INTRODUCTION:

“Don’t underestimate persons with Autism, try to understand.” Joell

Children are innocent, trusting and full of hope. Their childhood should be joyful and loving. Their lives should mature gradually, as they gain new experiences. Each child is a unique person, a person whose future will be affected for better or worse by the influences that mould his or her life during the early years.

The future of any society depends on its children. Parents are laying the foundation for their child’s lives. When a child born with developmental disorder, parents often need assistance in promoting normal developmental skills. There is no way to predict when a child should be able to master self help skills. Parents must be supported, included as the primary caretaker and teacher of the child, and also give proper information about the care, disease condition and commercially available devices that can aid in achievement of independence of their children.¹

Autism disorder, also known as childhood autism is a condition characterized by marked and sustained impairment in social interaction, deviance in communication and restricted or stereotyped patterns of behaviour and interest. Abnormalities in functioning in each of these areas must be present by the age of 3 years. Approximately 70 percent of individuals with autistic disorder function at a mentally retarded level and mental retardation is the most common co morbid diagnosis.²

In 1943 Leo Kanner first described 11 cases of Autistic disturbances in children. He carefully provided a developmental context for his observation. Later landmarks in classification occurred in 1978 when Rutter proposed a definition of Autism based on social delay and deviance that were not just a function of mental retardation but also communication problems, unusual behaviours such as stereotyped movements and mannerisms and onset before the age of 30 months.²

A cold, distant mother figure was thought to be responsible for the development of coldness and aloofness in the child. However, this theory replaced by understanding that organic rather reactive pathology underlies the disorder, genetic, congenital, immunologic, neuropathological and biochemical aberration have all been suggested.³

Autism is a complex developmental disorder of the brain functions accompanied by intellectual and behaviour deficit that very widely in type and severity. It is manifested during early childhood primarily 18-36 month of age. It occurs in 2 in 500 children and is about four times more common in males than in females and is not related to socioeconomic status, race or parenting style. In epidemiological studies the prevalence rate ranges from 4-5 per 10,000 children.⁴

The history of autism dates back to 1911, when Eugen Bleuler coined the term “autism” which means “living in self”. In 1943, the American child psychiatrist Leo Kanner described 11 children common traits of impairments in social interaction, good memory, echolalia, over sensitivity to certain stimuli especially sound, food problems, limitations in spontaneous activity, good intellectual potential often coming from talented families. He called the children autistic. In 1944, Hans Asperger, a pediatrician independent of Kanner, wrote about a group of children he called ‘autistic psychopaths’. In most aspects they resembled the children of Kanner’s description.⁵

Autism is a severe developmental disorder that begins at birth or within the first two-and-a-half years of life. Most autistic children are perfectly normal in appearance, but spend their time engaged in puzzling and disturbing behaviors which are markedly different from those of typical children.Autism is a pervasive developmental disorder defined by the presence of abnormal and/or impaired development that is manifest before the age of 3 years, and by the characteristic type of abnormal functioning in all three areas of social interaction, communication, and restricted, repetitive behaviour.The degree may vary from mild to very severe and is hence it is known as Autism Spectrum Disorder. At the lower end it is known as Classic Autism and at the upper end it is called Asperger Syndrome.³ On December 18, 2007, the United Nations General Assembly declared April 2 as World Autism Awareness Day ⁶

A child diagnosed with autism may represent a constant source of stress on the family unit, as not only the caregivers affected, but also siblings and relationships among family members. The stress results mainly from the extremely antisocial, disruptive behaviours associated with autism, such as self-injurious, tantrum and obsessive compulsive behaviours, which may preclude a normal family life.⁷

NEED FOR THE STUDY:

“Autism is the fastest growing developmental disability in our nation.” Mary Bono

Children are not the future, they are the present. Childhood is a time of development. Like all children Autistic children also need help to satisfy their developmental needs. Identify their behavioural problems and correction is very important. Parents are usually the first to notice unusual behaviors in their child. In some cases, the baby seemed “different” from birth, unresponsive to people or focusing intently on one item for long periods of time. The first signs of Autism can also appear in children who seem to have been developing normally. Research has shown that parents are usually correct about noticing developmental problems, although they may not realize the specific nature or degree of the problem.⁸

