Vulnerable Populations: The Advanced

Population/Public Health Nurse

Children with Disabilities: Autism
Lycia L. Harris
Jacksonville State University

Introduction
Children with disabilities face many challenges. From the time the disability is
identified, there are many doctors visits, therapies, scans, and sometimes surgeries
involved in the navigation of their care. The stress of care, especially care that is
typically life long, is sometimes difficult and extremely stressful on the patient and the
family.

Vulnerable Populations
* Vulnerable populations are populations at risk.
* The American Journal of Medicine defines a vulnerable population as: the
economically disadvantaged, racial and ethnic minorities, the uninsured, lowincome children, the elderly, the homeless, those with human
immunodeficiency virus (HIV), and those with other chronic health conditions,
including severe mental illness .
* Children with disabilities, such as autism, are a vulnerable population.

(ajmc.com, 2006)

The term 'autism spectrum disorders' (ASD) is the

common clinical nomenclature used to define these
lifelong disorders that impact the brain and behavior of
affected individuals.
Individuals with ASD are diverse in their symptom
presentation; for example, some individuals avoid social
contact while others are overly social and intrusive.
They also vary greatly in cognitive functioning level (for
example, from severe intellectual disability to well above
average intelligence) and their ability to function in real
life situations (for example, from living in an institutional
setting to full independent living with a spouse and
children).
(Reichow, 2016)

Quick Autism Facts

The exact reason for autism remains unknown.
Autism spectrum disorder (ASD) and autism is associated with disorders of
brain development.
People with autism have difficulty communicating (verbally and non-verbally)
People with autism display awkward behavior that is described as repetitive
and have difficulty interacting with others in social environments.

Heathy wise, children with autism may also have problems sleeping and
experience frequent gastrointestinal problems.
Although autism is associated with brain development, signs and symptoms of
autism is often not recognized until a child is 2 or 3 years old.
Surprisingly, given the often reported awkward behavior, there are children who
have autism, but have never been diagnosed.

Healthy People 20/20

Healthy people 2020 addresses vulnerable populations and
identifies illness prevention and health promotion objectives for them.
One of the four goals of health people 2020 is elimination of health
disparities, by addressing thirty-eight topics that emphasis access,
chronic health problems, injury, and violence prevention,
environmental health, food safety, education and community-based
programs, health communication, and health information technologies,
immunization and infectious disease, and public health infrastructure.
(healthypeople.gov)

Healthy People 20/20 : Objective DH-4

Objective DH-4: Reduce the proportions of people with disabilities who
report delays in receiving primary and periodic preventative care due to
specific barriers, addresses the differences and difficulties those with
disabilities face in obtaining healthcare related to those who do not have
disabilities

(heathypeople.gov)

Disparities and issues in vulnerable

populations must be identified quickly
and dealt with at both local and
national levels.
The Advanced Public Health Nurse is
in good position to assist those
considered vulnerable with their
issues.

Issues Impacting Children and

Families
with Autism

Access to Care
Access to healthcare for the disabled is a very
important issue facing our country. Research has
shown there is a great disparity between the types
of health care Americans with disabilities
experience verses those Americans who do not
have disabilities.
Careful monitoring of at risk groups and proper
reporting of data to focus groups and governmental
agencies should be done to aid that identification .

 The increase in the incidence of autism raises new concerns about

access to care, because autism is life-long issue.
There are greater disparities in access to care in the poor and
minorities.

(Falco, 2014)

There are huge disparities in access to care in poor families and

minorities. Problems attributed to poor access to care include:
single parent homes,
lack of insurance coverage even in states that mandate
autism coverage and
not enough trained professionals to aid in autism
diagnosis. Medicaid does not cover autism therapy for
young children at the most critical stages of their
development.

(Falco, 2014)

Under Diagnosis or
Miss-Diagnosis
People with autism have difficulty communicating
(verbally and non-verbally), display awkward
behavior that is described as repetitive and have
difficulty interacting with others in social
environments.
Surprisingly, given the often reported awkward
behavior, there are children who have autism, but
have never been diagnosed.

 Many children with autism and autism spectrum disorder(ASD) go

undiagnosed.
Early diagnosis and treatment are the keys to helping a child with autism
reach his or her full potential.
The average age of diagnosis of autism is over age 4 even though autism
can be diagnosed as early as 2 years of age.
One in 68 children in the United States has autism spectrum disorder which
is a 30% increase from the estimate of 1 in 88 children two years ago.
(Falco, 2014)

 Researchers at the University of Alabama at Birmingham, who lead the

Alabama Autism Surveillance project and studied 32 northern Alabama
counties as part of the report, say that Alabama's numbers show that one in
210 children have autism, much lower than the national average of one in 88
children.
It is widely felt that the children in Alabama are not being diagnosed and are
not getting proper services.

(Leech, 2012)

Communication and Cognitive

Problems
Children with Autism may have problems
developing language skills and
understanding what others say to them.
There may also be trouble communicating
non-verbally through the use of hand
gestures, making eye contact and facial
expressions.
(nidcd.nih.gov, 2016)

 Not every child with autism will have a language problem.

