AN EFFECTIVENESS OF INFORMATION BOOKLET ON

ASPERGER’S SYNDROME AMONG THE NURSING

STUDENTS IN A SELECTED NURSING COLLEGE AT

BANGALORE.

M.Sc Nursing Dissertation Protocol submitted to

Rajiv Gandhi University of Health Sciences,Karnataka,Bangalore.

By

Ms. SANDY KIMTHENHAT

M.Sc NURSING 1ST YEAR

2010-2012

Under the Guidance of

HOD, Department of Psychiatric Nursing

Nightingale College of Nursing

Guruvanna Devara Mutt

Near Binnyston garden

Magadi Road

Bangalore –23

1 NAME OF THE CANDIDATE AND ADDRESS

Ms. SANDY KIMTHENHATI YEAR M.Sc. NURSING, NIGHTINGALE COLLEGE OF NURSING,GURUVANNA DEVARA MUTT, NEAR BINNYSTON GARDEN,MAGADI ROADBANGALORE-23

2 NAME OF THE INSTITUTION

NIGHTINGALE COLLEGE OF NURING, GURUVANNA DEVARA MUTT, NEAR BINNYSTON GARDEN, MAGADI ROAD,BANGALORE-23

3 COURSE OF STUDY AND

SUBJECT M.SC NURSING IN PSYCHIATRY NURSING

4 DATE OF ADMISSION TO

THE COURSE

5 TITLE OF THE TOPIC:

“AN EFFECTIVENESS OF AN INFORMATION

BOOKLET ON ASPERGER’S SYNDROME AMONG

NURSING STUDENTS IN A SELECTED NURSING

COLLEGE AT BANGALORE" .

6.0 BRIEF RESUME OF THE INTENDED WORK:

INTRODUCTION In the middle of the twentieth century there was a name for a disorder that now appears to affect

an estimated 3.4 every 1,000 children ages 3-10, that causes disruption in families and unfulfilled

lives for many children. In 1943 Dr. Leo Kanner of the Johns Hopkins Hospital studied a group of

11 children and introduced the label early infantile autism into the English language. At the same

time a German scientist, Dr. Hans Asperger, described a milder form of the disorder that became

known as Asperger syndrome. Thus these two disorders were described and are today listed in the

Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TR (fourth edition, text revision)

as two of the five pervasive developmental disorders (PDD), more often referred to today as

autism spectrum disorders (ASD). All these disorders are characterized by varying degrees of

impairment in communication skills, social interactions, and restricted, repetitive and stereotyped

patterns of behavior.1

Asperger Syndrome (AS) named after the Austrian researcher Hans Asperger, is a developmental

disorder that is characterize by limited interests or an unusual preoccupation with a particular

subject to the exclusion of other activities :

Repetitive routines or rituals

Peculiarities in speech and language, such as speaking in an overly formal manner or

in a monotone, or taking figures of speech literally

Socially and emotionally inappropriate behavior and the inability to interact

successfully with peers

Problems with non-verbal communication, including the restricted use of gestures,

limited or inappropriate facial expressions, or a peculiar, stiff gaze

Clumsy and uncoordinated motor movements.2

Most recent reviews tend to estimate a prevalence of 1–2 per 1,000 for autism and close to 6 per

1,000 for ASD; because of inadequate data, these numbers may underestimate ASD's true

prevalence. PDD-NOS are the vast majority of ASD, Asperger's is about 0.3 per 1,000 and the

remaining ASD forms are much rarer. The number of reported cases of autism increased

dramatically in the 1990s and early 2000s. This increase is largely attributable to changes in

diagnostic practices, referral patterns, availability of services, age at diagnosis, and public

awareness, though as-yet-unidentified contributing environmental risk factors cannot be ruled out.

