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LICEO DE CAGAYAN UNIVERSITY

SCHOOL OF GRADUATE STUDIES
R.N. PELAEZ Blvd., Carmen, Cagayan de Oro City






PEDIA CARE CASE STUDY:
CHILD DEVELOPMENT ADJUSTMENT







SUBMITTED TO:
DR. MARILU DENSING-DIZON
SCHOOL OF GRADUATE STUDIES
LICEO DE CAGAYAN UNIVERSITY
CAGAYAN DE ORO CITY








SUBMITTED BY:
RUBELLE MICAH C. SAPONG
AUGUST 6, 2014

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TABLE OF CONTENTS
TITLE PAGE

I. INTRODUCTION 3

II. CLIENTS PROFILE 5

A. DEMOGRAPHIC DATA
B. HISTORY
C. OTHER ASSESSMENT

III. GROWTH AND DEVELOPMENT 6

A. COGNITIVE
B. PHYSICAL

IV. RELATED THEORIES 7

A. ABRAHAM MASLOWS HIERARCHY
OF NEEDS
B. FLORENCE NIGHTINGALES
ENVIRONMENTAL THEORY
C. SISTER CALLISTA ROYS
ROLE ADAPTATION MODEL

V. CONCLUSION 10

APPENDIX


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I. INTRODUCTION

Autism and Autism Spectrum Disorder (ASD) is a
neurodevelopmental disorder characterized by impaired social interaction,
verbal and non0verbal communication, and by restricted and repetitive
behavior. According to the Diagnostic and Statistical Manual for Mental
Disorders (DSM IV), one of the diagnostic criteria for children with autism
is that the symptoms must already be apparent before they reach the age
of 3. It is one of the recognized disorders under the Autism Spectrum
Disorders (also known as Pervasive Developmental Disorders) along with
the other two disorders which are Retts disorder, a pervasive
developmental disorder which is characterized by the development of
multiple deficits after a period of normal functioning; and Aspergers
disorder, which is characterized by the same impairments of social
interaction and restricted stereotyped behaviors as seen in autistic
disorder, but there are no language or cognitive delays in development.

Children with autism display little eye contact with and make few
facial expressions towards others; they use limited gestures to
communicate. They also have a limited capacity to relate to their parents
and as well as towards their peers. They also lack spontaneous
enjoyment, express no moods or emotional affect, and they cannot
engage in play or make-believe with toys. These children engage in
stereotyped behaviors such as hand flapping, body twisting, or head
banging.

Research has showed that 80% cases of autism are early onset,
with developmental delays starting in infancy. The other 20% of children
with autism have seemingly normal growth and development until 2 or 3
years old, and then they start to have a developmental regression or loss
of abilities. They stop talking and relating to parents and peers and begin
to demonstrate the behaviors described previously.

Autism is linked with genetics; many children with autism have a
relative with autism or autistic traits. Controversy continues about whether
measles, mumps, and rubella (MMR) vaccinations contribute to the
development of late-onset autism.

Autism tends to improve, in some cases substantially, as children
start to acquire and use language to communicate with others. In
adolescence, if the behavior starts to deteriorate, it may reflect the effects
of hormonal changes or difficulty meeting increasingly complex social
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demands. Autistic traits persist into adulthood, and most people with
autism remain dependent on some degree to others.

This case analysis is focused on the diagnosis of patient P. Patient
P is a patient diagnosed with Autism Spectrum Disorder. When he was
around 1 year old, his parents discovered that he hasnt spoken a word.
His parents wondered if there was something wrong with their child
because they know a child who is the same age as their son and that child
can already speak a few words but their son has always been silent. They
decided to bring their child to a pediatrician. The pediatrician informed
them that it is wrong to compare their childs development to another child
because each childs development varies. The pediatrician told them to
come back after 6 months if the child has still not spoken a word by then.
After 6 months, they returned and the pediatrician referred them to a
speech therapist. After 6 months of therapy, patient P showed no signs of
improvement and they were referred to a psychiatrist in Cebu. Patient P
was then diagnosed with autism. The parents were advised to bring
patient P for regular check-up every 6 months.