Autism is the fastest-growing serious developmental disability in the world. Autism affects as many as 1 in 150 children and 1 in 94 boys. More children will be diagnosed with Autism this year than with diabetes, cancer and AIDS combined. Boys are four times more likely than girls to have Autism. There is no medical detection or cure for Autism, but early diagnosis and intervention improve outcomes. Autism does not discriminate by geography, class, or ethnicity.⁶

Estimated number of individuals with Autism in selected nations on 2007 were, in China-1,100,000; India-2,000,000, United States-1,500,000, United Kindom-650,000, Mexico-150,000, Philippines-500,000, Thailand-180,000 individuals are suffering from Autism. While the World Health Organization does not maintain global statistics on the prevalence of Autism spectrum disorders or appropriate treatments specifically, its 2007 Global Burden of Disease report on mental and neurological disorders highlighted the critical situation the world faces with a growing population that includes those with Autism.⁹

Autism is increasing its proportion in our country. The alarming proportions by which it is rising can make India become the most populous country in the world having such neurological disorder. Approximately 4 million Autistic children and adults are there by the year 2020 it can well cross 8-10% of our population who will be falling under such category.As the medical community unable to find any suitable cause for its root, the only way available is early detection and intervention by which the symptoms of unacceptable language and behaviour can be minimized.⁹

Autism is a developmental disorder that is characterized by a qualitative alteration of social interaction, communication and repetitive stereotype behaviours, interest and activity. Earlier assessment of autism improves the outcome. Children with autism have significant need for medical care. Early identification of autism will improve the health and well being of the children.¹⁰

Therapeutic interventions for children with Autism spectrum disorder (ASD) is a specialized area. Early recognition of behaviour associative with autism is critical to implement appropriate intervention and family involvement. Nurses are in a key role to educate significant care givers to recognize and identify children with this problem. Early recognition referral and intensive early intervention improves the outcomes for children with ASD.⁴

Autism is common disorder of childhood. Yet, it often remains unrecognized and undiagnosed until or after late preschool age because of lack of appropriate tools. Developmental screening and specifically for autism have not been available. Preschool teachers have an important role in early recognition and evaluation of autism spectrum disorder because; they usually are the first point of contact for parents. It is important that preschool teacher should be able to recognize the signs and symptoms of autism in order to improve the prognosis.¹¹

A study was conducted on the experience of caregivers of children with autism. In this study a qualitative interview was conducted with caregivers of 16 children with autism. “Living in a world of our own” emerged as the essence of the caregivers’ experience. In “living in a world of our own” caregivers described it as a world of isolation. Three themes representing the essential challenging elements of the caregivers’ experience included vigilant parenting, sustaining the self and family, and fighting all the way. Although much is known about fundamental importance of support to caregivers of children with autism, findings from this study indicated that knowledge has not been adequately transferred to the care of children with autism.¹²

A study was done on child care problem and employment among families of preschool children with autism. In this, parents of 16,282 preschool children were surveyed. There were 82 children with autism in the sample, and 1,955 children at high risk on the basis of parents’ evaluation of developmental status. About 97% of preschool children diagnosed with autism were cared for in community settings. Thirty-nine percent of the parents of children with autism reported that child care problem had greatly affected their employment decisions, compared with other parents. In multivariate analyses, families with a child with autism were 7 times more likely to state that child care problems affected employment than other families. Conclusion of this study showed that autism is associated with higher use of child care services and higher probability that child care problems will greatly affect employment. These findings warrant the evaluation of the community resources available to families with children with autism.¹³

A study was done on caregivers-early intervention programme for autism. The early bird programme, a psycho-educational early intervention programme for care givers of children with autism was used. It aims to provide caregivers with skills to increase their child’s communication and manage challenging behaviours using behavioural techniques. Two interlinked studies examined access to the early bird programme and barriers which may affect uptake. Study 1 investigated who accessed the early bird program, and what factors influenced this choice. Study 2 was a qualitative investigation which focused on barrier to uptake for ethnic minority groups. Findings indicated that approximately 85% of families eligible for the programme do not participate. Ethnicity and length of wait time were significant factors in non-participation. The study concluded that a model of factors which may influence uptake of interventions targeting the families of children with autism can be managed best by preschool teachers.¹⁴

