Strategies To Support The Cognitive Development Of Autistic Children

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Chapter 1 Introduction 

1.1 Background 

Prevalence of psychological issues among children living in the UK has created healthcare burden on the care providers. Reportedly, it is recognised that up to 1.2 million populations of children in the United Kingdom are affected by autism spectrum disorder (ASD) (The Guardian, 2024). Autism is a relatively highly diagnosed health condition whose prevalence has been on the rise in the past decades; however, it is still not clear whether this condition is due to the actual rise in the occurrence of the disease or due to better diagnostic abilities (Hertz-Picciotto and Delwiche, 2009). Other possible causes of higher rates of diagnosed ASD may include enlarged diagnostic scope, higher rate of awareness among parents and teachers, and environmental factors such as use of pesticides, harmful and contaminated environment (Lord and Bishop, 2010). It is estimated that more than 700,000 people in the Great Britain have an autism spectrum disorder (BMA, 2020). Different literature has marked genetics as one of the factor associated with the occurrence of autism while heritability rate is estimated to range from 45% to a high of 90% in people (Persico and Napolioni, 2013). Some of the factors that may enhance the risk to the autism among children include; high parental age and preterm births (Fuchs et al. 2018). Environmental sources such as exposure to air pollutants and pesticides during fetal development might be involved, but there is a scarcity of advocacy research on this topic (Leiss and Kotch, 2010). The language abilities in autistic children are described as delayed, while other children with no autism have been observed to develop language skills earlier than these children. Other general cognitive impairments such as issues in cognitive processing, learning, and memory are often observed among the children with autism (Ramey and Regier, 2019). Autism is believed to arise from atypical neural connections, and this could explain why different children with autism may have varying developmental syndromes such as neurofibromatosis (NF1 and NF2 genes), X-linked Rett (MECP2 gene) (Genovese and Butler, 2023). Interventions that has been used for the development of cognition in autistic children include the early behavioral interventions, the speech and language therapy, occupational therapy with a focus on sensory integration, social skills development programs and training, educational assistance, picture exchange communication system, and medications that are used to treat other related conditions such as the attention deficit hyperactivity disorder (Chung et al. 2024). Parent training programs also exist and are helpful for managing the health issues of such children at homes. Specifically, development of individual education plans along with proper instruction and behavior management interventions for every child are paramount. This is because ongoing assessment can easily allow the continuation of the intervention since the child is continually growing. According to NICE (National Institute for Health and Care Excellence) guidelines, children with attention deficit hyperactivity disorder should be given proper care and the treatment and be supported by a coordinated care plan that incorporates a multi-disciplinary team of health, education and social care services (NICE, 2019). NICE guidelines for parents states that; parents should be trained on autism-awareness, classroom accommodations, social skills development and identification for learning disorders and psychiatric disorders as well. It must respect the child’s age, abilities and characteristics concerning the development stages. The NHS goals for Autism services are to increase the availability of access and support throughout the life span (NHS, 2023). These are areas that require more focus; the support of women, other adults, and those with less severe conditions, yet affected. Although people’s understanding of autism as well as its occurrence has improved significantly, the support and assistance offered to those on the spectrum should increase to meet the increasing demand. It can be stated as, with the continuation of research and further education of people, the situation of autistic people in the UK will improve. 

1.2 Problem statement 

Despite the findings and studies presented, much is still unknown on the best practices that can be employed to enhance the learning of these children. It is important to consider that most existing interventions aimed at children with ASD are focused on the enhancement of social communication and the reduction of problematic behaviors, with the absence of certain essential cognitive outcomes (Watkins et al. 2017). Some methods that may help the child learn and develop are incorporating daily structure and schedules, using visual aids and supports, identifying the child’s interests and including them in activities/learning, using sequential breaking down of tasks, providing real-life examples and practical learning, encouraging the usage of reinforces, modifying the language in development and the type and manner in which communication is done, addressing issues of sensitivity, adapting curriculum and assignments, encouraging the child to The techniques that have been applied involve individualized approaches such as encouraging learning, communication, organization, and focus as a way of helping autistic children improve their cognitive abilities. Furthermore, there are certain gaps mainly concerning the overall guidelines about implementing cognitive-based interventions for children with ASD by considering the difference in the level of support they require for making the intervention universal and easy to perform. In addition, while such techniques as computerised training, behavioural interventions, and cognitive-behavioral therapies have been found to be effective, there is still need for more investigation with these strategies (Baker-Ericzén et al. 2023). To date, however, there is no systematic follow-up that examines the impact of cognitive interventions for autistic children in the long-term. 

