RAJIVGANDHIUNIVERSITY OF HEALTH SCIENCESBENGALURU, KARNATAKA

PROFORMA FOR REGISTERATION OF

SUBJECTS FOR DISSERTATION

1 / NAME OF CANDIDATE AND ADDRESS / Mr. SATHISH D. K
1 YEAR M Sc NURSING
BGS COLLEGE OF NURSING,
MYSORE
2 / NAME OF THE INSTITUTION / BGS COLLEGE OF NURSING
MYSORE
3 / COURSE STUDY AND
SUBJECT / I YEAR M.SC. NURSING
CHILD HEALTH NURSING
4 / DATE OF ADMISSION TO COURSE / 30/06/2012
5 / TITLE OF THE TOPIC / A STUDY TO EVALUATE THE EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME ON KNOWLEDGE REGARDING AUTISM AMONG PARENTS OF AUTISTIC CHILDREN AT SELECTED AUTISTICSCHOOL AT MYSORE.
  1. BRIEF RESUME OF THE INTENDED WORK

INTRODUCTION

Child is a gift of life to a mother. It is a wonderful and pleasant experience to have a baby. When the child grows and develops into an adult stage, along with the physiological development, the child’s mental capabilities also need to be developed. During this process of growth and development child may suffer from many psychological and behavioral problems. So it is important for mother to know about the child’s behavioral problems during the early years of their children life.

At some developmental stage all children will display some psychological and behavioral abnormalities but they may be considered as disorders depend on their frequency and persistence and the effect they have on physical, emotional and social functioning. The child's problems are often multi-factorial and the way in which they are expressed may be influenced by a range of factors including developmental stage, temperament, coping and adaptive abilities of family, the nature and the duration of stress. Children do not always display their reactions to events immediately although they may emerge later. Children should be allowed to express their true fears and anxieties about impending events. Young children will tend to react to stressful situations with impaired physiological functions such as feeding and sleeping disturbances 1.

Pervasive developmental disorder refers to a group of disorders characterized by delays in the development of socialization and communication skills. Autism is a developmental brain disorder characterized by impaired social interaction and communication skills and by a limited range of activities and interests and it is the most characteristic and best-studied pervasive developmental disorder 2

Autism was first described in 1943 by Johns Hopkins psychiatrist Leo Kanner, and again in 1944 by Austrian pediatrician Hans Asperger. Kanner applied the term to children who were socially withdrawn and preoccupied with routine, who struggled to acquire spoken language yet often possessed intellectual gifts that ruled out a diagnosis of mental retardation 2.

Autism is characterized by impaired development in social interaction, communication, and behavior. The degree of autism varies from mild to severe. Severely afflicted patients can appear to have a profound intellectual disability. Research tends to continue to refute the idea that immunizations cause autism. The cause of autism is unknown. The optimal treatment of autism involves an educational or vocational program that is suited to the developmental level of the child or adult, respectively 3.

6.1 NEED FOR THE STUDY:

Autism afflicts one out of every 100 to 166 children and it affects the lives of many children and their families. It tends to affect about five boys to every one girl. But autistic girls will tend to have more severe symptoms and greater cognitive impairment. The disorder becomes apparent in children generally by the age of 3 years 4.

Mothers of children with autism were significantly less likely than those of typically developing children to report having taken prenatal vitamins during the three months before and the first month of pregnancy5.

A study was conducted to help identify environmental and other factors that may put children at risk for developing conditions within the autism spectrum disorders (ASDs).This study involves the parents of 2- to 5-year-old children who have been diagnosed with ASD conditions, as well as the parents of children who do not have ASD conditions. Parents will be interviewed by telephone by trained GSPH staff and asked about demographic information and information on air pollution and other environmental exposures for each residential area will be obtained. The study showed that environmental and other exposures had a risk for developing autism in children 6.

A study was conducted to examine the prenatal and birth history as potential sources of risk factors in relation to the onset of autism on a cohort of 164 families of autistic children at New Jersey, over a two-year period. Intake prenatal and birth history information was obtained from each family and reviewed by a clinician. Results revealed that systemic problems at the prenatal and natal stage are associated with the risk of autism in children 7.