It is unknown whether autism's prevalence increased during the same period. An increase in

prevalence would suggest directing more attention and funding toward changing environmental

factors instead of continuing to focus on genetics.3

For example, one study found a reduction of brain activity in the frontal lobe of AS children when

they are asked to respond to the tasks that required them to use their judgment. Another study

found differences in activity when children were asked to respond to facial expressions. A

different study investigating brain function in adults with AS revealed abnormal levels of specific

proteins that correlates with obsessive and repetitive behaviors.2

In 1993, the World Health Organization published the 10th edition of the International

Classification of Diseases, and in 2000, the Diagnostic Statistical Manual text revision (DSM-IV-TR)

was released. This was the first time that both textbooks included Asperger's disorder-also

known as Asperger's syndrome-as one of the PDDs. Prior to this inclusion, many individuals were

misdiagnosed or not diagnosed until today.4

In 1994, the World Health Organisation (WHO) published the tenth edition of the International

Classification of Diseases (ICD-10) and in 1994 the American Psychiatric Association published

the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). This

was the first time both diagnostic textbooks included Asperger’s syndrome as one of several

Pervasive Developmental Disorders. There is currently ongoing controversy as to whether to

eliminate Asperger's syndrome as a separate disorder, and instead merge it under autism spectrum

disorders (ASD) in DSM -V to be released in 2013.

NEED FOR STUDY

The prevalence of Asperger's syndrome and autism spectrum disorders has increased

exponentially. The occurrence may approach 1 in 100 for all types of autism spectrum disorders.

Ultimately, this could account for 700,000 to 2,000,000 individuals in the United States with

Asperger's syndrome. Asperger's syndrome is four times more common in males than females.

Girls are most frequently misdiagnosed with a nonverbal learning disability rather than Asperger's

syndrome.4

Restricted areas of interest are a common symptom of pervasive developmental disorders. In

severe autism this may manifest as an overriding attachment to a specific object. Aspies tend to

focus on an area of interest to the point of obsession. A child with Asperger’s may develop an

interest in buses, for instance, and memorize every bus number and route in town. He or she may

also be able to recite the makes and model yea of every bus in the fleet.5

The restricted interests of people with Asperger’s are mixed blessings. Many Aspies channel their

interests and specialized knowledge into their careers, and can be very successful. On the other

hand an Aspie child may talk incessantly about, say, clocks, while lacking the social

perceptiveness needed to spot when a listener is bored or frustrated.5

Because Asperger's syndrome has been diagnosed in the United States only recently, it is unclear

how many people have the disorder. Some studies indicate that 2 out of every 10,000 children

have AS in the United States. Other studies indicate that as many as 3–4 of every 1000 children

have this condition. Asperger's syndrome affects boys more often than girls, and siblings of

children with the disorder are at increased risk.( Stanley J. Swierzewski, 2007)6

A population study in Sweden estimates the prevalence of Asperger disorder as 1 case in 300

children. Although this estimate is convincing for Sweden, the findings may not apply elsewhere

because they are based on a homogeneous population.6

Because of the divergent diagnostic criteria used in the United States and Canada, estimates of

Asperger disorder frequency widely vary. Various studies indicate rates ranging from 1 case in

250-10,000 children. Additional epidemiologic studies are needed, using widely accepted criteria

and a screening instrument that targets these criteria.6

Likely, many people with Asperger disorder are undiagnosed in North America. Many people

with Asperger disorder are probably members of the general population without awareness of their

diagnosis. Family and friends probably accommodate the signs of Asperger disorder as

idiosyncrasies of the individual.6

If Asperger disorder is diagnosed, then social skills training and other psychological interventions

may be provided to the person. Additionally, some benefits may be available to people who have

disabilities such as Asperger disorder.7

Well-known Asperger syndrome expert Tony Attwood suggests that females learn to better compensate for their impairments because of differences in socialization. Some preliminary

evidence for this is found in the Ehlers & Gillberg study, which found a 4:1 male to female ratio in

the people they thought definitely had AS but a much less lopsided 2.3 to 1 ratio when merely

suspected or otherwise borderline cases were included.

Individuals with Asperger disorder appear to have normal lifespan; however, they seem to endure

an increased prevalence of co morbid psychiatric maladies (eg, depression, mood disorders,

obsessive-compulsive disorder, Tourette disorder).Asperger disorder has no racial predilection and

the estimated male-to-female ratio is approximately 4:1.Asperger disorder is commonly diagnosed

in the early school years and less frequently during early childhood or even adulthood.7

One of the proposed changes in DSM-V that is set to be released in 2012 is to eliminate Asperger

syndrome as a separate diagnosis, and fold it under autism spectrum disorders. Under the proposed

changes, ASD will be rated on a scale ranging from severe, through moderate, to mild, based on

clinical presentation.