1.3 Aims and Objectives 

The aim of this research is to explore the effective strategies that can manage cognitive skills of the children with Autism in the UK. This aim is accompanied by the following objectives: 

1. To explore the effectiveness of psychotherapies and strategies adopted by care providers in the UK to manage the cognitive issues of the Autism children (5-10 years).
2. To study the factors that impact on the effectiveness of cognitive strategies. 

1.4 Research Questions 

1. How cognitive strategies and therapies can serve in cognitive development of the autism children (5-10 years) in the UK?
2. What factors can affect the effective usage and outcomes of cognitive strategies?

1.5 Rationale and Significance of the study 

The main idea behind this study is to explore the effectiveness of strategies that can serve in the cognitive development of autistic children in the UK. Autism spectrum disorder is a developmental disability which affects the individual's ability to communicate with others, interact with them, and have repetitive behaviours (Watkins et al. 2017). ASD is recognised globally with the UK having one child in every 100 diagnosed with the disorder (The Guardian, 2024). Though a lot of effort has been devoted to studying and implementing interventions regarding social skills and behaviour among children with autism, little has been done as regards the identification of approaches along with their drawbacks to support the cognitive development of such children. Skills such as memory, attention, planning, and problem-solving are the building blocks of learning and growing up in children (Brown and DeLoache, 2013). Identifying ways and means through which the cognitive skills in such children could be enhanced could go a long way in determining the child’s academic achievement as well as the quality of their life. This study will therefore seek to fill this research gap by seeking to establish communication, treatment and teaching strategies that can be employed by parents, therapists and caregivers to enhance cognitive abilities in children with ASD. Despite large population-based studies, smaller trials have assessed the effectiveness of specific interventions like music therapy, cognitive approaches and healthy lifestyles; however, there is relatively little evidence about the kind of interventions to enhance cognition in this population in the UK context (Northey et al. 2018). To better understand the current practices that are implemented to enhance the cognitive skills of autistic children, a survey with professionals working in the field and focus groups with parents and teachers are planned. Thus, having presented the easily understandable and evidence-based recommendations, this study can improve autistic services and provide parents and teachers with valuable means that can contribute to setting the home and school learning environments. 

Chapter 2 Research Methodology 

2.1 PICO Framework

The PICO Framework is provided below:

2.2 Research design 

Research design is defined as, the plan, methods, procedures and techniques that the researchers employ in the performance of any research study (Abutabenjeh and Jaradat, 2018). It consists of three major phases namely data gathering, data analysis and data interpretation. This research study has adopted a qualitative research design in order to determine the efficacy of cognitive therapies and strategies that may enhance the cognitive development and skills of children with autism in the UK. According to Worthington (2013), qualitative research design is a research method that uses structured or unstructured interviews, text analysis and non-numerical data to study people and their experiences in the social world. Not only does it facilitate the development of hypotheses but also enables the quantitative researchers to follow up the findings of the studies to gain more understanding and knowledge. This research study has incorporated the qualitative research method to employ the systematic literature review. It is a type of research design that is secondary in nature and is used to evaluate the strengths and weaknesses of the available literature on the research topic in question (Dziopa and Ahern, 2011). Similarly, it helped in the systematic execution of the critical investigation of the chosen study variables which cannot be possible while adopting other research methods like mixed methods and quantitative methods. Thus, a systematic review is an appropriate strategy to collate the research concerned with intervention for autistic children's cognitive advancement. In some cases, an individual study could report an insignificant result perhaps due to a low statistical power, or vice versa; a systematic review could therefore combine results from the various studies to assess the outcomes more comprehensively. It enables one to compare and find out which part of a certain technique is efficient in dealing with a certain problem. Included in the practical limitations of conducting this systematic review of such a vast amount of autism intervention literature is the risk of bias of viewing only those studies that were selected. A comprehensive description is helpful in better defining the intervention's effectiveness, clients, and context. This also affirms conclusions and assists in providing recommendations for the strategies that may be efficient in addressing the concerns of this diverse group.