Early and intensive autism education can help children grow and learn new skills. The goal of this education is to help with the difficult symptoms of autism in a child and to improve the child's skills that help him or her talk, interact, play, learn, and care for his or her needs 8.

6.2. REVIEW OF LITERATURES

  1. Literatures related to prevalence of autism
  2. Literatures related to knowledge of mothers regarding autism
  3. Literatures related to effectiveness of structured teaching programme.

1. Literatures related to prevalence of autism

A study was conducted to determine the relationship between the proportion of children who received the recommended vaccines by age 2 years and the prevalence of autism in each U.S. state from 2001 and 2007. Results showed that there is a positive and statistically significant relationship. The higher the proportion of children receiving recommended vaccinations, the higher was the prevalence of AUT. A 1% increase in vaccination was associated with an additional 680 children having AUT. These results suggest that although mercury has been removed from many vaccines, other culprits may link vaccines to autism9.

A study was conducted to compare the reported receipt of family-centered care between parents of white and black children with autism spectrum disorders (ASD) in the United States. Parents of 35386 children, aged 0 to 17 years, were surveyed by the National Survey of Children with Special Health Care Needs (NS-CSHCN) 2005-2006. The results revealed that the prevalence of autism is more among white parents than black parents reported receiving family-centered care. Lastly, among parents with a child with ASD, being black was associated with lower reporting of family-centered care for 3 of 5 items 10.

A study was conducted to determine the prevalence of autism in US children. Data was collected from children aged 3 to 8 years from the 1997-2008 National Health Interview Surveys. Results showed that boys had a higher prevalence of autism than girls. Hispanic children had the lowest prevalence of autism than non-Hispanic white and black children. Autism, attention deficit hyperactivity disorder, and other developmental delays increased, whereas hearing loss showed a significant decline. This study concluded that the number of children with autism has increased, requiring more health and education services 11.

2. Literatures related to difficulties experienced by mothers having autistic child

A descriptive study was conducted to determine the difficulties experienced by mothers with autistic child. The study was carried out in one public and two private rehabilitation centers. A structured questionnaire was used as a tool for collecting the data from a sample of 106 mothers having autistic children. The findings of this study showed that mothers did not have enough knowledge about their child's condition. Mothers felt severe sadness, and they indicated that after having a disabled child, their social life, working life, and family relationships were all affected 12.

A study was conducted to explore and categorize the experiences of mothers having an autistic child using a phenomenological design in the qualitative tradition in Turkey. Semi structured interviews were conducted with 43 mothers regarding their experiences with their autistic children. Findings revealed that the mothers expressed feelings of burden and stress because of their child's behaviors associated with autism, as well as their own role and future expectations, and the complexity of care needed by their children at home. These findings support the need for training programs for mothers and parents conducted by nurses and other healthcare professionals who have special knowledge and skill to provide education and modeling of therapeutic interventions 13.

A study aimed to investigate the association between maternal self-efficacy and parenting cognitions among mothers of children with autism. Data was collected by using questionnaires from 174 mothers. In a hierarchical linear regression, depression, parenting stress, agency, and guilt each accounted for unique variance in maternal self-efficacy when controlling for time since diagnosis and the presence of a second child with a disability. Result showed that autism knowledge was not associated with parenting self-efficacy. Self-efficacy was associated with well-being, agency, and feelings of guilt among mothers of children with autism. Parent- and family-based interventions designed to support parental well-being and focusing on parenting cognitions may enhance parenting self-efficacy 14.

3. Literatures related to effectiveness of structured teaching programme

A study was conducted to assess the effectiveness of structure teaching programme on developmental problems of children among mother attending OPD in selected hospital, Bangalore. A pre-experimental and evaluative research approach was used with one group pre-test post-test design. A purposive sampling technique was used to select 40 samples. Findings of this study revealed that the mean post-test knowledge score of antenatal mothers attending self-care strategies significantly higher than that of their mean pre-test knowledge score 15.