The recent studies and statistics throws a light that Asperger’s Syndrome is more prevalent among

male than female and the incidence is mainly among the school going children. The main causes

of Asperger’s Syndrome are unknown but family studies suggest a possible relation to autistic

syndrome. So it is evident that children’s especially school going are susceptible to this condition

and through information booklet, knowledge regarding this condition can be enhance among the

lame people through the nursing students. So the investigator is very much interested in doing this

topic.

6.2

REVIEW OF LITERATURE

INTRODUCTION

Review of literature is a key step in the research process. The typical purpose of analyzing

a review of existing literature is to generate questions and to identify what is known and

what is unknown about the topic. The major goals of review of literature are to develop a

strong knowledge base to carry out research and non research scholarly activity.

The review has been divided under the following headings:

a) Studies related to prevalence, etiology, and clinical features.

b) Comparative studies related to researches done on Asperger’s syndrome.

Studies related to prevalence, etiology and clinical features of Asperger’s Syndrome

PREVALENCE

Ehlers and Gilbert (1993) did a total population study of school going children aged

between 7 to 16 yrs and concluded that the prevalence rate 36 per 10000 children and the

ratio between male to female was 4:1.8

Fombonne et al (2001) surveyed 15 000 children in Staffordshire, England, aged between

2,5 yrs and 6,5 yrs with the aim of estimating prevalence of persuasive developmental

disorder using DSM –IV criteria. Results concluded the estimated prevalence of 62,6 per 10

000 (1:160) for children with persuasive developmental disorder and 2,5 per 10 000 for

Asperger’s Syndrome.8

Webb et al (2003), conducted a study on both autism and Asperger Syndrome using the

autism spectrum screening questionnaire on 11 692 children, aged between 7 to 11 yrs in

primary school in Cardiff, Wales and found that the prevalence rates were 25 out of 10 000.8

In 2007 - the most recent government survey on the rate of autism - the Centres for Disease

Control (CDC) found that the rate is higher than the rates found from studies conducted in

the United States during the 1980s and early 1990s (survey based on data from 2000 and

2002). The CDC survey assigned a diagnosis of autism spectrum disorder based on health

and school records of 8 year olds in 14 communities throughout the U.S. Debate continues

about whether this represents a true increase in the prevalence of autism. The CDC report

confirms other recent epidemiologic studies documenting that more children are being

diagnosed with an ASD than ever before.1

Data from an earlier report of the CDC's Atlanta-based program found the rate of autism

spectrum disorder was 3.4 per 1,000 for children 3 to 10 years of age. Summarizing this and

several other major studies on autism prevalence, CDC estimates that 2-6 per 1,000 (from 1

in 500 to 1 in 150) children have an ASD. The risk is 3-4 times higher in males than females.

Compared to the prevalence of other childhood conditions, this rate is lower than the rate of

mental retardation (9.7 per 1,000 children), but higher than the rates for cerebral palsy (2.8

per 1,000 children), hearing loss (1.1 per 1,000 children), and vision impairment (0.9 per

1,000 children).3 The CDC notes that these studies do not provide a national estimate.1

In 1993 Ehlers & Gillberg carried out a study among total population in Sweden and found that, at a minimum, 3.6 per 1000 school-aged children

definitely meet the criteria for Asperger syndrome. If merely suspected cases are included, the prevalence becomes approximately 7.1 per 1000. Like

other conditions classified as autism spectrum disorders, Asperger syndrome appears to be more prevalent among males than females, with males

making up approximately 75-80 percent of diagnoses.9

ETIOLOGY

Hans Asperger described common symptoms among his patients' family members, especially

fathers, and research supports this observation and suggests a genetic contribution to Asperger

syndrome. Although no specific gene has yet been identified, multiple factors are believed to

play a role in the expression of autism, given the phenotypic variability, evidence for a genetic

link is the tendency for AS to run in families and an observed higher incidence of family

members who have behavioral symptoms similar to AS but in a more limited form (for

example, slight difficulties with social interaction, language, or reading). Most research

suggests that all autism spectrum disorders have shared genetic mechanisms, but AS may have

a stronger genetic component than autism.10

At the present, there is no known cause for this very common and heterogeneous disorder

(1/1,000) which occurs in all races, ethnic groups and socioeconomic levels. The research

literature by Piven and Folstein (1997) supports that it is more common in males than females

(4:1) when the intellectual quotient is greater than 50 but there is a 1:1 gender ratio in the

children who are more intellectually impaired .11

For the majority of families with an autistic child and an unknown etiology, counseling is

problematic. The research reveals that a family is at 2.7% risk after one child with autism.