2.3 Research approach 

Research approach refers to the process or the method that is used in gathering, analyzing and interpreting data that has been collected (Teherani et al. 2015). Since the current research study has chosen the quantitative research design, the most suitable research approach was the deductive research approach in order to make conclusions based on the theories and previous findings from the literature. The inductive approach is a process of searching for patterns in observations and building the explanation based on the collected data (Liu, 2016). It also assists the researchers in identifying the pattern of reasoning from general information to specific results. As for the methodology, the significance of the inductive approach was seen in this research as it helped in arriving at the overall conclusions of the study and presented the important implications related to the research topic. An inductive research approach is appropriate for conducting a systematic literature review on the strategies used towards fostering the cognitive development of children with autism. While in a deductive approach, the researcher begins by positing a theory, inductive research enables conclusions to develop from the data through the thematic approach. Since there are numerous possible approaches to cognitive support and no specific theoretical framework indicating that some strategies are more effective than others for autistic children, an inductive approach allows the researcher to get acquainted with the existing approaches and trends, free from any preconceptions. This enables one to think of new categories and fresh theoretical perspectives in a bottom-up manner by examining a multitude of literature via qualitative analysis of an assortment of studies. Inductive orientation is more appropriate for developing knowledge about this multifaceted issue in a grounded, highly That is why an inductive orientation is suitable when working on this topic in an unimposing, loosely structured manner according to the phenomenon.

2.4 Selection criteria 

The inclusion and exclusion criteria of this review are given below.

Table 1 Selection criteria

2.5 Search Strategy 

The databases used for the present review were PubMed, Ebsco and Google Scholar Search Engine to aimed at presenting strategies which could be useful to enhance cognitive development in children with ASD. The following key terms were used while accessing the chosen databases:

These terms were then connected by Boolean operators such as AND and OR. Additional filters applied included Boolean Operators and English language to be published between the year 2010 and the present. The types of evidence sought were systematic reviews of randomised control trials, quasi-experimental research, cross-sectional studies, case reports, and qualitative work. The reference lists of the relevant articles were scanned and further relevant studies were searched for if any. 

2.6 PRISMA Framework

2.7 Critical Appraisal Tool 

Critical appraisal and analysis are the foundation of literature studies. This helps the researchers to examine the collected data using meta-analysis to check for bias and the chance of the outcomes being untrue (Kirongo and Odoyo, 2020). An investigation by Bihu (2020) pointed out that the procedures that identify the research judgment and the appropriateness are the critical analysis and the appraisal which allow the investigators to carefully but rigorously assess the research. In the critical review here, the researchers have conducted the studies by Critical Appraisal Skills Programme (CASP) checklist as they evaluate some of the vital components such as how well the objectives are achieved, the research methodology and the research findings Since CASP is the most powerful tool for assessing critical skills by providing questions’ grading guidelines and proficient assessment of scientific literature, it is the best option for this purpose (Taherdoost, 2021). Initially, the critical appraisal of the chosen studies or rather assessment of their suitability for the analysis was done. Hence, the most eligible ones were set aside for analysis. The critical appraisal of this research has enabled the researchers to explore the risk bias and trustworthiness of the study to avoid any chances of false data and manipulation in the current findings. 

2.8 Data analysis 

Data analysis is also another particular stage of the review or for any other research. It is referred to as a way of collecting and analysing data by arranging it in a way that it could be interpreted. This review has presented that data analysis is achieved through some stages like the data collection, and the use of several logical and statistical models to model and analyse the data. Likewise, the thematic analysis method was applied as it allows for gathering qualitative data in terms of texts and qualitative indicators and examining the quality of the data and notions of different participants. The researchers can use this method to trace the texts where similarities and deviations are displayed in the collected findings (Braun and Clarke, 2012). Themes related to the research questions and the objectives were constructed that were answered through the findings of the selected studies.

