RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,

BANGALORE, KARNATAKA

PROFORMA FOR REGISTRATION FOR SUBJECT FOR

DISSERTATION

1 NAME OF THE CANDIDATE Mrs. VANITHA.N

AND ADDRESS
I Year M.Sc (N) Student,

ACHARYA COLLEEGE OF NURSING,

BANGALORE -32

2 NAME OF THE INSTITUTION ACHARYA COLLEEGE OF NURSING,

CHOLANAGAR, R. T. NAGAR POST,

BANGALORE -32

3 Course of study and subject M.Sc. (Nursing)

CHILD HEALTH NURSING

4 Date of admission to the course 20.04.2010

5 Title of the topic A study to evaluate the effectiveness of video

assisted teaching programme regarding autism
among primary school teachers at selected rural
schools of Bangalore.

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6. BRIEF RESUME OF THE INTENDED WORK
6.1 INTRODUCTION

Wish you could see the

World thru their eyes……..
Autism……..
They see things differently

Autism is not a puzzle, nor a disease. Autism is a challenge but certainly not a
divesting one. It is about finding a way to survive in an overwhelming confusing world. It
is about developing differently in a different pace and with different leaps.1

Autism is a disorder of neural developmental disorder characterized by impaired

social interaction and communication and by restricted and repetitive behavior. The
neurological disorder sets in with the first three years of life and impacts on information
processing in the brain by altering how nerve cells and their synapses connect and
organize.2

There is every reason to assume that autism has always existed. However, the
word was first used by the Swiss psychiatrist, Eugen Bleuler, in 1911, and this concept
evolved enormously since then. Leo Kanner is generally believed to be the first person to
employ the term in the way we understand it today. 3

Autism is one of the three recognized disorders in the autism spectrum disorders
(ASD), the other two being Asperger syndrome and pervasive developmental disorder. In
rare cases, autism is strongly associated with agents that cause birth defects, other
controversial proposed environment causes such as heavy metals, pesticides or childhood

2
vaccines. It has a higher incidence in first born males from well educated bright families
in which the mother has a history of perinatal complications.2

Appropriate early intervention is important to treat child with autism. The parents,
physicians, and specialists should discuss what is best for the child. Parents should be
educated regarding behavioral techniques so that they can participate in all aspects of the
child's care and treatment. Counseling and support may be helpful for the parents. Special
education classes are available for autistic children. Medication can be recommended to
treat specific symptoms such as seizures, hyperactivity, extreme mood changes, or self-
injurious behaviors.4

Children under 16 yr of age constitute over 40 percent of India’s population and

information about their mental health needs is a national imperative. From the early
1960s, there have been efforts at conducting epidemiological studies in community, clinic
and school settings. Community surveys have the advantage of being more
representative; they include children and adolescents who do not attend school and
those who do not access mental health services.5

School plays a significant role in children's mental health care. Teacher's assessment is
predictive of the child's subsequent mental health. Although it is difficult for both
teachers and parents to recognize especially depression in a child, observations made by
adults will complement the information received from the child. Teachers' knowledge of
mental health should be increased and clear-cut instructions should be provided for them
by health care professionals. Teacher’s assessments of child’s mental health should be
utilized to a greater extent than presently.6

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6.2 NEED FOR THE STUDY

India is a home to almost 19% of the world’s children. More than one third of the
country’s population, around 480 million, is below the age of 25 years (54% of the
population). According to an assumption, 40% of these children are in need of care and
protection, which indicates the extent of the problem.7

The prevalence of autism in India was about 0.5 per 1000 during the 1990’s as
opposed to today’s 1-2 per 1000. Estimated prevalence to be approximately 6.6 per 1,000
(or 1/150) children in the United States, in 2008, and as many as 12 in 1,000 (or 1/80)
children with an ASD in Europe and Scandinavia. Among Asian country like Hong Kong
reported 1.68 cases of autism per 1000 for children less than 15 years. In Denmark
incidence of autism is increasing continuously it was about 0.5 new cases per 10,000
children in 1990’s and about 4.5 new per 10,000 children in 2000. In Germany a study
found that inpatient admission rates for children with ASD increased to 30% from 2000
to 2005.8

