursing Care of Autistic Children." August 22, 2022. https://ivypanda.com/essays/nursing-care-of-autistic-children/.

Bibliography

IvyPanda . "Nursing Care of Autistic Children." August 22, 2022. https://ivypanda.com/essays/nursing-care-of-autistic-children/.

• The Diagnosis of People With ASD
• Autism Spectrum Disorder (ASD)
• Laboratory Diagnosis of Autism Spectrum Disorders
• High Level Autistic Disorder
• ASD: Diagnostic and Statistical Manual of Mental Disorders
• Emerging Adults With ASD and the Importance of Close Relationships
• Autistic Community: Media Representation
• Autism Spectrum Disorder
• Children With Autism Spectrum Disorder: The Training Program for Caregivers
• Cognitive-Behavior Therapy for Autistic Children
• Inexpediency of a Collaborative Agreement Between Physicians and Nurses
• Infection Prevention in Hospitals: The Importance of Hand Washing Among Surgical Nurses
• Team-Based Learning in Nursing
• Competing Needs Involving Patient Portals
• Competing Needs in Improving Access to Healthcare