Chapter 3 Results and Findings 

3.1 Introduction 

This part of the review plays a crucial role because it provides the outcome and the findings of the performed analysis. The outcomes of the systematic review, which are compiled in a tabular format depicting the sum ups of the six selected studies, are illustrated in Appendix A. Thematic analysis of the selected studies is conducted to find out the elements and explore the role of using analytics to address claims and frauds in business entities. It supplies all the assessment of the critical appraisal and risk bias tools, as well as shows the list of all the studies used for the analysis and their importance.

3.2 Critical Appraisal 

The findings of the critical appraisal checklist are defined in appendices to provide broader knowledge and insights into the studies. The score of critical appraisal has not affected the findings that are discussed in the thematic analysis. Hence it helped in the selection of articles, based on their research objectives, research methodology and the discussion of the findings. the findings of the CASP checklist are attached in Appendix A. 

3.3 Summary Matrix

3.4 Thematic analysis 

3.4.1 Theme 1: Effectiveness of psychotherapies and strategies to manage the cognitive issues of autistic children.

The use of psychotherapies has got much attention in recent times in managing the psychological issues of children to avoid the side effects of medicinal usage. ASD children and adults can use psychotherapies, but it is considered that this is possible only with certain modifications due to socio-communication problems and neuropsychological restrictions which are typical for subjects with ASD. To address this theme, the study by Spain and Happé, (2020) was found effective as they found that while nothing is commanding in the empirical research related to best practices for individuals undergoing antipsychotic treatment. When 50 people had been confronted, 18 agreed to be involved in Round 1, nine in Round 2 and eight in Round number 3. Overall, there was fairly good agreement on which particular statements were constitutive of CBT, with an average of 155 total statements deemed as either essential or important by a cohort of fifteen independently ratifying academics. The change was therefore welcomed and applied practically to the structure and process of therapy; specifically, an individualised formulation-derived approach was valued in the choice of which intervention or technique to use. This research should be continued to investigate whether the adapted CBT is effective enough to bring a positive change in treatment results and its acceptability level.

With regards to the study by Williams et al. (2024) is also found suitable to address this theme, as it applied the MAP Feasibility randomised control trial. The chosen intervention is compared with the best practice treatment i.e. Social Communication Intervention for Pre-schoolers–Intensive with music-assisted programmes for language skills and learning in pre-school children with autism. This trial has ensured a comparison of the designed groups before interventions. Specifically, ninety-one people indicated a willingness to participate in the study; of which 27 fulfilled inclusion criteria and were randomly assigned to either musical programmes or SCIP-I. Participants were three children and their parents; they attended two 45-minute sessions per week, for a total of eighteen weeks, which involved virtual coaching from a speech and language therapist. To facilitate repeated practice in between appointments, a MyPT smartphone application was created. Thus, across the study period, researchers identified that about 20% of the participants engaged in the intervention and produced data for the assessment of the outcome measures. In short, researchers found a greater improvement of the experimental group in the following domains, social responsiveness, understanding of words and phrases and number of words spoken and parent-child interaction at 3 months post-intervention follow-up in the music-assisted programmes as compared to the SCIP-Intensive. These findings highlight the possibility of recruiting the above-mentioned population into an RCT and the music-assisted programmes were found to be highly acceptable as perceived by the parents from the interviews conducted. Firstly, future research should carry out a large-scale clinical trial to determine the potential of music-assisted programmes in enhancing early vocabulary development for autistic children. 

In addition, Tanksale et al. (2021) worked to evaluate the effects of a yoga-based program integrated with third-wave CBT components on self-regulation in autism spectrum children.. The intervention group's improvement in the primary outcome was measured by the executive functions. Secondary measures comprise sleep, anxiety, and emotion recognition. Subsequently, to attrition, questionnaire data collected at baseline, post-intervention, as well as the 6-week follow-up from participants in the intervention (n=31) and the waitlist conditions (n=30) were examined. In the case of the intervention group, the subscale mean score comparison indicates a decrease in parent-reported global executive difficulties from the baseline to post-intervention, and from baseline to the follow-up assessment with a small to moderate effect size. 