The etiology of autism is still unclear but recent studies suggest that genetics play
a major role in conferring susceptibility. Recent neuro imaging research studies indicate
that autism may be caused by atypical functioning in the central nervous system,
particularly in the limbic system: Amygdale and Hippocampus. In autistic children,
losses of language and/or social skills occur during the second year of life, usually
between 15 and 21 months of age. Co-morbidity with mental retardation, epilepsy,
disruptive behaviors and learning difficulty is very common. Although there is currently
no known cure for autism there is evidence to suggest that early intervention therapy can
improve functioning of autistic children. Judicious use of psychotropic drugs is necessary
to manage associated aggression, hyperactivity, self-mutilation, temper tantrums; but
drugs are not a substitute for behavioral and educational interventions. The family
physician can play an important role in detecting autism early, coordinating its
assessment and treatment, counseling the parents and classroom teacher, and monitoring
the child's progress on a long term basis.9

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 Autism is the third most common developmental disability whose incidence is

greater than that of Down’s Syndrome 2 and Cerebral Palsy. According to Cohen and
Volkmar (1997), no other childhood disability has such clearly defined and consistent
diagnostic criteria; indeed, the manifestations of autistic symptoms are remarkably
consistent across nations and cultures. Daley (2002) speculates that the reason why
autism is such a misunderstood and misdiagnosed condition is because it frequently falls
between the cracks of mental retardation and mental illness .Indeed, many of its

behavioral manifestations are seen as indicative of “madness‟; hence it carries immense

stigma.10

A study was conducted to identify the cases of autism among children with
language, communication and behavior disorder, to ascertain the associated co-
morbidities and create a sensitive awareness among various health care professionals in
All India Institute of Medical Science, New Delhi, India. 62 patients fulfilled the DSM
IV criteria for autism out of 72 referred. The result showed that male: female ratio was
8:1 and the important co-morbidities included mental challenged (95%), hyperactivity
(53%) and seizures (10%) cases. The researchers suggested that, autism does occur in
Indian children but diagnosis often missed hence, the health care professionals need to be
acquainted with knowledge regarding the developmental disabilities of autistic children
by a more structured teaching programme.11

A qualitative study was conducted for systematic review of prevalence studies of

autism spectrum disorders in. Among the samples one group of studies estimated the
prevalence of typical autism and the other group on all autism spectrum disorders (ASD).
The extent of variation among studies and overall prevalence were estimated using meta-
analysis, of which 37 estimated the prevalence of typical autism and 23 the prevalence of
all ASD. The study concluded that there was high degree of heterogeneity among
observed studies and autism prevalence estimates 61% in the particular study location.

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 A comparative study was conducted to determine the views of teachers and parent
on autism .Surveying of beliefs regarding various aspects of the disorder was done among
47 teachers and parents of autistic children. Parent and teacher responses were compared
to those obtained from a group of 22 "specialists" in autism, drawn from across the
country. Both parents and teachers were found to harbor misconceptions regarding
cognitive, developmental, and emotional features of autism.13

Children with autism can still perform daily functions and can be integrated in
normal classrooms while at school. However, this is predicated upon the teacher’s
willingness children and their patience to learn methods for teaching autistic children.
Autistic children learn a lot, even though they are limited due to their disability, autistic
children can really surprise us when it comes to how much knowledge they can retain.14

Teachers can have an immense impact on young people’s health. Everyday at

least 5-6 hour it is the school teachers who come in contact with school children. If
teachers are educated especially about autism, with the help of a learning module, it will
help the teachers to identify signs and symptoms of autism as early as possible and take
remedial measures promptly. Currently the need of autistic children in India are not being
met in either the regular or special education systems with an understanding teacher or
possibly an aide, a more able autistic child could function very well in a regular school
and learn valuable social skills from his peers. Also the rigidity and pressure of schools in
India can make it difficult for an autistic child to cope without special allowances. Some
middle and lower functioning children, who form the majority of autistic children, may
attend special schools, but these schools almost always lack an understanding of effective
methods of handling the challenging behaviors of autistic children.15

From the above mentioned information, it was found that autism is prevalent in
India and teachers are lacking knowledge regarding the disabilities of children with
autism. So the investigator found it relevant to provide a video assisted teaching
programme on autism which includes definition, incidence, etiology, risk factors, signs

6
and symptoms and role of parents and teachers in management of child with autism in
order to create awareness among rural primary school teachers and improve their
knowledge in assisting the autistic children.

6.2 REVIEW OF LITERATURE

The purpose of review of literature is the identification, selection, critical analysis
and reporting of existing information on the problem chosen for the study.

Review of literature helps to know what is already known that is these helps in
developing a broad conceptual content into which the research problem will fit in. Main
goal is to develop a sound knowledge in development of nursing theory, education,
practice and research

The results of studies conducted in various aspects of autism are presented below:
6.2.1-Review of literature related to autism among children.
6.2.2-Review of literature related to knowledge of primary school teachers
regarding autism.