A study was conducted to determine the effectiveness of structure teaching programme module in selected hospital of Erode, Tamilnadu among mothers regarding selected developmental disorders of children. 60 mothers participated in the study. Non probability purposive sampling technique was used. Findings of the study indicated that in experimental group, the mean post-test knowledge score (61.17) is higher than the mean post-test knowledge score of (16.13) of control group with ‘t’ value 33.01P<0.001 level of significance. This study indicates that planned self-instructional module is effective in improving the knowledge of mothers16.

6.3 STATEMENT OF THE PROBLEM:

A Study To Evaluate The Effectiveness Of Structured Teaching Programme On Knowledge Regarding Autism Among Parents Of Autistic Children At Selected Autistic School At Mysore.

6.4. OBJECTIVES:

  1. To assess the pre test level of knowledgeamong parent’s of Autistic Children.
  2. To evaluate the effectiveness of structured teaching programme on knowledge regarding autism among parents Of Autistic Children at SelectedAutisticSchool atMysore.
  3. To find out the association between pre testlevel of knowledge of parents regarding autism with selected demographic variables.

6.5. OPERATIONAL DEFINITIONS

Effectiveness:

Refers to the extent to which structured teaching programme have achieved the desired effect on knowledge of parent’s children regarding autism.

Structure teaching programme:

Refers to a explanatory material prepared in English and Kannada regarding prevention and management of autism.

Knowledge:

Refers to the information possessed by parents of children regarding autism assessed by structured knowledge questionnaires.

Parents:

Refers to the fathers and mothers of children with autism.

6.6 CONCEPTUAL FREAME WORK:

In this study Von Bertlafly`s System theory

6.7 HYPOTHESIS:

At 0.05 level of significance

H1: There will be significant difference between mean pre-test and post-test knowledge scores on autism among parents of autistic children in selected autistic school at mysore

H2: There will be significant association between mean pre testknowledge regarding on autism among parents of autistic children in selected autistic school at Mysore

6.8. ASSUMPTIONS

  1. Autistic behavior is common in children.
  2. Parents may have less knowledge regarding prevention and management of autism.
  3. Structured teaching programme may help in improving the knowledge of parents.

6.9. DELIMITATION

The study is limited to

1.Parents of autistic children.

2.Parents of children selected autistic school.

3.Parents of autistic children available at the time of study.

7.0MATERIALS AND METHOD

7.1SOURCES OF DATA

Data will be collected from to parents autistic children selected autistic school.

7.1.1 RESEARCH DESIGN

Pre-experimental design (one group pre test-post test design).

7.1.2 RESEARCH APPROACH

Evaluative research approach

7.1.3 RESEARCH VARIABLES

Independent Variable: structure teaching programme on knowledge regarding autism

Dependent variable: Knowledge level of parents regarding autistic children.

Demographic Variables: Age, education, occupation, religion, family type, number of children, family income and source of information.

7.1.4SETTING

The study will be conducted in selected autistic schools at Mysore.

7.1.5POPULATION

Population in the study consists of parents of autistic children from a selected autistic schools at Mysore.

7.2METHODS OF DATA COLLECTION:

7.2.1 SAMPLING PROCEDURE:

Sample: Sample consist of parents of autistic children in selected autistic schools

Sample technique: Convenient sampling technique

7.2.2 Sample size: 50

7.2.3 INCLUSION CRITERIA

  1. Parents having children with autism.
  2. Parents who are willing to participate in the study.

7.2.4 EXCLUSION CRITERIA

  1. Parents who are not available at time of study.
  2. Parents who cannot understand both English and Kannada.

7.2.5Instrument used

Tools for data collection are divided into following categories:

Part I: Items on demographic variables will be listed under structured questionnaires.

Part II: Structured knowledge questionnaires regarding autism management.

7.2.6 Methods of collection of data:

Data will be collected by direct administration of structured knowledge questionnaire regarding management on autism among parents of autistic children.