Ability to communicate varies depending on his or her intellectual and social
development.
Some children may be totally unable to speak
Some children may have huge vocabularies and speak about certain
subjects in great detail.
Most children with ASD have little to no problem pronouncing words
The majority of children with ASD have difficulty using language effectively,
especially when talking to other people.
Many have problems with the meaning and rhythm of words and sentences.
Many are unable to understand body language and vocal tones.
(nidcd.nih.gov, 2016)

Autism

The Advanced Public Health

Nurse (APHN)
and Autism

 Addressing the needs of disabled children with ASD involves making

healthcare, education and ease of access to services apart of the overall
care and management of this population.
It is important for APHNs to be conscious of this underserved community in
order to meet its needs.

APHN Strategies to Address Poor Access To Care in

Autism
As the clinician, the APHN can become familiar with developmental theory and signs and symptoms
of autism. This can be useful when doing assessments in the community to identify those children who
may need further developmental assessment. Most children with autism have no other co-morbidities.
As the educator, the APHN can educate families on needs of children with ASD and connect them to
available community services to aid in improving access.
As the administrator, the APHN can create clinics within institutions or health centers specifically
focusing on children with ASD or create mobile clinics to reach the underserved .
As the consultant, the APHN can problem solve with families, other health care agencies to review
community needs to make access to care accessible to all.
As the researcher, the APHN can come up with evidenced-based guidelines for access to care
base on demographics and community assessments and help develop policy related to access to care.

APHN Strategies to Address Under Diagnosis or MissDiagnosis in Autism

As the clinician, the APHN can learn developmental theory and signs and symptoms of
autism to aid in promoting early diagnosis and intervention, in primary care clinics.
As the educator, the APHN can go out to health agencies, and community centers to
educate parents and other health care providers on signs and symptoms of ASD.
As the administrator, the APHN can create programs and services that educate health
care providers and families on ASD within hospitals or community based health clinics.
As the consultant, the APHN can go to primary care providers and school administrators
to teach signs and symptoms of ASD.
As the researcher, the APHN can look at and assess reasons children with ASD go
underdiagnosed and create evidenced-based changes in the community.

APHN Strategies to Address Problems with

Communication and Cognition in Autism
As the clinician, the APHN can assess for signs and symptoms of autism and connect
those identified with services within the community. Early identification is the key to
success.
As the educator, the APHN can teach parents and school administrators ways to
identify problems with a child's language and communication such as not making eye
contact.
As the administrator, the APHN can institute early identification programs and mobile
clinics to reach the underserved or those who would other wise go undiagnosed.
As the consultant, the APHN can review programs that deal with childhood
assessment of communication and cognition and intervene, if necessary, to make
assessments more autism specific.
As the researcher, the APHN can look at current assessment tools and determine their
effectiveness.

Eriksons Developmental
Theory
and Autism

Erik Erikson was an American psychologist, born in and immigrated from

Germany, who developed a theory of human psychosocial development.
Eriksons work was based on the work of Sigmund Freud and his psychosexual theory of development. However, in contrast to Freuds theory that
human development follows a pattern based on sexuality, Erikson theorized
that development, particularly child development, was influenced by society
and cultural factors.
Both Erikson and Freud theorized, in order for a person to develop normally,
they must successfully complete each developmental stage.

Application of Eriksons
Theory in Care and Treatment
of Children with Autism

Major Concepts of Eriksons

Theory
Each stage must be mastered to facilitate
positive progression to the next

Erik Eriksons Theory of Development

Presents a psychosocial crisis life model that is highly regarded
Has eight stages of human development
Erikson believed that the stages of development are genetically inevitable in
shaping human development
Stages of human development occur in all people

 The APHN should implement Eriksons developmental theory when working

with children with ASD. Though there are differences in communication and
cognition compared to children who do not have ASD, it is still very important
to remember that each person must master their current developmental stage
in order to progress to the next stage appropriately.

Conclusion

 Children with Autism are a vulnerable population. In many

instances, these children lack appropriate access to care, are
under-diagnosed, and have communication and cognitive
deficits. It is important for the APHN to recognize signs and
symptoms of ASD to identify these at risk children and connect
them with early intervention services and therapies. Early
identification and connection with services proves to promote
positive outcomes in children with ASD.

References
A Parents Guide: Finding Help for Young Children with Disabilities (Birth 5). Retrieved:
September 5, 2016 from: National Dissemination Center for Children with Disabilities Online
http://NICHCY.org
Falco, M. (2014, March 28). Autism rates now 1 in 68 U.S. children: CDC. Retrieved from
CNN: http://www.cnn.com/2014/03/27/heath/cdc-autism/
Healthypeople. (2016, Retrieved July 13). Disability Health. Retrieved from Healthy
People.gov: http://www.healthypeople.gov
Leech, M. (2012, March 29). Autism Diagnoses for Alabama Children Jump 50 Percent
Since 2002. Retrieved from Al.com:
http://www.al.com/spotnews/2012/03/autism_diagnosis_for_alabama_c.html

 Nidcd.nih.gov, 2016. Autism Spectrum Disorder: Communication Problems in Children.

Retrieved : September 8, 2016 from National Institute on Deafness and Other Communication
Disorders (NIDCD): http://www.nidcd.nih.gov
Reichow, B. B. (2016, Retrieved September 8). Early intensive behavorial intervention
(EIBI) for young children autism spectrum disorders (ASD). Retrieved from Cochrane
Database of Systemic Reviews:
http://www.onlinelibrary.wiley.com.lib-proxy.jsu.edu/doi/10.1002/14651858.CD009260.pub
2/full
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