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The Clinical Educator and Autism Advocate

Penn Nursing’s clinician educators are all about relationships. Through their practice, scholarship, patient care and teaching, they create deep and sustaining connections that inform nursing practice, advance knowledge and enhance care.

Perhaps one of the biggest rewards for a clinician educator like Margaret Souders, PhD, CRNP, assistant professor of Human Genetics at Penn Nursing, is directly engaging students in her clinical practice and seeing them gain firsthand knowledge in working with a vulnerable population she is passionate about.

“Nursing is a practice profession,” says Dr. Souders, whose practice in the Child and Adolescent Psychiatry Department in the Autism Integrated Care Program at the Children’s Hospital of Philadelphia (CHOP) informs her teaching, research and scholarship. “My students participate in my clinical practice with me to learn how to diagnose autism spectrum disorder (ASD) and care for these children and their families. Not many nurses know a lot about ASD, because they’re often afraid to interface with sometimes-aggressive children.”

Aggression in children with ASD can cause a vicious cycle of behavior problems, escalated stress and worsening behavior. This cycle can interfere with interventions to help the child with ASD. Souders has dedicated her career to finding ways to break that cycle, and encourages students to join her in her clinical practice and research in order to continue
to build an important body of knowledge.

“Margaret has been able to develop a really collaborative, team-based approach to caring for children with autism,” says Julie Fairman, PhD, RN, FAAN, Nightingale Professor of Nursing, chair of the Department of Biobehavioral Health Sciences and director emerita of the Barbara Bates Center for the Study of the History of Nursing. “She works on both practice and research teams to improve care delivery to these children. That’s her strength, as is getting the services these children need and working on transitions of these services as they grow into young adults.”

Dr. Fairman calls Dr. Souders “the ultimate example of how clinician educators combine education, research and practice.”

Preparing the next generation of ASD care providers

Good clinician educators don’t just impart knowledge – they use their experience to impact teaching. As co-director of a minor in autism, Dr. Souders teaches three courses – one focused on the epidemiology of ASD, screening and diagnosis; another that outlines treatments for ASD; and a leadership course. “This summer, we created simulations to help
nurses interface with very aggressive children,” she says. “Our goal is to teach them to de-escalate a situation without feeling scared. These simulations will help nurses gain confidence interacting with aggressive kids, re-direct behaviors and help families to feel that they’re being treated with dignity.” Dr. Fairman says these simulations are a very effective way to teach nursing students how to work with children in high-stress situations before they
head into a clinic, or if clinical experience is not immediately available.

Dr. Souders herself entered the field dealing with an aggressive child in a somewhat desperate situation.

“I was a pediatric nurse practitioner at CHOP taking care of children with chronic illnesses on long-term respirator and ventilator support,” she says. “I got a call one day from the bio-behavioral unit at CHOP that they needed a nurse practitioner to help deal with a child who was very aggressive and selfinjurious,hitting her head 450 times in 15 minutes.I wasn’t afraid, and I was able to get through to her, conduct a physical exam and send her for a CT scan. I really like kids and think I have an instinctual way of interacting with them. I became fascinated with diagnosing children and helping families manage.”

Including students in revolutionary research to alleviate sleep symptoms

Much of Dr. Souders’ research focuses on cognitive behavioral therapy modified for children with ASD and insomnia, a common problem in this population. She is enthusiastic about involving her students in her research. “As a result of this research, I can prepare nurses
and occupational therapists to go into homes and make ecological changes that help parents create relaxing routines, activities and environments that will encourage their children to sleep,” she explains.

Her experiences and drive to learn more in order to help her patients sets an example for her students.

After earning her bachelor’s, master’s and doctoral degrees in nursing from Penn Nursing, Dr. Souders completed a postdoctoral fellowship in sleep medicine, which prepared her for her unique role in addressing the connection between sleep and behavioral issues in children with ASD.

“While I was pursuing my doctoral degree and caring for children in my clinical practice, I realized a lot of my kids didn’t sleep well and their parents were overwhelmed,” she says. “This was a big clinical problem with no studies or evidence to back up interventions. I decided to conduct my own studies and gather the data myself.”

She recently completed a United States Department of Defense (DOD) grant project on the feasibility of tailored behavioral interventions for insomnia in children with ASD. Through her work, Dr. Souders has helped improve sleep for children with ASD by about an hour each night.

Half of children who have autism have trouble falling or staying asleep, which may make their symptoms worse. Blue light from TVs and other technology can be part of the problem.Half of children who have autism have trouble falling or staying asleep, which may make their symptoms worse. Blue light from TVs and other technology can be part of the problem.“Many of these children have severe anxiety or symptoms of attention deficit hyperactivity (ADHD) disorder, so they’re always in a hyper-aroused state,” explains Dr. Souders. “Calming strategies and ecological changes can make a big difference. Blue light from TVs and other technology, pets in the bedroom and too many stuffed animals are some of the problems we see. For sleep, a child’s room should be cool and quiet, have an orangey glow that fades into darkness and be free of clutter.”

Dr. Souders is now pursuing additional grants that will allow her to continue, and improve upon, these studies. And, she’s eager to continue working with a new generation of clinicians willing to take on the unique challenges that come with ASD.

“Penn Nursing students are brilliant and innovative,” she says. “They just need to be exposed to really important bodies of knowledge and learn by doing in order to become excellent clinicians.”