Early intervention for children with autism is a complex topic. Early intervention programmes are beneficial for children with autism. This improves developmental functioning and decrease maladaptive behaviours. Identification of children with autistic behavioural problem can be better done by preschool teachers, as children spent most of their wake full hours in the pre schools.¹⁵

From the available literature reviewed, it is found that autism is a complex developmental disorder which is evident during preschool years. Various factors are responsible for a better prognosis of this condition. As this condition is seen during the preschool years, the preschool teachers if are knowledgeable can help in an early identification of this condition. With this focus the researchers found it relevant to evaluate the effectiveness of a self instruction module on autism for preschool teachers with a specific focus on early identification.

OBJECTIVES:

1. Assess the knowledge of preschool teachers regarding autism in children.

2. Prepare a self instructional module on autism for preschool teachers.

3. Evaluate the effectiveness of the self instructional module on autism for preschool teachers.

4. Determine association between the mean pre test knowledge scores of preschool teachers regarding autism and selected socio demographic variables.

HYPOTHESIS:

H₁- The mean post test knowledge scores of preschool teachers regarding autism is significantly higher than their mean pre test knowledge scores.

H₂- There is a significant association between the mean pre test knowledge scores of the preschool teachers and the selected socio demographic variables.

POPULATION:

Population refers to the entire aggregate of individuals or objects having common characteristics.

In the present study the target population for the study comprised of preschool teachers who are working in selected schools, Bangalore.

SAMPLE AND SAMPLE SIZE:

Sample consists of a subset of a population selected in a research study. This study was conducted among preschool teachers those who are working in selected settings at Bangalore. The Sample size for the present study consists of 60 preschool teachers.

_{RESEARCH SETTING:}

This study was conducted among preschool teachers those who are working in selected settings at Bangalore.

SAMPLING TECHNIQUE:

Sampling is the process of selecting a portion of population to represent the entire population.

In order to assess the knowledge of preschool teachers regarding Autism a purposive sampling technique was used.

RESEARCH APPROACH:

A research approach tells the researcher about the collection of data that is, what to collect, how to collect and how to analyze. It also suggests possible conclusions to be drawn from the data.

A Pre-Experimental approach was adapted for this study since the investigation is aimed to evaluate the effectiveness of self instructional module on Autism.

RESEARCH DESIGN:

Research design depicts the overall plan for organizing scientific investigation. It helps the researcher in the selection of subjects, manipulation of independent variables and observation of a type of statistical method to be used to interpret the data.

One-group pre test-post test design was selected for the study.

DESCRIPTION OF THE TOOL:

To meet the objectives of the study the tool was developed by the investigator. The tool used for the study comprised of structured knowledge questionnaire on Autism.

A structured knowledge questionnaire was developed after review of literature and discussion with experts

Description of SIM:

The Self instructional module consisted of the following content area.

Content of the SIM were organized in 8 units with relevant A.V. aids.

Unit-I: Deals with general information of Autism.

Unit-II: Deals with Cause of Autism.

Unit-III: Deals with problems occur with Autism.

Unit-IV: Deals with Early identification of Autism.

Unit-V: Deals with role of health professional in Autism

Unit-VI: Deals with care of child at home

Unit-VII: Deals with benefits for child with Autis

_{VARIABLES OF THE STUDY:}

Dependent variable:

A dependent variable is the variable the researcher is interested in understanding, explaining or predicting.

In this study, the dependent variable is knowledge of preschool teachers regarding Autism.

Independent variable:

An independent variable is the variable that has presumed effective on the dependent variable.

In the present study the independent variable is the self instructional module regarding Autism.

Attribute variables:

Attribute variables are those uncontrolled variables (i.e., variable that cannot be manipulated by the experimenter) that may have a significant influence upon the results of a study.

In this study attribute variables are age, gender, religion, professional qualification and total years of experience

RESULTS:

Statistical analysis is a method of rendering quantitative information meaningfully and intelligently. Statistical procedures enable the researcher to summarize, organize, evaluate, interpret and communicate numerical information.