At the age of 4 years the specialist Dr. VD diagnosed patient P with
Autism Spectrum Disorder. This case analysis shall discuss the progress
of patient P, specifically his growth and development and as well as the
different theories that can be associated with Autism Spectrum Disorder.
The theories that are going to be used in this case analysis are, Florence
Nightingales Environmental Theory, Abraham Maslows Hierarchy of
Needs, and Sister Callista Roys Role Adaptation Model .
















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II. CLIENTS PROFILE

A. DEMOGRAPHIC DATA
NAME: Patient P
AGE: 8 years old
SEX: Male
DATE OF BIRTH: November 6, 2006
HOME ADDRESS: Brgy. Carangan , Ozamis City
RELIGION: Roman Catholic
CURRENT EDUCATIONAL LEVEL: Elementary Level
DIAGNOSIS: Autism Spectrum Disorder

B. HISTORY

When patient P was around one year old and a few months,
his parents noticed that he had not spoken a word and they found it
odd. The parents decided to bring patient P to a pediatrician. The
pediatrician informed the parents that there are times when children
have delayed language development, the pediatrician told them to
observe patient P for a few more months and return for follow-up
check-up after 6 months.

After 6 months of observation, the parents brought patient
P back for follow-up check-up and the pediatrician referred them to
a speech therapist to help patient P cope with his communication
problem. After month of therapy, the therapist observed that patient
P was not getting any better and the therapist asked them to visit a
specialist in Cebu.

When Patient P was 4 years old, patient P was diagnosed
with Autism Spectrum Disorder by the specialist Dr. VD.

C. OTHER ASSESSMENT

Patient P shows a lot of concentration when he watches
television. He sometimes displays crying outbursts and temper
tantrums. He is very active and is always jumping around the room. He
does not have any visible lesions or other signs of disruption of his skin
integrity.

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III. GROWTH AND DEVELOPMENT ASSESSMENT

A. COGNITIVE
In the school age years, children are growing and developing
rapidly. In terms of their cognitive abilities, they are now starting to
understand the value of money. They also now have longer
attention spans and they are starting to grasp the concept of space.
These are examples of the normal cognitive development of a
school age child.
In Patient Ps case, he does not have the cognitive abilities
of a normal school age child because he has Autism Spectrum
Disorder which causes children who are afflicted with this disorder
to have a delayed development, specially their cognitive/ adaptive
development. Normal children are able to articulate their feelings
well, and they also have increased number of words in their
vocabulary. However, Patient P can only utter the words mama and
papa despite his age. He has difficulty in communicating which is
one of the reasons why he has poor tolerance towards frustration.
His attention span is fleeting. He cant make eye contact for more
than 3 seconds. He cant tell the time, which means that he must
never be left unsupervised because he will not eat on his own
accord. However, he is able to understand and perform simple
tasks such as closing and opening of the windows and turning on
the television. He is also able to follow simple instructions.

B. PHYSICAL
In the school age years, children grow rapidly in terms of
their physical attributes. They start to gain a lot of weight and they
are growing taller by the day. They also have improved control over
their body, especially when it comes to their hand-eye coordination
and as well as their agility.
Patient Ps height and weight are within the normal range of
an average school age child. However his fine motor and gross
motor control is not as good. He cant lift objects that are not that
heavy such as plastic chairs and the like. His control over his hands
is also not that good, he cant grasp objects properly; his hold is
weak. His gait is slightly concentrated on the right side. He jumps all
around the place, which is one of his steorotypic behaviors.

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IV. RELATED THEORIES

A. ABRAHAM MASLOWS HIERARCHY OF NEEDS

Abraham Maslow made a theory regarding the general
needs of humans. He derived a hierarchy of these needs.
Basically, in order to ascend in the hierarchy, one must have met
the needs of stage before that. There are 5 stages in the
hierarchy; the physiological needs, safety and security needs,
love and belongingness needs, self-esteem, and self-
actualization.