6.2.1-Review of literature related to autism among children:

A study was conducted to assess the prevalence of autism spectrum disorder. The
Autism and Developmental Disabilities Monitoring (ADDM) Network collected data
from 11 ADDM Network sites in 2006 and compared with the child developmental
referral centre (CDC) data from 10 sites in 2002. It was found that 2,757 (0.9%) of
307,790 children aged 8 years residing in the 11 ADDM sites were identified as having
an ASD in 2006, indicating an overall average prevalence of 9.0 per 1,000 population.
The average prevalence of ASDs identified among children aged 8 years increased 57%
from 2002 to 2006. The researcher concluded that an increased prevalence of identified
ASDs among U.S. children aged 8 years and indicated the need to regard ASDs as an
urgent public health concern.16

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 A study was conducted to assess the incidence of childhood autism. Cumulative
incidence up to age 5 years was calculated for childhood autism among a birth cohort
from four successive years (1988 to 1991). The cumulative incidence recorded was 27.2
per 10,000 populations and by sex were 38.4 per 10,000 in males, and 15.5 per 10,000 in
females. The proportions of children with high-functioning autism who had Binet IQs of
70 and over and those with Binet IQs of 85 and over were 25.3% and 13.7%
respectively.17

A study was conducted to assess the increased prevalence rate of autism with
changes in diagnostic criteria. The patient acquiring an autism diagnosis was elevated in
periods between 1992 and 2005 in which the practices for diagnosing autism changed.
Using the probability of diagnostic change between 1992 and 2005 to generalize to the
population with autism, it was estimated that 26.4% of increase caseload. Through this
study it was concluded that changes in diagnostic practices is found to be associated with
increased case load of autism.18

A study was done to examine the treatment rates and patterns in children and
adolescents with ASDs. Data collected among 353 parents of children and adolescents
with ASD from public schools. Results showed that 46.7% of subjects had taken at least
one psychotropic medication in the past year, 17.3% of subjects had taken some type of
specially formulated vitamin or supplement, 15.5% on a modified diet, 11.9% had some
combination of psychotropic medication, and 4.8% had taken an anticonvulsant. The
result indicated that greater age, lower adaptive skills and social competence, and higher
levels of problem behavior were associated with greater medication use.19

A study was conducted to determine apparent behavioral characteristics of autism

in early childhood in. A comparison of behavioral data obtained from parents and clinical
observation of 26 children (23 boys and 3 girls) younger than age 48 months with a
clinical diagnosis of autism in CDC was taken for the study. Results suggested that
deficits in the areas of social interaction, imitation, play, and nonverbal communication
are more prominent than insistence on sameness and routines in young children with
autism.20

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 A pilot study was done to evaluate the effectiveness of a group-based intervention
aiming at improving social and communication skills in individuals with ASD. A sample
of 17 children and adolescents received treatment according to the manualised Frankfurt
Social Skills Training (KONTAKT) for 11 months. Parent, teacher, expert and blind
expert ratings were assessed to judge outcome regarding peer interaction, autistic
behaviors, adaptive functioning and family burden before and after the treatment. The
participants exhibited improvements in social skills from 0.02 to 0.69 after treatment.
Findings indicated that KONTAKT might be useful for enhancing social skills and
reducing autism-related psychopathology over time in different contexts.21

6.2.2-Review of literature related to knowledge of primary school teachers

regarding autism.

A study conducted to examine teacher’s knowledge on symptoms, concerns, and

self-efficacy for teaching Children with autism. A sample of 105 general education
teachers, 29 special education teachers, and 32 other educational specialist professionals
(e.g., aides, speech pathologists, occupational therapists, and Title teachers) from eleven
elementary schools were selected. The study showed that Special education teachers
have higher knowledge regarding autism and higher self-efficacy in teaching children
with autism. (Mean= 3.65) than general education teachers (Mean = 2.47). General
education teachers show higher ratings of concern about having a student with autism in
their class (Mean= 4.04) than special education teachers (Mean= 3.03). Thus the
researcher concluded that general education teachers need additional workshops, teacher
preparation courses, and fieldwork experiences on autism.22

A study was conducted to identify strategies used by teachers in education of

children with ASD. A sample of 185 teachers educating 226 children with ASD was
surveyed. From The study it was revealed that top five strategies being used (Gentle
Teaching, sensory integration, cognitive behavioral modification, assistive technology,
and Social Stories) are recognized as lacking a scientific basis for implementation.