This data is somewhat confounded by the "Reproductive Stoppage Rules" since many parents

stop reproducing after the birth of a severely handicapped child (Jones and Szatmeri, 1988). In

1989, Ritvo evaluated the risk of autism in those families with one autistic child who did

choose to reproduce. He found 8.6% prevalence in these families (Ritvo et al, 1989). Although

 

 

the genetics of autism remains unclear, families with an autistic child should receive

counseling when considering a future pregnancy in order to receive the most current

information on their reproductive risks.11

Although its etiology is unknown, Asperger disorder is a behavioral syndrome caused by one

or more influences acting on the CNS. Reports of families with multiple members meeting the

criteria for this disorder suggest a genetic contribution to development of the disorder.

Asperger disorder and autistic disorder are likely genetically related. Unfavorable experiences

in the prenatal, perinatal, and postnatal periods may increase the likelihood of Asperger

disorder.11

As with so many PDDs, the causes of Asperger’s syndrome are unclear. A genetic component

seems to exist, but environmental factors may also play a role. Asperger’s is more common in

males than females, although exactly why gender plays a role in Asperger’s is unknown.

CLINICAL FEATURES

In 2005 Schnur J describes that Asperger's syndrome is not generally identified until the child

reaches age 3 or 4, and oftentimes not until age 11 or above. Even though parents often report

concerns about their child's development, it is not until they begin to have significant

difficulties with peer relationships in day care and school that parents really see the

differences. As the child becomes older, it is not uncommon for parents to take their child to a

mental health center due to concerns about depression.4

In 2006, Attwood T reported that intense and unusual preoccupations are often observed very

early in development and are sometimes the first signs of Asperger's syndrome noted by

parents. The timing, intensity, and nature of these interests are reflective of the disorder. The

more intense and unusual the interest or activity, the more it is suggestive of Asperger's

syndrome. One may not initially be concerned with a child having an intense interest.

However, the interest or activity can become all consuming and becomes eccentric.4

Stiff, pedantic, one-sided conversation style is most noticeable when the individual with

Asperger's syndrome is talking about their special interest. A lack of social reciprocity and

inability to interpret the listeners verbal and nonverbal social cues results in the individual

being perceived as self cantered, lacking empathy, and very formal in their manner of

speaking.4

Gardiner did two comparative experiments on incidental (implicit) and intentional (explicit)

memory performance in adults with Asperger's syndrome and individually matched controls.

Experiment 1 involved perceptual tests using word fragment cues whereas Experiment 2

Involved conceptual tests using paired associate cues. Performance in both the incidental tests

and intentional tests was similar for both groups with one exception. The adults with

Asperger's syndrome were more likely to falsely recall words that had not actually been

studied. These findings further delimit the nature of memory impairments in adults with

Asperger's Syndrome.12

Losh et al (2003) did a study to examines the narrative abilities of 28 high-functioning

children with autism or Asperger's Syndrome and 22 typically developing children across two

different discourse contexts. As compared with the typically developing children, the high-

functioning group performed relatively well in the storybook context but exhibited difficulty

imbuing their narratives of personal experience with the more sophisticated characteristics

typically employed by the comparison group. Furthermore, children with autism or Asperger's

Syndrome demonstrated impairments inferring and building on the underlying causal

relationships both within and across story episodes in both narrative contexts. Findings further

revealed that the narrative abilities of children with autism or Asperger's Syndrome were

associated with performance on measures of emotional understanding, but not theory of mind

or verbal IQ.13

Engstrom et al (2003) did a study on psychosocial functioning in Swedish adults with

Asperger’s Syndrome (AS) or high-functioning autism (HFA). A systematically selected

sample of patients and relatives was interviewed concerning their psychosocial situation. The

majority was living independently. All persons but one was unemployed. None was married

and none had children. Only a few had some kind of partner. Most persons needed a high level

of public and/or private support. The overall adjustment was rated good in 12 percent, fair in