This chapter deals with analysis and interpretation of data collected from 60 Preschool teachers regarding Autism, keeping in view the objectives of the study. One group pre test and post test design was adapted to evaluate the effectiveness of the self instructional module regarding knowledge of Preschool teachers regarding Autism.

ORGANIZATION OF STUDY FINDINGS:

Both descriptive and inferential statistics were used to analyze the data. Analysis is organized under the following headings.

Section I: Socio- Demographic profile of the Preschool teachers.

Section II: Pre-test knowledge scores of the Preschool teachers regarding Autism.

Section III: Post-test knowledge scores of the Preschool teachers regarding Autism.

Section IV: Comparison of mean pre-test and post-test knowledge scores of the Preschool teachers regarding Autism.

Section V: Association between mean pre-test knowledge score with selected Socio- demographic variables.

Table – 1 Pre test knowledge level of preschool teachers regarding AUTISM n=60

Knowledge Level	Category	Respondents
Knowledge Level	Category	Number	%
Inadequate	< 50 % Score	45	75
Moderate	50-75 % Score	15	25
Adequate	> 75 % Score	0	0

In table 1, it is observed that majority of the Preschool teachers in the pretest 45(75%) had inadequate knowledge, 15 (25%) of Preschool teachers had moderate knowledge regarding AUTISM. It also seen that none of the Preschool teachers who participated in the study had adequate knowledge regarding AUTISM.

Table – 2 Post test knowledge level of Preschool teachers regarding AUTISM n=60

Knowledge Level	Category	Respondents
Knowledge Level	Category	Number	%
Inadequate	< 50% Score	0	0.0
Moderate	51-75 % Score	50	83.33
Adequate	> 75 % Score	10	16.67

Table – 3 Over all Percentage pre test and Post test knowledge level of Preschool teachers regarding AUTISM.

Domain	Max. Score	Respondents Knowledge			Paired ‘t’
Domain	Max. Score	Mean	SD (%)	Mean (%)	Test
Pre test	30	14.16	1.98	47.22	19.82**
Post test	30	20.33	2.73	67.77
Enhancement	30	6.16	1.7	20.53

** Significant at 1% level, t (0.01,29 df) = 2.46

TABLE – 4 Association between the mean pre test knowledge scores of preschool teachers regarding autism and selected socio demographic variables n=60

S.no	Demographic variables	No	%	Level of Knowledge
				Inadequate (<50%)		Moderate (50-75%)		Chisquare
				No	%	No	%	Chisquare
1	Age
	a. 21-30 years	30	50	28	93.33	2	6.67	14.8
	b. 31-40 years	14	23.33	10	71.43	4	28.57	df 3
	c. 41-50 years	12	20	6	50.00	6	50.00	S
	d. 51 and above	4	6.67	1	25.00	3	75.00
2	Gender
	a. Female	23	38.33	14	60.87	9	39.13	3.97
	b. Male	37	61.67	31	83.78	6	16.22	df 1 S
3	Professional Qualification
	a. MA Bed	11	18.33	7	63.64	4	36.36	4
	b. BSc Bed	13	21.67	8	61.54	5	38.46	df 3
	c. BA Med	29	48.33	25	86.21	4	13.79	N.S
	d. Any Other	7	11.67	5	71.43	2	28.57
4	Religion
	a. Hindu	30	50	24	80.00	6	20.00	1.6
	b. Muslim	10	16.67	8	80.00	2	20.00	df 3
	c. Christian	20	33.33	13	65.00	7	35.00	N.S
	d. Others	0	0	0	0.00	0	0.00
5	Total Years of Experience
	a. 1-3 Years	10	16.67	8	80.00	2	20.00	0.27
	b. 4-6 Years	20	33.33	15	75.00	5	25.00	df 3
	c. 7-9 Years	10	16.67	7	70.00	3	30.00	N.S
	d. 9 and above	20	33.33	15	75.00	5	25.00

N.S- Not Significant S- Significant at 5% level (i.e., 0.05%)

Table 2 shows that majority of the Preschool teachers in the post test 50(83.33%) had moderate knowledge, 10 (16.67%) Preschool teachers had adequate knowledge regarding AUTISM and none of samples were under category of inadequate knowledge on AUTISM. Thus the SIM regarding AUTISM was found to be effective.