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Results highlight clear implications for pre-service and in-service educator training, and
the need for continued research to document evidence-based strategy use in public
schools for students with ASD.23

A descriptive study was conducted to assess the knowledge, practices employed,

and training needs of special education teachers serving students with autism. A survey
instrument was used to collect data from 498 participants in the study and they reported
the greatest knowledge in general autism, and the least knowledge in sensory motor
development. The greatest level of implementation was in individualization and support
strategies and lowest in social skills. The Participants indicated the need for training
regarding social skill development and sensory motor development for children with
autism.24

A study was done to assess the Knowledge, attitudes and practices on childhood
developmental and behavioral disorder (CDABD) among 503 pre-school teachers, aged
30-44 years. Result revealed that 56% of the teacher achieved a pass rate in knowledge.
The pass rate in aspects of ND (normal development), ASD and attention
deficit/hyperactive disorder, was 66%, 68% and 32%, respectively. The researchers
concluded that there is a deficit in knowledge of pre-school teachers regarding CDABD
and suggested for special need (SN) education, more training and resource support to
improve their knowledge and skills to aid integration.25

A study was conducted to examine attitudes and physiological responses

demonstrated by pre-service learners towards young children with ASD. The Self-
Assessment Manikin (SAM) and two physiological measures (skin conductance and heart
rate responses) were obtained. Four behaviors (two control and two problematic)
depicting preschool-age males with ASD were viewed by pre-service learners who either
had limited (n = 15) or substantial experience (n = 15) in working with this population.
Results revealed significant differences between behaviors (control versus problematic)
on two out of three SAM ratings and on both physiological measures. The result reveled
that regardless of level of experience, pre-service learners exhibited decreased skill in
managing problematic behavior and increased arousal to develop managerial ability of

10
such children. The researcher concluded that the pre-service learners need to be educated
regarding autism spectrum disorder. 26

6.4 STATEMENT OF THE PROBLEM:

A study to evaluate the effectiveness of video assisted teaching programme

regarding autism among primary school teachers at selected rural schools of Bangalore.

6.5 OBJECTIVES:

1. To assess the knowledge regarding autism among primary school teachers

2. To evaluate the effectiveness of video assisted teaching programme by comparing
the mean pretest-posttest knowledge scores of primary school teachers
3. To determine the association between the pre and post test knowledge level of
primary school teachers with selected socio demographic variables

6.6 OPERATIONAL DEFINITION:

Evaluation:

In this study, it refers to the method of estimating and interpreting the

effectiveness of video assisted teaching programme regarding autism among primary
school teachers.

Effectiveness:

In this study, it refers to the significant enhancement in the level of knowledge

among primary school teachers regarding autism as measured through the correct
responses to the structured knowledge questionnaire by comparing pre and post test
knowledge scores.

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Video assisted teaching programme:

In this study, it refers to a systematic organized teaching programme prepared by

the investigator and validated by experts contains video clips regarding autism such as
definition, incidence, etiology, risk factors, signs and symptoms and role of parents and
teachers in management of children with autism.

Knowledge:
In this study, it refers to level of understanding of information about autism which
will be measured by the structured knowledge questionnaire.

Autism:

In this study, it refers to neuro developmental disorder characterized by impaired

social interaction and communication, and by restricted and repetitive behaviors.

Primary school teachers:

In this study, it refers to Primary school teachers of selected government and

private schools in rural areas.

6.7 HYPOTHESIS:
H1: The mean post test knowledge score of primary school teachers will be higher than
the mean pretest knowledge score regarding autism.

H2: There will be significant association between selected socio demographic variables
with the mean pre and post test knowledge level of primary school teachers regarding
autism.

6.8 RESEARCH VARIABLES:

Independent variables:
In this study, independent variable is video assisted teaching programme.

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Dependent variable:
In this study, dependent variable is knowledge of the primary school teachers
regarding autism.

Socio Demographic variable:

In this study, socio demographic variables are age, gender, religion, qualification,
marital status, type of family, teaching experience, teaching classes and source of
information.

6.8 ASSUMPTIONS:

In this study it is assumed that

 primary school teachers may have some knowledge regarding autistic child’s
activities such as impaired communication, social interaction and low IQ.
 the structured knowledge questionnaire could be an effective tool in evaluating
the knowledge of primary school teachers.
 video assisted teaching could be an effective method in improving the knowledge
of primary school teachers regarding autism.

6.9 DELIMITATIONS:

The study is delimited to

 primary school teachers working in selected rural schools of Bangalore
 the sample size is limited to 60
 study is delimited to one month

PROJECTED OUTCOME:
The video assisted teaching programme will be provide beneficial information in
improving the knowledge of primary school teachers regarding autism and the findings

13
will elicit the relationship between the information expected and the information received
by primary school teachers regarding autism.