The study by Parsons et al. (2019) assessed the impact of play intention on a pragmatic language intervention for children with AS. The study involved 71 children with autism who were first randomly assigned to an intervention-first group (72 children, of whom 28 were analyzed) or a waitlist-first group (85 children, of whom 34 were analyzed). Parents practised home-facilitated trials of clinic play sessions with a TD child, and children participated in 10 weekly clinic play sessions. Assessment of pragmatics before and after the intervention was done using the Pragmatics Observational Measure-POM 2 and the Social Emotional Evaluation SEE. Post-operative medication utilisation reduced was substantially higher in participants in the intervention-first condition relative to the usual care condition for POM-2 gains (p = 0. 031, d = 0. 57), see figures 2 and 3 for visual representation. Follow-up analyses at 3 months showed the treatment effects were significant (p < 0. 001–0. 05) with d = 0. 49–0. 64. Therefore the analysis of scores obtained at follow-up from the clinic as well as at home did not show any significant difference to the pattern identified by POM-2. Research evidence thus validates the implemented strategy of using play, peer-mediated, video-feedback, and parent training as effective interventional practices to improve pragmatic language in children with ASD. Also, the type of relationship between a Playmate and a child, the difference in age between children within the dyad, and the age category of the child with autism were not statistically significant on POM-2 or SEE scores. It was observed that the main TACL-4 score yielded a significant, positive and large effect on all the outcome scores. 

3.4.2 Theme 2: Factors affecting the significance of psychotherapies for autistic children 

This research theme was designed to address objective three of this review to explore the factors that result in affecting the application and outcomes of psychotherapies for autistic children in the UK. The chosen research by Aithal et al. (2021) aims to explore the impact of Dance Movement Psychotherapy (DMP) intervention for assessing the well-being of the care providers of autism spectrum disorders. The study has compared the chosen intervention with the standard care routines. The participants were 37 caregivers of children with ASD who were parents and close relatives of the free lunch program supervisees enrolled in Two SEN Schools and were randomly divided into the DMP intervention group and the control group based on their availability to attend the sessions. The participants in the experimental group underwent five DMP sessions that were conducted every week and each session took ninety minutes. DMI, Adult Wellbeing Scale (AWS) and Parenting Stress Index-Short Form (PSI-SF) were used before and after DMP to assess the improvement in the well-being of the caregivers and the reduction of parental stress through DMP intervention. Retention at this site was low and a mere 50 % of the participants in the DMP intervention arm attended at least 70 % of the sessions until the completion of the intervention. Thus, the MCID for a small effect size was reached for both OHQoL and the WHI index in the DMP intervention group but not in the control group. 

Another research by Roudbarani et al. (2023) has paid attention towards the barriers and facilitators in psychotherapies from the perspective of autistic adults. The study has also focused on the enhanced critical incident study to achieve its research objectives. This study was carried out by using qualitative and exploratory approaches in which the eight autistic adults have taken part in the interviews. A total of 147 critical incidents were identified from the interviews as well as the key categories important in therapeutic practice. This paper also outlined aspects concerning therapy including trust and respect and the practical aspects, clients, the structure of sessions and knowledge regarding autism, support for individual needs, options towards mental health, and family/advocacy. These factors were grouped into eight broad areas that could be of interest to those engaged in therapeutic activities. This research evidence indicates that the process of providing psychotherapy to autistic adults is similar to providing similar work to nonautistic adults in that this work also involves elements of person-centred approaches and employment of the general supportive processes. There are also differences in this work that provide reasons for requirements for basic information about autism to exist among providers. It may also be beneficial to gain more knowledge from the experiences of autistic adults to better enhance the current shifted mental health care for autistic adults. The current literature is partially developed for expounding on the needs and preferences of autistic adults who are in a position to receive mental health by virtue of psychotherapy.