7.2.7 Plan for data analysis: In this study, descriptive and inferential statistical test will be used.

  • Demographic data will be analyzed using number, frequency and percentage.
  • Effectiveness of STP will be measured by using paired‘t’ test, mean & standard deviation.
  • Chi square test to determine the association between the pre test knowledge of parents regarding autism and selected demographic variables.
  • Does the study require any investigation or interventions to be conducted on patients or other human or animal?

Yes, only educational intervention for parents of under-five children with autism regarding autism at selected autistic school at Mysore.

7.4Has the ethical clearance been obtained from your institution?

Yes, Ethical clearance will be obtained from the research committee of BGS college of nursing.

Written permission will be obtained from the authority of autistic school to conduct the research study.

The informed consent will be obtained from the samples for their willingness to participate in the study.

  1. REFERENCES
  1. Harland P, Reijneveld SA, Brugman E, et al. Family factors and life events as risk factors for behavioral and emotional problems in children. Eur Child Adolesc Psychiatry 2002 Aug;11(4):176-84. Available from:
  2. Madeleine Nash J. The Secrets of Autism.

3.Roxanne Dryden-Edwards. Autism facts. Medicine net 2011 Jun; Available from:

  1. Arthur Schoenstadt. Autistic Children: An Overview. Med TV: Health information brought to life 2008 Nov; Available from:
  1. Rebecca J. Schmidt. Women Who Start Prenatal Vitamins Early Are Less Likely To Have Children With Autism. Pregnancy / Obstetrics 2011 May; Available from:
  1. University of PittsburghGraduateSchool of Public Health. Environmental Risk Factors For Childhood Autism. Pediatrics / Children's Health. 2011 Jun; Avialable from:
  1. Brimacombe M, Ming X, Lamendola M.Prenatal and birth complications in autism.Matern Child Health J. 2007 Jan;11(1):73-9. Epub 2006 Oct 12. Avaialble from:
  1. The Importance of Autism Education.
  2. Delong G. A Positive Association found between Autism Prevalence and Childhood Vaccination uptake across the U.S. Population. J Toxicol Environ Health A. 2011 Jan;74(14):903-16. Available from:
  1. Montes G, Halterman JS. White-Black Disparities in Family-Centered Care Among Children with Autism in the United States. Acad Pediatr 2011 May. Available from:
  1. BoyleCA et. al. Trends in the Prevalence of Developmental Disabilities in US Children, 1997-2008. Pediatrics. 2011 Jun;127(6):1034-42. Epub 2011 May. Available from:
  1. Sen E, Yurtsever S. Difficulties experienced by families with disabled children. J Spec Pediatr Nurs. 2007 Oct;12(4):238-52. Available from:
  1. Bilgin H, Kucuk L. Raising an autistic child: perspectives from Turkish mothers. J Child Adolesc Psychiatr Nurs. 2010 May;23(2):92-9. Available from:
  1. Kuhn JC, Carter AS. Maternal self-efficacy and associated parenting cognitions among mothers of children with autism. Am J Orthopsychiatry. 2006 Oct;76(4):564-75. Available from:
  1. Boro Enu. Self-instructional module self-care strategies antenatal mother. 2007; Available from:
  1. MerlinMB. Assessement of the effectiveness of self instructional module regarding selected developmental disorders of children among mothers. University of Chennai. Tamil nadu.2005.

9 / SIGNATURE OF THE CANDIATE / MR. SATHISH .D.K
10 / REMARK OF THE GUIDE
11 / NAME AND DESIGNATION (in block letters)
11.1 GUIDE / Mr. ARUL
ASST PROFESSOR & HOD
DEPT OF CHILD HEALTH NURSING
BGS COLLEGE OF NURSING,MYSORE
11.2 SIGNATURE
11.3 CO-GUIDE(if any)
11.4 SIGNATURE
12 / 12.1 HEAD OF THE DEPARTMENT / Mr. ARUL
ASST PROFESSOR & HOD
DEPT OF CHILD HEALTH NURSING
BGS COLLEGE OF NURSING,MYSORE
12.2 SIGNATURE
13 / 13.1 REMARK OF THE CHAIRMEN AND PRINCIPAL
13.2 SIGNATURE