Using Picture Schedules in Medical Settings for Patients With an Autism Spectrum Disorder

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Autism is a neurobiological disorder that compromises ability to communicate and can be accompanied by anxiety, particularly for those in unfamiliar settings with unknown people. To improve communication, children with autism often relate well to pictures; however the literature describes no studies of picture schedules for patients with autism in medical settings. Our pilot project demonstrates how picture schedules for medical settings can relieve anxiety in children with autism and suggests that this approach should be employed as an innovative way to interact with patients with autism.

Section snippets

Constructing Picture Schedules

School-aged children with autism use pictures throughout their day to guide them through transitions. Picture schedules are designed to improve communication with children who have autism, decrease anxiety-related, problem behaviors, and increase overall compliance (Anderson et al., 1997, Bryan and Gast, 2000, Cafiero, 1998, Dugan, 2007, Fittipaldi-Wert and Mowling, 2009, Spriggs et al., 2007). They contain several series of pictures that depict the elements of activities, chronologically and

Purpose

This paper describes a project pilot testing picture schedules for children with autism in a tertiary hospital. Specifically, this descriptive feasibility study sought to answer these questions:

  • 1.

    Do the picture schedules decrease maladaptive behaviors and alleviate distress in individuals with autism in medical settings?

  • 2.

    Do parents/caregivers feel less distress when picture schedules are available for their child in medical settings?

  • 3.

    Is the use of picture schedules feasible within medical settings?

Literature Search

A literature search was conducted using four databases: two medical databases, the Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Medline (PubMed); an educational database, Education Resources Information Center (ERIC); and a psychological database, APA PsychNET. No limitations were put on the searches. The key terms autism + picture schedules yielded 23 articles. Eighteen articles were relevant to this project. These articles discussed using picture schedules with

Description of Project and Evaluation

The staff at a major medical center identified the need for making medical visits more tolerable for children and adults with autism. Working with autism experts, it was suggested that healthcare providers might best care for patients with autism by using pictures to inform them of what is expected, which, in turn, could alleviate anxiety. Picture schedules are used for this purpose in other settings, however very specific pictures of medical procedures were not found. Therefore, the first step

Results

Our results were encouraging, in that 87.5% of staff and 77.8% of parents/caregivers felt picture schedules decreased anxious behaviors of the child. Only one staff member felt that the picture schedules were not effective. In addition, 87.5% of staff and 88.9% of parents/caregivers thought the patient exhibited less distress. One staff member did not find that using picture schedules decreased child distress behaviors and one parent was unsure. Most parents/caregivers (77.8%) thought that the

Discussion

Overall, our pilot study revealed that healthcare providers and parents/caregivers found picture schedules reduced maladaptive behaviors in children with autism visiting a clinic. Children with autism and their parents routinely use picture schedules in educational and community settings, and are generally very familiar with them. Indeed, two parents commented that, in other settings, their children have been using picture schedules for some time and are used to having them available and all

Nursing Implications

Nurses are held responsible for following through with medical and nursing care plans, which can be very difficult with a child with autism who is scared, unsure of spoken language, and suffering from multiple developmental and cognitive disabilities. By adopting a simple picture schedule as a communication tool, nurses can explain to patients with autism what is expected of them, and help decrease patients' anxiety and fear (Table 3). Although this pilot study was small, the results are

Acknowledgments

This project was funded by the University of Iowa Hospitals and Clinics Children's Miracle Network and by a University of Iowa Hospitals and Clinics Process Improvement Grant. The authors would like to acknowledge the kids who are so brave in dealing with the day to day challenges that come with having autism; and the parents, who fight and advocate with unending persistence for equality and understanding among society for their children. The first author would also like to acknowledge his son,

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