A brief but insightful article that stresses the importance of communication is Autistic Kids Benefit from Dads' Involvement. This also applies to the issue of parental stress but echoes other studies that emphasize the importance of communication skills in treating autistic children. There article notes that autism is a disability or disorder that appears during the first three years of life and is characterized by problems interacting and communicating with others. Related to this is a discussion of the father's role in communication. Researchers found that, …teaching fathers how to talk to and play with their autistic children in a home setting improved communication, increased the number of intelligible words the youngsters spoke by more than 50% and helped dads get more involved in their care."

( Autistic Kids Benefit from Dads' Involvement)

An article that explores the issue of communication, nursing and the autistic child is Observing communication skills in staff interacting with adults suffering from intellectual disability, autism and schizophrenia by Bakken et al. (2008). This study emphasizes the need for a more integrated and multi-disciplinary approach to dealing with autistic children. This communicative approach includes sources from both intellectual disability nursing and psychiatric nursing. (Bakken et al. 2008) The authors also reiterate the finding that autism displays a wide range of cognitive impairments which "….include restricted ability of abstraction, introspection, understanding of other individuals, and the ability of sharing attention." (Bakken et al. 2008) This is a major factor that impact of the nurse's ability to deal adequately with these patients. The study therefore finds that nursing staff must "…aim at clarity and a high level of contextual attachment in their communication & #8230;." (Bakken et al. 2008) It therefore follows, as is also suggested in the study by Lesinskien? et al. (2002) that, "The patients' idiosyncratic communication and behavioural acts require that the communicating partner know the patient well enough to integrate both contextual and situational knowledge." (Bakken et al. 2008)

Furthermore, this study also reiterates a point that has already been referred to and which is echoed in many similar studies; namely that dealing with these problems from a nursing perspective requires more in-depth research as well as the development of more cogent theoretical structures to understand issues like communication and the hospital environment. This study isolates aspects such as the nurses' adaptation to the communications level of the patient as a necessary skill in treating the autistic child; as well as the importance of non-verbal communicative acts, such as gestures, augmentation devices etc. These are aspects that are stressed as fundamental nursing skills in dealing with this category of patient.

The study by Bakken et al., is useful in that it points out that while other studies have emphasized the importance of these communication skills in nursing the autistic child, yet "few has examined specific skills." This implies an obvious gap in the knowledge base in nursing these children.

An article which deals with the problem of nursing the autistic patient and which sheds some light on the above-mentioned issue of communications skills in nursing the autistic child is Effective communication related to psychotic disorganised behaviour in adults with intellectual disability and autism (2008). The article states that nursing staff that have work experience in terms of communication were found to be more effective in interacting with the autistic individual. This finding therefore emphasizes that communication skills should be an essential part of any nursing training programs that is directed at any from of treatment of the autistic child.

An innovative theory that deals with this issue is facilitated communication in the treatment of autistic children. In an article entitled Facilitated communication: significance of and use to the nursing of persons with autism with severe disabilities of action and communication by Beste ( 2007), discusses this concept. This refers to a method that is "…applied to persons with autism who are apraxic and unable to speak and communicate with gestures or facial expressions." (Beste 2007)

Another important aspect of research into communication techniques is an insightful article entitled Eye Contact and Autism by Worth ( 2008). This study refers to research to "…determine whether the amount of eye contact made by children with autism was different from that of other children and whether that measurement could be used to predict levels of social disability." (Worth, 2008, p. 21) These and other similar research studies are an important component of the nurse's ongoing need...

This is the view that is stressed for example in Autism: An Interdisciplinary Approach ( 2004) by Elias et al. This approach has become necessary because of the wide range and variety of variables that have to be taken into account in dealing with the autistic child.
An article which also delves into the multidisciplinary aspects of nursing treatment of autism is Approach with Care. As more children are diagnosed with autism, nurses learn how to respond to their needs ( 2005). This article also refers to somatosensory disturbances that include hypersensitivity to sounds, smells, touch, textures, and visual perception distortion among children with autism. This leads to a discussion of aspect such as speech therapy and the development of social skills, and, for example, the reading of facial expressions. (Ray 2005)

The literature is also concerned with the view that nurse should be aware of the latest theories and technologies as these can not help with aspects of communication but also in the general treatment of the autistic child. An example is sensory therapy for autistic children. A number of studies indicate a link between sensory integration therapy and improving the quality of life for autistic children. This form of therapy is viewed as a "….valuable tool to teach autistic children how to interact with their environment." ( Evans R.) The problem of sensory integration is a crucial factor for many autistic children. It is very often the case that the sensory impulses of the child conflict with and are contradicted by those expected by the society in which they have to interact.

Sensory integration refers to the "…process in the normal brain which pulls together all of the various sensory messages in order to form coherent information on which we can act. Basically everything we do requires sensory integration." (Evans R.) Sensory integration therapy is therefore an attempt to rectify this sensory disparity and dysfunction in autistic children.

2. Parental issues and stressors

As one commentator notes, "Caring for an autistic child can be a relentless and labor-intensive task." (Autistic Kids Benefit from Dads' Involvement) This refers to the pressure and stress that many parents have to endure in dealing with an autistic child. However, the literature is also clears that parents play a vital role in the treatment of the autistic child and it is often the case that nursing staff work in tandem and in conjunction with parents in devising strategies and implementing protocols in dealing with children who have this condition.

The interaction of parents, family and nursing staff is stressed in a number of articles and studies. A good example is Nursing Management of Autism. This article summarizes the goals of treatment in autism as increasing social acceptability and to "…decrease odd behavioral symptoms and to improve verbal and non-verbal communication. Both language remediation and academic remediation are often required. " (Nursing Management of Autism ) The article stresses that these children require appropriate behavioral interventions to "…reinforce socially acceptable behavior and encourage self-care skills." (Nursing Management of Autism ) Educational and behavioral interventions are currently considered the treatment of choice. It therefore follows that parents need to be trained about various concepts and in some of the skills of behavior modifications. (Nursing Management of Autism)

However, this also places a great degree of stress and pressure on the parents who are usually working and who may have other children who also require attention. This leads to the issue of parental stressors, which is also an issue that the nurse has to take into account in the overall assessment of any treatment and management protocols.

A number of articles deal with the way in which the nurse can reduce the stress factor for parents. It is suggested that by informing the parents abut the reality of the situation stress is reduced through a reduction of uncertainty. A study by Howlin (1997) indicates that only ten percent of parents had their child's condition explained to them. Therefore he nurse can assist the patient through education. This view is explored in a study by Sara Salamonsen entitled Increasing rates of autism diagnosis; A nurse's role. The author notes that, "Because so few families are being adequately informed, the nurse's role as an educator…