75 percent and poor in 12 percent. Adult persons with AS/HFA have extensive need for

support from their families and/or society. 14

Comparative studies related to research done on Asperger’s Syndrome

Most of the research done on Asperger’s Syndrome has been in the form of comparative

studies of Asperger’s Syndrome and autism including high functioning autism. Most

researchers did a comparison of Asperger’s Syndrome, autism and deficits of attention, motor

control and perception involving a comparative of cognitive profile of 120 children. These

results mostly concluded that Asperger Syndrome, autism and high functioning autism do not

show significant differentiation. Ozonoff et al (1991);Manjiviona et al (1995); Schultz et al

(2005)8

Church et al (2000) conducted a study regarding the social issues, behavioral and academic

experiences of 40 children between 3-15 yrs who were diagnosed to have Asperger’s

Syndrome. Among the samples, 67% experienced auditory sensitivities, 62% tactile

sensitivities and 73% were described as clumsy.8

Szatmari et al(1995) did a comparative study of 47 children with a diagnosis of autism and a

mean age of 65,1 month 21 children with a diagnosis of Asperger’s Syndrome and mean age

of 68,6 months, differentiated on the basis of delayed and deviant language development. The

conclusion of the study indicates that Asperger’s Syndrome as a group demonstrates robust

differences across other Persuasive Developmental Disorder symptoms, adaptive behaviors

and cognitive measures of language competence. No major differences can be seen on aspects

of non verbal communication, non verbal cognition or motor development.8

Ozonoff et al (2000) did a comparative study among group of 12 adolescents (mean age 13, 9

yrs) with AS and group of 23 adolescents (mean age 13,3 yrs) with a diagnosis of high

functioning autism. The results of the study found that mean verbal intelligence (VIQ) was 120

and higher than mean non verbal or performance intelligence (PIQ) of 107,8 in the Asperger’s

Syndrome group. He also concluded that Asperger’s Syndrome is on the same spectrum as

other autistic syndromes and differ primarily in degree of impairment.8

In another research on new genetic study, Dr Bhismadev Chakrabarti and Prof Simon-Baron

Cohen from autism research in Cambridge conduct research in which 68 genes were chosen

either because they were known to play a role in neutral growth, social behavior or sex

hormones (testosterone & estrogen) and concluded that Asperger’s Syndrome occurs far more

often in male than in female.15

Data from an earlier report of the CDC's Atlanta-based program found the rate of autism

spectrum disorder was 3.4 per 1,000 for children 3 to 10 years of age. Summarizing this and

several other major studies on autism prevalence, CDC estimates that 2-6 per 1,000 (from 1 in

500 to 1 in 150) children have an ASD. The risk is 3-4 times higher in males than females.

Compared to the prevalence of other childhood conditions, this rate is lower than the rate of

mental retardation (9.7 per 1,000 children), but higher than the rates for cerebral palsy (2.8 per

1,000 children), hearing loss (1.1 per 1,000 children), and vision impairment (0.9 per 1,000

children).3 The CDC notes that these studies do not provide a national estimate.1

Research is being conducted to identify ' the chromosomal location and eventually the multiple

genes responsible for autism. Because of the twin studies and population genetics, it is

believed that there will be 3 to 5 genes responsible for autism. Presently, preliminary data

suggests chromosomes 7, 9, and 15 may be good locations for further investigation.11

STATEMENT OF PROBLEM:

“ An effectiveness of information booklet on Asperger’s Syndrome among the

nursing students in a selected nursing college at Bangalore”

OBJECTIVES OF THE STUDY

6.3

6.4

6.5

6.6

To assess the knowledge of the students on Asperger’s Syndrome.

To prepare and validate the booklet on Asperger’s Syndrome.

To evaluate the effectiveness of the booklet on Asperger’s Syndrome.

To find out the association between the effectiveness of the booklet among the nursing

students with their selected demographic variables such as age, sex and family

background.

HYPOTHESIS The hypothesis will be tested at 0.05 level of significance

H1: The mean post test score on Asperger’s Syndrome will be significantly greater

than the pre test knowledge score among the nursing students.