As children with autism are primarily taken care of and attention at their homes, the study by Green et al. (2022) is found useful in assessing the impact of social communication therapy upon autistic children at home. This study has helped in assessing the significance of the home environment in combination with psychotherapy to manage the health and psychological well-being of the children for cognitive development. Self-generation of adjusted treatment effects may also pose a problem to autistic children since such children may find it hard to generalize the effects of the treatment outside the treatment setting. It has been introduced as Paediatric Autism Communication Therapy (PACT) and has been effective when done in the clinic. Here, researchers examined the PACT-G home-plus-education design to look at the total impact and to explore the mediating pathways through which the impact spreads between two settings. In this single-blinded, parallel, randomised, placebo-controlled trial, researchers included autistic children, 2–11 years of age treated in two UK cities Manchester and Newcastle or in the Greater London area. DSM-IV-TR AS diagnosis required that Autism Diagnostic Observation Schedule-second edition (ADOS-2) and parent-rated Social Communication Questionnaire (SCQ-lifetime) scores were core values of children. Total score of 15 or more that met criteria on ADOS-2; and children older than 5 years were included if they had intentional communication, but an expressive language developmental level of no more than 48 months. Eligible children were randomly assigned (1:1), block randomised (block size 2 and 4 and stratified by site, age 2–4 years and 5–11 years and sexes) to PACT-G plus treatment as usual or treatment as usual only. The anonymity of participants was maintained by the research assessors in that they were unaware of the treatment that had been assigned to particular patients. PACT-G intervention aimed to be provided in a similar way to simultaneous interactions which took place with the child's parents at home and with a Learning Support Assistant (LSA) at the child's place of learning in face-to-face and through telepractice sessions within 6 months to facilitate real adult-child social interaction. This routine care consisted of any health services, advice, or other support accessed through educational institutions or the community. Essentially, the main analysis was on the change in autism symptom severity, as assessed by the ADOS-2 by external observers at 12 months compared to baseline. The secondary dependent measures were BOSCC and child-adult dyadic social interaction in different situations at the 12-month follow-up. Other secondary outcome measures were assessed using the following composites such as vocabulary, language, anxiety, stereotyped behaviour, compliant behaviour, parental and child health, and overall child disruptive behaviour. The severity and nature of adverse events experienced by the participants and caregivers in all trial families were determined by the researchers at each contact and by the therapists in the PACT-G group at each visit. ISRCTN 25378536 is the study identifier from the ISRCTN Registry assigned to this study. Across 18 January 2017 and 19 April 2018, 555 children were referred, 249 were deemed caregiver-child eligible, agreed to participate and were randomly assigned to PACT-G (n= 122) or treatment as usual (n=127). 

In addition, the study by Kitzerow et al. (2020) is found essential as it has focused on the training of autistic patients to improve their executive functions. This randomized, controlled trial compared an experimental executive function (EF) intervention to a control treatment in childhood ASD. A total of 70 children with ASD aged between 7 and 11 years with IQ of 80 or above were randomized into the experimental group which consisted of EF training games set on the web and metacognition face-to-face coaching or the control group, which was a waitlist. Predictors and outcomes assessed included neural response regarding EF, lab-based EF behaviour implementation and generalizability of EF skills. Secondary endpoints for the sample included perceived social function. Testing and all the associated activities were done with the assistance of other staff who were not aware of any group allocation. Overall, children showed an alteration in neural response compared to the waitlist group for trained children (ηp2 = 0.14). Training effects were not observed when using lab-based, standardized tasks (ηp2s < 0.02), although the findings did not generalize to caregiver-reported EF skills outside of the laboratory context (ηp2 = 0.001). Yet, based on the results obtained here, the training group presented fewer repetitive behaviour symptoms (ηp2 = 0.15) after training. Regarding adverse events, there were no dropouts from the training group or potential complications. Results indicate that it is possible to implement a short, specific computer-based training program with additional coaching that has positive effects on neural activity and stereotypic movements of SAs, and school-age children with ASD.

Chapter 4 Recommendations and implications for nursing 

4.1 Summarised findings 

This review has paid attention towards children on the autism spectrum, numerous interventions have been researched to foster the cognitive aspects of their learning. It is found that structure, routine, and visuals are to be implemented as the key elements to help the child. Autistic children are known for routines and anything that they can easily follow, possibly with the help of pictures or graphic displays of anything that is to happen or be done next. This serves to alleviate the feeling of powerlessness that is characteristic of dependency. As for the textual information, pictures, written instructions or a video are also helpful in teaching autistic children since they need more time and instructions to comprehend it. Teaching strategies used in early childhood education should be presented in a way that would address the particularities of the child and their abilities. Each of these approaches has its own particular approaches, but there are several general instructions that hold true across the board. For example, breaking a task into its constituent parts or encouraging a lot of positive reinforcement and guided practice. Technology can also be used as a way to support children in terms of helping them speak or express themselves and manage their feelings or behaviour. The present article focuses on the idea of how learning activities can be developed with reference to a child’s interests for the benefit of motivation, interest and understanding. Interests make an autistic child focus on something and include aspects of automatic reinforcer within a functional skill. Some approaches such as cognitive therapies that feature the utilization of peers are also effective in teaching social skills since they involve interaction with a friendly role model in the natural environment. While there are likely to be some aggressive behaviours as observed above, it is important that the next time the child exhibits such behaviours, a patient response with understanding is used instead of punishing the child. With structure and routine, unpredicted events that cause disruptions for youth with autism can be controlled to an extent. However, the fostering of flexibility and resilience is subtly encouraged and it is a long-term process of training. The ability to change perspectives and mindsets in autistic children and the ability to help them manage changes can be taught through thoughtful validation, effective communication, and praise for attempts.

