A nurse is caring for a 10-year-old child with autism spectrum disorder (ASD) who becomes agitated and exhibits repetitive behaviors (rocking back and forth, flapping hands, making loud vocalizations) when the daily routine is disrupted, such as after being told that lunch will be delayed by 30 minutes due to a kitchen issue. Which nursing intervention should the nurse implement first?
The child begins rocking back and forth, flapping hands, and making loud vocalizations after being told that lunch will be delayed by 30 minutes due to a kitchen issue.
1Provide a visual schedule showing the revised daily routine with specific times✓ 정답
2Remove the child from the stimulating environment immediately
3Offer the child a preferred snack to distract from the routine change
4Use physical restraints to prevent self-injurious behaviors
해설
Visual schedules provide predictability and structure, which are evidence-based for managing routine changes in ASD. Other options may increase agitation or are inappropriate for non-emergent situations.
Clinical Judgment
This question assesses the nurse's top-priority clinical judgment when a child with Autism Spectrum Disorder (ASD) faces an unpredictable situation (lunch delay). The key is recognizing that the child's anxiety and stimming stem from a change in routine, and selecting an intervention that addresses that root cause. Providing a Visual Schedule (Option 1) is a root cause resolution approach that clarifies the disruption visually and structurally, respecting the child's cognitive processing style and reducing anxiety. Other interventions only address symptoms or could worsen the situation.
Memory Tip: Visuals First for ASD Fear of Change.
KR vs US: In Korea, the focus might be more on explaining the situation and offering comfort, whereas NGN/US nursing emphasizes systematically applying evidence-based interventions that meet the specific neurodiversity needs of a child with ASD. Visual supports are central to this.
Clinical Practice Guide
When caring for children with ASD, providing predictability and structure is the top priority. When routine changes are unavoidable, you must notify them in advance, explain using visual tools (photos, pictures, text), and clearly show the new routine after the change. A child's stimming behavior is a sign of stress, so instead of labeling it as "problem behavior" and trying to suppress it, understand it as a means of communication and focus on finding the underlying cause.
Caution: In SATA (Select All That Apply) questions asking for the "first/initial/priority intervention," unless there is a safety threat (respiratory distress, severe self-injury), educational/preventive interventions that address the cause of the behavior often take priority over environmental modifications or restrictive interventions. Physical restraint in option 4 is a last resort and is not appropriate in this case.
Autism Spectrum Disorder — Autism spectrum disorder. A neurodevelopmental disorder characterized by persistent deficits in social interaction and communication, along with restricted, repetitive patterns of behavior, interests, and activities.
Stimming (Self-Stimulatory Behavior) — Stimming behaviors. Repetitive movements or sounds such as body rocking, hand flapping, and hand waving. In ASD, these may appear as a way to regulate sensory input, manage anxiety, or express pleasure.
Visual Schedule — Visual schedule. A tool that shows the sequence of activities or routines using pictures, photos, and text. It provides predictability and structure for children with ASD, reducing anxiety and facilitating transitions.
Evidence-Based Intervention — Evidence-based interventions. Therapeutic approaches whose effectiveness has been proven through scientific research. In ASD nursing, this includes visual supports, applied behavior analysis (ABA), etc.
Least Restrictive Principle — Least restrictive principle. An ethical and legal principle that the least restrictive intervention should be applied only when necessary, while maximally protecting the patient's rights and autonomy. Physical restraint is a last resort.