H 2: There will be significant association between knowledge scores on Asperger’s

Syndrome among the nursing students with their selected demographic variables such

as age, sex and family background.

OPERATIONAL DEFINITIONS:

EFFECTIVENESS

In this study it refers to producing the desired or intended result of information booklet on

Asperger’s Syndrome as measured by the instrument and shown by the post test scores of the

sample.

INFORMATION BOOKLET

In this study, it refers to the booklet consisting of all the necessary information like its

definition, incidence, causes, diagnosis, clinical features, treatment and prognosis of

Asperger’s Syndrome.

KNOWLEDGE

Here, it refers to the correct responses of the students to the knowledge part of the

questionnaire of the interview schedule and information booklet and expressed as knowledge

scores.

6.7

6.8

ASPERGER’S SYNDROME

It refers to the presence of social deficits in children and adolescents who have high

cognitive functioning and apparently normal early language development.

NURSING STUDENTS

In this study it refers to the students who are undergoing nursing courses.

ASSUMPTIONS

Nursing students will have adequate knowledge regarding Asperger’s Syndrome.

Information booklet on Asperger’s Syndrome for the nursing students will be able to enhance their knowledge

DELIMITATIONS

To provide clarity and consistency, the following limitations have been set for the presenting study :

To those students who are undergoing nursing courses.

To those who can read and write English

To those who attend the college

PROJECTED OUTCOME

The present study will help the nursing students to enhance their knowledge regarding

Asperger’s Syndrome.

MATERIALS AND METHODS

6.9

7.0

7.1 SOURCE OF DATA

The data will be collected from the students who are undergoing nursing courses in a

selected nursing college at Bangalore.

7.1.1 RESEARCH DESIGN

The research design adopted for this study is pretest – posttest design

RESEARCH APPROACH

The research approach used in this study is descriptive survey approach. An individual to

individual survey will be done for each sample

7.1.2 SETTING:.

The study will be conducted in a selected Nursing College at Bangalore.

7.1.3 POPULATION

The population selected is students who are undergoing nursing courses.

7.2 METHOD OF DATA COLLECTION

7.2.1 SAMPLING PROCEDURE

The Sampling Technique adopted for this study is random sampling..

7.2.2 SAMPLE SIZE

The sample size is 60.

7.2.3 INCLUSION CRITERIA

The criteria for sample selection are students who

Are undergoing nursing courses

Are willing to participate in the study

Can read and write English.

Are attending the college

7.2.4 EXCLUSION CRITERIA

Students who have opted for other courses apart from nursing.

Students who either cannot write or read English

Students who are not willing to participate in the study.

Students who are unable to attend the college.

7.2.5 INSTRUMENT INTENDED TO BE USED

SELECTION OF TOOL

This consist of three parts :

PART 1 : Consist of demographic variables such as age, sex and family background

PART 2: Questionnaire will be used to assess the knowledge. 25 Questions will be used.

PART 3: Observation and rating scale will be used to assess the practice.

SCORING PROCEDURE

For knowledge assessment

If answer is yes - 1

If answer is no - 0

SCORING INTERPRETATION:

Level of knowledge Range

Adequate knowledge Above 75%

Moderate adequate knowledge 51- 75%

In adequate knowledge 50% and below

FOR PRACTISE Good :- 75-100% Average :- 50-75% Poor :- Below 50%

7.2.6 DATA COLLECTION METHOD

Prior-permission will be obtained from the Management, The Principal, and from the staffs

of selected Nursing College at Bangalore before conducting the study. Interview will be

conducted between 9 am to 4 pm. Data will be collected from 5-7 samples per day. The

duration will be 4 weeks. The duration of study will be 30 minutes will be spent per each

subject.

7.2.7 PILOT STUDY

6 samples will be selected and study will be conducted to find out the feasibility.

7.2.8 DATA ANALYSIS PLAN

The data obtained will be analyzed in view of the objectives of the study

using comparative and inferential statistics.

The plan for data analysis was as follows: -

Mean, Median and Mode, Standard deviation is used for accessing

the knowledge scores

Frequencies and percentage of distribution will be used to analyze

the demographic data.

Chi-square test to find out the association between knowledge with

selected demographic variables. The significant findings will be

experienced in tables, figures and graph.