4.2 Implications for nursing practices 

This paper argues that nurses take active participation in enhancing the cognitive development of the children with autism. As for the implications for nursing practice, this paper proposes to promote the early screening and diagnosis of the condition. That means it allows for early intervention, which is supported by numerous studies with evidences that are presented in previous chapters. They have basic understanding of early indicators of autism and report any concerns to professionals who refer the child for diagnostic evaluation. As per the findings and the perception of the family members who took part in the studies that are included in the analysis of this review, it is suggested that properly, nurses should provide the parents and caregivers with information on development and when to refer the child. The second issue is that nurses need to become a member of the cross-functional team managing an autistic child’s care plan (Rutherford-Owen et al. 2023). This entails advising on practices that can be used in the consideration of developmental evidence in service delivery, observing the child’s learning progress, and contributing to the adjustment of the treatment model if necessary. The strategies that nurses can help support and maintain are as follows: behavioral interventions, speech and language therapy, occupational therapy and educational services (Gosa et al. 2020). Nurses can also educate the families to follow up on recommendations and maybe encourage them through what maybe an emotionally challenging period. Moreover, nurses should also support and promote autism friendly environment and inclusive measures wherever possible (Garner et al. 2024). Galeti et al. (2020) also suggested that measures like reducing noise levels, establishing an orderly routine, using picture or visual timers and organizing access to comfort articles can help autistic children to feel less stressed in hospitals. It is also noteworthy that encouraging children to participate in community services and other social activities may also contribute to the cognitive development. When they provide supportive evidence based care and taking advocacy roles, the nurses can play a great role in changing developmental pathways for this vulnerable group.

4.3 Key aspects and policy implications 

Essential support from pediatric nurses to the autistic children is beneficiaries concerning their cognitive development. NICE guidelines include ‘supporting people with decisions about their care’ and ‘communication and information sharing between professionals and families and carers (NICE, 2017). While, in comparison to the NMC Code, it entails putting people and families at the centre of care and making decisions in line with the best available evidence (NMC, 2019). Moreover, the NICE guidelines for autism care stress factors such as awareness of sensitivities in terms of touch, sound, taste, smell, and sight and also the way an autistic person communicates and the need to help to reduce anxiety (NICE, 2017). Nurses should support environment changes and help them implement pictures and other graphic displays such as picture schedules. The NMC Code instructs nurses to value diversity, communicates effectively and minimizes harm, and considers development when treating children (NMC, 2019). For the cognitive development, the nurses can guide shared focus during the play activities, songs and games, use the clear and simple language when explaining actions and use praises when encouraging positive behaviors and other useful techniques include sub divided tasks and the use of clues. The organization of care by the means of multi-disciplinary teams, individualized nursing care and educational initiatives regarding best-practice interventions enables the nurse to effectively fulfill their role for these children. It is also critical to listen to parents’ consideration and values as well to ensure quality if care to autistic children at homes (Leadbitter et al. 2020). Adherence to clinical practice guidelines and organisational policies and admission of family and developmental aspects of care into practice will facilitate the use of strategies that promote the development of autistic youths among pediatric nurses.