7. MATERIALS AND METHODS:

7.1 SOURCE OF DATA:

7.1.1 RESEARCH DESIGN:

The research design which would be more suited for this study will be one group
pretest and post test used under quasi experimental approach.

Schematic representation of research design:

GROUP PRE-TEST INTERVENTION POST-TEST
Primary school O1 X O2
teachers working in
Day-1 Day-1 Day-7
rural areas of
Bangalore

KEY WORDS:

O1- Pre-test to assess the knowledge of primary school teachers regarding autism..

X- Administration of video assisted teaching programme regarding autism to primary

school teachers.

O2- post test to assess the knowledge of primary school teachers after administration of
video assisted teaching programme.

7.1.2 RESEARCH SETTING:

This study will be done at selected rural schools of Bangalore.

7.1.3 POPULATION

Target population – all rural primary school teachers

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 Accessible population –primary school teachers working in selected schools.

7.1.4 SAMPLE:

The sample consists of the primary school teachers working at selected rural
schools, Bangalore.

7.1.5 SAMPLE SIZE:

The sample size consists of 60 primary school teachers who fulfill the inclusion
criteria.

7.1.6 SAMPLING TECHNIQUE:

Convenience sampling technique will be adopted to select the sample for the
study.

7.1.7 SAMPLING CRITERIA:

Inclusion criteria:

 The study includes primary school teachers of selected government and private
schools in rural areas of Bangalore.
 The teachers who are willing to participate in the study.
 The teacher who can read and write Kannada.

Exclusion criteria:

 The teachers who are not available at the time of data collection.

7.2 METHODS OF DATA COLLECTION:

INSTRUMENT USED FOR THE STUDY

The data collection will be done with the help of structured knowledge questionnaire.
It consist of

15
Section A- It consist of demographic data like age, gender, religion, qualification,
marital status, type of family, teaching experience, teaching classes and source of
information.
Section B- the investigator will collect the data by giving structured knowledge
questionnaire.

7.2.1 PLAN FOR DATA COLLECTION PROCEDURE:

Content validity of the tool will be ascertained in consultation with guide and
experts like pediatrician, pediatrics nurse and psychologist. Reliability of the tool will be
ascertained by split half method. Prior to the study, written permission will be obtained
from the concerned authority.
After obtaining permission from the concerned authority an informed consent will
be obtain from the subject. The process of the study will be explained to the subjects.
After explaining the process of study, socio demographic data will be collected with the
help of a structured questionnaire. The knowledge of primary school teachers regarding
autism will be assessed by using structured knowledge questionnaire. Video assisted
teaching programme will be provided to primary school regarding autism on the same
day of pre test.
After 7 days post test will be conducted to evaluate the effectiveness of video
assisted teaching programme regarding autism among primary school teachers.

7.2.2 DATA ANALYSIS METHOD:

Data analysis will be done by using descriptive and inferential statistics. The
descriptive statistics like mean and standard deviation, frequency distribution and
percentage will be used to assess the demographic variables. The inferential statistics
like paired ’t’ test and chi square test (χ 2) will be used to compare the pre and post test
knowledge score and to find out the association between the mean pretest and posttest
knowledge scores with selected sociodemographic variables respectively.

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7.3 DOSE THE STUDY REQUIRES ANY INVESTIGATION OR
INTERVENTIONS TO BE CONDUCTED ON PATIENTS OR
OTHER HUMAN OR ANIMALS
Yes,
A video assisted teaching programme will be given to primary school teachers in
selected rural schools at Bangalore.

7.4 HAS ETHICAL CLEARANCE BEEN OBTAINED?

Yes,
A written permission from institutional authority will be obtained. Consent from the
primary school teachers before conducting the study. Confidentiality and anonymity of
the subjects will be maintained.

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Schlitt, Gabriele Schmötzer et al. Pilot evaluation of the Frankfurt Social Skills

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[online]. 2006 Available from: URL: drc.ohiolink.edu/handle/2374.OX/19163
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 SIGNATURE OF CANDIDATE

10. REMARKS OF THE GUIDE

11 NAME AND DESIGNATION :

11.1 GUIDE MRS. ASWALT AMALI

ROSE.S
HOD CHILD HEALTH
NURSING
11.2 SIGNATURE

11.3 HEAD OF THE DEPARTMENT MRS. ASWALT AMALI

ROSE.S

11.4 SIGNATURE

12.1 REMARK OF THE CHAIRMAN

OR PRINCIPAL

12.2 SIGNATURE

20