DOES THE STUDY REQUIRE ANY INVESTIGATION OR

INTERVENTION TO BE CONDUCTED ON PATIENTS OR OTHER

HUMANS OR ANIMALS?

- No-

HAS THE ETHICAL CLEARANCE BEEN OBTAINED FROM YOUR

7.3

7.4

INSTITUTION?

Yes, Ethical clearance will be been obtained from the research committee of Nightingale

college of nursing.

Consent will be taken from selected nursing college, and permission will be taken from

study subjects before the collection of data.

8.0 LIST OF REFERENCES

1) Rockville. Autism Spectrum Disorders: Pervasive Developmental Disorders.

National Institute of Child Health and Human Developmental.2001.Available

URL:

http://www.nimh.nih.gov/health/publication/autism/complete_index.shtml.

2) NINDS .Asperger’s Syndrome Factsheet. NIH Publication (Jan 2005)

Available URL:

http://www.ninds.nih.gov/disorders/asperger/detail_asperger.htm.

3) Baron IS. Autism Spectrum Disorder: Complex, Controversial and

Confounding. Neuropsychology Rev.2008;18(4):2712 Available URL:

http://en.wikipedia.org/wiki/Asperger_Syndrome.

4) Kristi Weber.Asperger’s Syndrome: From Hiding to Thinking. The American

Journal of Primary Health Care. July 2008.Vol 33.No 7.Page-14-21. Available

URL:

http://www.nursingcentre.com/library/journalarticle.asp?article_id_802969

5) Michael Mcgrath.Asperger’s Syndrome-A persuasive Developmental

Disorders on Autism Spectrum. June 2003. Available URL:

http://www.suite101.com/content/asperger’s_syndrome_as_a55960.

6) Stanley J.Swierzewski.Autism Overview: Incidence and Prevalence of

Autism.1 March 2000. Available URL:

http://www.neurologychannel.com/autism/index.shtml.

7) James Robert Brasic.Asperger’s Syndrome- Overview Differential Diagnoses

and Workup, Treatment and Medication, follow-up Multimedia.7 July 2010.

Available URL:

http://www.emedicine.medscape.com/article/912296-overview

8) Lynett Joan. The Neuropsychological Profiles of Learners with Asperger’s

Syndrome. November 2008. Available URL:

http://www.uir/ac.za/bitstream/10500/1359/1/thesis/pdf.

9) A Wisdom Archive: Aperger’s Syndrome- Speech and Language

Peculiarities. Available URL:

http://www.experiencefestival.com/Asperger_Syndrome_Prevalence.

10) Asperger’s Syndrome – Causes of Autism. 25 November 2010. Available

URL:

http://www.enwikipedia.org/wiki/Asperger_Syndrome.

11) Carole Samango-Sprouse. Pediatric Services: Diagnosing Autism.7 March

2010. Available URL:

http://www.paediatric.services/index/html.

12) Gardiner JM, Bowler DM, Grice SJ. Further Evidence of Priming and

Impaired Recall in Adults with Asperger’s Syndrome. June 2003:33(3):259-

69. Available URL:

http://www.ncbi.nmm.nih.gov/pub_med/12908827.biomediexperth.com.

13) Losh M, Capps L. Narrative ability in high-functioning children with autism

or Asperger Syndrome. June 2003. Available URL:

http://www.springlink.com/index/N2758274082597/q5.pdf

14) Engstrom I, Ekstrom L,Emilson B. Psychosocial functioning in a group of

Swedish adults with Asperger’s Syndrome or high-functioning autism. 7

March 2003.(1) 99-160. Available URL:

http://www.aut.sagepub.com/content/7/1/99.short.

15) Dr Chakrabarti, Prof Cohen. New study of Asperger’s Syndrome; Autistic

Traits and Empathy. July 2009-0:00 PDT. Available URL:

http://www.medicalnewstoday.com/articles/157802.php.

9. SIGNATURE OF THE CANDIDATE

10. REMARKS OF THE GUIDE

11. NAME AND DESIGNATION OF

11.1 GUIDE

11.2 SIGNATURE

11.3CO-GUIDE

11.4SIGNATURE

11.5 HEAD OF DEPARTMENT

11.6 SIGNATURE

12 12.1 REMARKSOF THE PRINCIPAL