Table 3 shows that the overall pre intervention mean was 14.16 and mean % of 47.22% ± 1.98 and post intervention mean was 20.33 and mean % was 67.77% ± 2.73 So the knowledge level of preschool teachers had a enhancement in level of knowledge as observed by mean of 6.16, mean % of 20.53 ± 1.7. Since the post test value is more than the pre test, the self instructional module was effective.

The comparison of pre and post test knowledge of preschool teachers reveals that the overall improvement mean was 20.53 with standard deviation of 1.7. The obtained value was higher than the table value, t= 19.82 which is highly significant at 0.05 level than the table value so, the research hypothesis (H₁) is accepted and null hypothesis is rejected. So it indicates that self instructional module was effective.

The analysis of association of selected Socio-demographic variables of preschool teachers regarding Autism, Chi-square test revealed that there was significant association between the pre school teacher’s knowledge score with the selected socio-demographic variables such as age and gender. Because the obtained value was more than the table value at P≤ 0.05 level of significance. So the research hypothesis H₁is accepted and the null hypothesis H₀ is rejected.

SUMMARY:

This chapter has dealt with analysis and interpretation of data by using descriptive and inferential statistics. Analysis was carried out on the basis of objectives and hypothesis of the study. Frequency and percentage distribution were used to explain socio demographic variables. A‘t’ test was done to evaluate the effectiveness of self instructional module regarding Autism. Chi-square (χ²) test was done to find out association between mean of the pre test knowledge score and selected socio demographic variables. The level of significance for all inferential analysis was set at 0.05 level of significance.

DISCUSSION:

Discuss the significant findings on the levels of knowledge of preschool teachers regarding Autism. The findings of data analysis were discussed in accordance with the objectives and stated hypotheses of the present study.

Therefore the present study was undertaken to assess the effectiveness of a self instructional module on Autism for preschool teachers in selected schools at Bangalore.

In order to achieve the objectives of the study, purposive sampling technique was used to select the sample. The data was collected from 60 preschool teachers in selected schools at Bangalore.

The findings of the study were discussed according to the objectives and hypothesis.

1. Socio-demographic characteristics of preschool teachers:

The study findings revealed that the preschool teachers under the age group of 21-30 were about 30(50.0%), 31-40 were 14(23.33%), 41-50 were 12(20.0%) and remaining 04 (6.67%) were in the age group of 51 and above years. Regarding gender majority of respondents 37(61.67%) were male whereas 23(38.33%) were female. Regarding religion majority of respondent

30(50.0%) were Hindus, 20(33.33%) were Christian and 10(16.67%) were Muslims. In relation to educational qualification, majority of the respondents 29(48.33%) were BA Med, 13(21.67%) were Bsc Bed, 11(18.33%) were MA Bed and 7(11.67%) were having other qualification. Regarding total years of experience, 20 (33.33%) of the preschool teachers had 4-06 and 9 and above years of experience, and the remaining 10 (16.67%) of the preschool teachers had 1-3 and 7-9 years of experience.

2. a) Mean percentage pre test and post test knowledge score of preschool teachers on Autism:

In the present study, it was found that the overall mean pre test knowledge scores of preschool teachers on Autism found to be 47.22% ± 1.98. The overall post test mean knowledge gained score of preschool teachers on Autism was 67.77 ± 2.73.

b) Comparison of pre-test and post test mean percentage knowledge score of preschool teachers in order to evaluate the effectiveness of Self instructional module regarding Autism:

In the present study, the mean percentage of post test knowledge scores on Autism was 67.77% which was higher than the mean percentage of pre test knowledge score 47.22% with an enhancement of 20.53%. A paired ‘t’ test was done 19.82 and it was found to be significant t (29df =2.46), P < 0.05). Regarding all the knowledge aspects under investigation the enhancement is found to be significant at 0.05 level of significant (P ≤ 0.05).

3. Association between mean pre-test knowledge scores and selected socio- demographic variables of preschool teachers:

The socio-demographic variables to which an association was assessed are age, gender, religion, professional qualification and total years of experience. Among these a statistically significant association was found between age and gender with chi-square (χ2) value of 14.8 (3df) and 3.97 (1df) respectively at 0.05 level of significant p ≤ 0.05.

