A world of their own - Pervasive Developmental Disorders Any child coming to the hospital for a procedure or an operation experiences a high degree of anxiety. When a child with Pervasive Developmental Disorder (PDD or Autism) comes to the hospital or the operating room, the anxiety of the child, as well as the caregivers, increases 1000%. This lens will help give you some understanding and some techniques to help the visit to the OR or hospital easier for patient, family and staff.
I was an inpatient Child and Adolescent Psychiatric Nurse for 7 years when I made a change and came to the operating room. Within my first 2 months in the operating room, I heard the unmistakeable cry of an autistic child. I watched as the staff didn't understand the disease or how to deal with the child, only increasing his anxiety, as well as, the anxiety of the parents, other families and patients in the room, and the staff. It was then I knew I had to help teach my colleagues the best way to help all involved have a smooth transition for these special kids.
What is PDD?
There are many different names given to the children that have developmental disorders. The most common name is: Autism. This falls under a larger umbrella of Pervasive Developmental Disorders (PDD) or even Autistic Spectrum Disorders (ASD). Included under these umbrellas are diagnoses including: Autistic Disorder, Rett's Disorder, Childhood Disintegrative Disorder, Asperger's Disorder, Pervasive Developmental Disorder NOS. Each has similar characteristics, yet all have select features that sets it aside as its own diagnosis.
All these children have problems with: Development, language, communication, socialization and motor behaviors.
Can you imagine....
When I give this talk, I do a small exercise to introduce the caregivers to the disease. It is a little difficult to perform on the internet, but if you have a good imagination, you will get the general idea.
Imagine if you will...you are in a room with 50 strangers for a lecture. You are asked to stand up in the front of the room, shoulder to shoulder with all the other participants. While standing there, you are asked to sing "Row, Row, Row your boat" in a round. Then, you are asked to clap while singing. Then there is loud and obnoxious music being played. Someone has started to turn the lights on and off. Then, the lecturer starts their lecture.
The scene is overstimulating to say the least and for the next 2 minutes of the lecture, you don't retain anything that was said. This is a typical day for the child with PDD. They are constantly overstimulated and can't focus on one thing. In just 2 minutes, the participants get somewhat frustrated. Think if you had to live with that every minute, of every hour, of every day.
Early Warning Signs
There are some early warning signs you can look for, that can tip you off that your child might have some degree of PDD. The earlier the intervention is made, the better prognosis the child has.
* No big smiles or warm joyful expressions by 6 months old.
* No back and forth sharing by 9 months old.
* No babbling by 12 months old.
* No words by 16 months old.
* No gestures by 18 months old (pointing, waving, showing).
* No two word prases by 24 months old.
* Loss of skills at any age.
Things you can do to make the visit successful
1. Provide consistency and predictability - as little change as possible.
- Few room changes. Keep them in on place as long as you can - it helps them
gain familiarity
- Keep a constant figure with them at all times (parent/caregiver)
- Know that a visit that might take 15 minutes with a normal developmental
child could take 1 hour with these children. Provide them the needed time.
2. Present information either verbally and/or visually, depending how this child learns.
- Find out from the parent/caregiver how this patient communicates. Have parent bring
picture cards/communication cards from home.
- Avoid long strings of verbal instructions, they can't remember the sequence.
Tell them each thing you want them to do individually, waiting until the first task is
completed until you give them the next direction.
3. Recognize inappropriate behaviors as a sign of distress.
- Try not to focus on the inappropriate behavior (unless the child is hurting themself).
- If they are more comfortable sitting on the floor, allow them to be on the floor.
- Utilize those things that make them comfortable. If they like doing puzzles, allow
them to continue doing their puzzle while you listen to their heart.
4. Reduce stimulation.
5. Remember that each child is unique and the person that knows that child best is the parent/caregiver.
6. Plan ahead. Early communication with the parent/caregiver to know likes and dislikes of child before they arrive.
7. Be flexible and creative. Don't be afraid to work outside of the box to make it work.