In the case of patient P, his needs are mostly met by his
family, specially by his parents. The parents have established a
daily routine for him, in order to let him participate in meeting his
needs. Patient P has difficulty in communication; therefore, he
cannot inform his parents when he is feeling hungry. The
established routine helps his parents feed him on time and it also
helps Patient P meet his physiological needs. With the love and
support provided by his family, he has achieved his safety and
security needs, as well as his love and belongingness needs.
Since patient P has difficulty in communication and social
interaction, I am not quite sure if he has already achieved the
other 2 stages of the hierarchy of needs.

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B. FLORENCE NIGHTINGALES ENVIRONMENTAL THEORY


Florence Nightingales environmental theory emphasizes on
the manipulation of the environment in order to help patients
recover fully. Back in the day, Nightingale observed that patients
who were treated in a clean environment were most likely to
recover faster than the ones who were treated in a dirty
environment. She established the fact that the environment can
greatly affect a patients health.


In the case of patient P, his primary physician Dr. VD
advised his parents to manipulate his environment in order for
him to maximize his potentials. The parents have established a
routine for patient P to follow, in order to meet his basic needs.
Certain activities were also encouraged for patient P, in order to
help with his development; such as the beading therapy- which
involves making patient P use beads and insert it into a thread,
this activitys goal was to improve or to increase his attention
span and improve his control over his hands. The manipulation of
patient Ps environment has made him docile unlike other
patients with the same disorder. People with ASD (Autism
Spectrum Disorder) lack the ability to recognize danger and their
response to pain is not normal; these people are also very
hyperactive and they are very susceptible to falls and other
accident-related injuries. That is why it is very important to
control the childs environment to keep him safe.

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C. SISTER CALLISTA ROYS ROLE ADAPTATION MODEL

Roy's model of nursing sees an individual as a set of
interrelated systems, biological, psychological, and social. The
individual tries to maintain a balance between each of these
systems and the outside world. However, there is no absolute
level of balance. According to Roy we all strive to live within a
band where we can cope adequately. This band will be unique to
an individual. The adaptation level is the range of adaptability
within which the individual can deal effectively with new
experiences.

Input Control Processes Effectors Output






FEEDBACK
Diagram 1. Roys Adaptation Model

Children who do not have developmental problems are able
to cope normally whenever they experience stressors or stimuli
in their daily lives. Patient P has delayed development which
means that his coping is not as good as those of normal children.
When he wants something, he has difficulty in expressing which
makes it hard for his caregivers to understand him, his coping is
manifested through his tantrums and sometimes because of the
gap in communication, he ends up not getting what he wants.
The next time he wants something, he might not express them
anymore because he wont be able to express it anyway which
makes him more agitated and restless. Frustrations also cause
him to make ineffective response to stress, an example of which
is his sudden outburst crying and his throwing fits and temper
tantrums.
Stimuli
Adaptatio
n Level
Coping
processes


Cognator

Physiological
Functions

Self-concept
Role Function
Interdepende
nce
Adaptive and
Ineffective
Responses
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V. CONCLUSION

Generally, studies have shown that patients with Autism
Spectrum Disorder can survive with the assistance of their significant
others. Studies have also shown that there are some patients who are
able to function effectively that they could even get married.

Through proper management and supervision, it is highly
possible for Patient P to obtain his optimal functioning. Also, it is also
important to follow through the therapies and routines that have been
prescribed and set-up for him. Even though his progress is slow, the
important thing is he is still developing and improving even if his
improvement is significantly slower than normal. It is important to
continue to provide positive reinforcement and also provide a safe
environment for him to exist in. Also, it is also important for him to
continue to interact with new people in order to improve his social
skills. The doctor has recommended that Patient P should continue to
attend school as long as he can because it will help him greatly with his
social skills training. It is also important to show a lot of patience in
dealing with him and with other people who are also mentally or
physically challenged.

The Filipino culture does not deal with disabilities well, that is
why it is important for medical professionals to maintain an unbiased
view of our patients. It is heartbreaking to think that the society shuns
those who are different and are treated as filthy beings. We, as nurses
may not be able to change the world, but in our little ways we can
somehow show our patients and their families that we wont judge
them no matter who they are, and that despite of all their imperfections,
we will care for them.