Chapter 5 Limitations 

One potential drawback of such systematic review is the selection of only a few of research articles on different interference procedures. But even in Autism spectrum disorder cases many studies have limited by small sample size or may not sample this diverse population. This reduce the external validity of their study. They also did not cultivate the habit of asking patients about any medication they were taking other than the antipsychotic drug being prescribed. Moreover, the naturalistic nature of the studies mean there are not enough rigorously designed randomized controlled trials, widely regarded as the most accurate for assessing interventions. With regards to the some selected studies, they have employed more questionable research designs that are less reliable and objective such as observational or qualitative studies which have shown significant bias through the outcomes of CASP checklist. This prove challenging when one wants to establish a clear cause-effect relationship about the effectiveness of the intervention within a systematic review. Additionally, included studies have variation in the participant characteristics, interventions tested, methods to measure the impacts on cognition, and follow-up time of the studies. The different designs have complicated the integration of the findings in a way that allows for thematic-analysis and the extraction of relevant conclusions. Due to such limitations, the review authors have required special precaution while arriving at the conclusion, and ensured that they do not overstate the evidence with regards to cognitive development interventions for autistic individuals. It means that these limitations have brought to the forefront and foregrounded within the review as a way of creating a context for concluding and identifying implications for future research. 

Chapter 6 Conclusion

6.1 Findings of the study 

Traditional behavioral approaches targeted at enhancing communication, social skills, cognition, play, and adaptive behaviors have been identified as the most suitable for young autistic children. Techniques which organizes, repeats, and rewards the information desired in children with ASD has confirmed notable raises in IQ, communication, and academic achievement, besides other aspects of development. High intensity interventions for multiple years at the early stages of childhood are considered as the perfect treatment. It is possible to educate the autistic child using their special interests in a way that enhances learning, interest and motivation, acquisition of skills and development. Other objects like pictures, written instructions and videos are also beneficial for a cognitive aspect as there are many forms of assistive technology including picture communication or a speech-generating device to help with language and communication. Other interventions include the parent-mediated interventions where parents receive training on the different techniques to be applied in dealing with the child at home during interaction with the autistic child. It is a favorable approach for parents and caregivers as well as encourages learning at every possible moment within the child’s schedule. 

6.2 Recommendations 

It is important that an early intervention is made to enhance the cognitive fundament of the autistic children. Described in the systematic review, studies of training programs that target aggregated IQ, social cognition, social attention, language, and daily living skills appear to have potential in the education of autistic children. These are the behavioral interventions, technological interventions, play interventions, and developmental interventional. It is suggested that all children with autism to have early and frequent access to such evidence based cognitive training programs. The studies also portray how neural plasticity is at its peak in the early years of development, thus implying that early intervention should be pursued (Hadders-Algra, 2021). The training procedures which were behavioral and technology based seem to help in the improvement of IQ, social attention, and language. Specifically, studies focusing on intervention using behavioral strategies and virtual reality training to improve joint attention have been effective. It is also evident that developmental interjection involving play therapy can enhance the social communication of many children with Autism as well as their ability to perform daily activities. In future, more investigation is needed that directly compare the results of the most effective types of training. Future studies should perhaps incorporate a larger sample size with uniform outcomes and evaluate which strategies appear to be more effective in specific groups of children with autism. Researchers should propose greater emphasis on investigations of home and community-based strategies parents can employ for carrying out learning exercises between professional therapy sessions. 

6.3 Future directions and implications 

The observed limitations specify the need for future research to build more evidence for effective approaches and strategies for enhancing cognitive skills in children with autism. More vast observational researches that include various populations of children with ASD should be conducted to compare the effectiveness of the interventions for various subgroups of children. Furthermore, a greater number of cohort based studies where outcomes are measured at different points in the development would help to elucidate the longer term effects of implementing early intervention strategies. More specific efforts should be made by the researchers to find out about the Child Characteristics and Skills which may help in able to look out for details about the particular strategies which may be used for supporting visual processing, executive functions, language and communication development. This means that the outlined personalized approach may help improve results achieved in the health sector. Additionally, there is a need to provide parents, therapists and educators with practical knowledge and resources regarding cognitive intervention approaches for children with ASD. Dissemination efforts on a large scale are necessary as in parenting classes or online courses for therapists, or even as part of education programs for teachers. More importantly, improving the knowledge of which approaches are beneficial for autistic children can significantly improve the practices of those who work with the children most directly and therefore greatly help their cognitive development throughout their childhood.