In the present study all the other socio-demographic characteristics like religion χ2 1.6, professional qualification χ2 4 and Total years of experience χ2 0.27 at 0.05 level of significance, indicated a non-significant association.

CONCLUSION:

The study was conducted to evaluate the effectiveness of a self instructional module on Autism for preschool teachers in selected settings, Bangalore. In the present study, 60 preschool teachers were selected by using purposive sampling technique.

The research approach adopted in the present study is a Pre-experimental approach with a view to measure the knowledge on pre test and effectiveness associated in the post test is to explore the knowledge gain of preschool teachers regarding Autism. A knowledge questionnaire was used to assess the knowledge of preschool teachers regarding Autism. The data was interpreted by suitable appropriate statistical methods.

This Chapter Deals With the Following Conclusions:

· The study findings revealed that the age groups of 21-30 were about 30(50.0%), 31-40 were 14(23.33%), 41-50 were 12(20.0%) and remaining 04 (6.67%) were in the age group of 51 and above years.

· Regarding gender majority of respondents 37(61.67%) were male whereas 23(38.33%) were female.

· Regarding religion majority of respondent 30(50.0%) were Hindus, 20(33.33%) were Christian and 10(16.67%) were Muslims.

· In relation to educational qualification, majority of the respondents 29(48.33%) were BA Med, 13(21.67%) were B.Sc. Bed, 11(18.33%) were MA Bed and 7(11.67%) were having other qualification.

· Regarding total years of experience, 20 (33.33%) of the preschool teachers had 4-06 and 9 and above years of experience, and the remaining 10 (16.67%) of the preschool teachers had 1-3 and 7-9 years of experience.

· Overall mean pre test knowledge scores of preschool teachers on Autism were found to be inadequate 47.22± 1.98.

· Overall mean post test knowledge scores of preschool teachers on Autism were found to be adequate 67.77 ± 2.73.

· A paired ‘t’ test result indicated a statistically significant difference between the pre test and post test knowledge score regarding Autism for all the knowledge aspects under investigation t (29=2.46), P<0.05), from which it can be inferred that the self instructional module was effective in enhancing the knowledge of the preschool teachers on Autism.

· There were significant associations found between age and gender with knowledge level of preschool teachers on Autism.

IMPLICATIONS:

The results of the study show that preschool teachers on Autism during pre test. So the study has several implications for nursing education, nursing practice, nursing administration and nursing research.

Nursing Practice:

Today, health care delivery system has changed from a care-oriented approach to promotion of health and prevention of illness oriented approach. So, it focuses mainly on primary prevention, which is aimed at health promotion. Considering these factors, nursing personnel can contribute much for Autism by creating awareness in the schools through health programmes, camps and special programmes and mass media education.

Nursing Education:

Nurse educator can teach the preschool teachers to acquire adequate knowledge and skills in Autism. They can also teach preschool teachers the techniques and complications of Autism. Nurse educator can teach to adopt appropriate preventive measures against complications associated with Autism. Findings of the present study show that majority of Pre School teachers have not attended health programme related to Autism.

Nursing Administration:

The main focus of nursing administration is to organize seminars and workshop and other educational programmes for staff nurses as a part of in-service education programme by which knowledge towards Autism shall be enhanced.

Nurse administrator can make a separate budget in each hospital to develop health-teaching material in this regard and make accessible to the needy population. They also can start training of volunteers to provide specialized care to Autism.

Nursing Research:

The findings of the study show that majority of the preschool teachers on Autism. Based on these findings the researchers can conduct further studies on awareness and improvement of knowledge of preschool teachers on Autism related care. The study will motivate the beginning researchers to conduct studies with different variables on large scale. Nursing research can help to identify the existing knowledge gap in the nursing profession. This will help to improve the quality and standard of nursing care based on evidence based practice.

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Received on 24.10.2018 Modified on 03.12.2018

Int. J. Nur. Edu. and Research. 2019; 7(2): 221-228.

DOI: 10.5958/2454-2660.2019.00048.6