Autism and the Nurse Practitioner

allnurses Guide · May 28, 2009

Hi,

I'm a new FNP, and in my opinion, a PNP track might be the better route for you. We did not spend a lot of time on pediatrics and I did one semester of clinical in a pedi practice, but I would not feel comfortable dealing with the needs of this population as an FNP. I'm good with the routine medical care, but not the psycho-social issues the parents and children deal with. You'll get a much more in depth education on pediatrics in a PNP program, and you could ask to do clinicals at a site that works with autistic children.

As the aunt of a gorgeous autistic little boy, bless you for considering this field. I think you have some wonderful ideas for practice and could make a big difference in these families' lives.

Sheri FNP-C · May 28, 2009

That sounds like an amazing idea!!!!

Like the previous poster, my initial reaction was to suggest PNP, however I am having 2nd thoughts. One reason is that the rise in autism has resulted in many autistic children now, but they will grow into autistic adults still needing some specialized care. My autistic child sees a "neurodevelopmental pediatrician." However, he is still very young so we have not discussed what happens when he reaches adulthood. Hopefully, all the therapy we are doing now will mean he doesn't need anything extra as an adult. At least with FNP you are legally able to care for patients of all ages and can continue learning and growing in the autism field after graduation. I kind of equate this to the FNPs who take positions in derm, renal, neuro, etc. These are all areas that were not well covered in my FNP program, but learning continues long after licensure.

Good luck!

jer_sd · May 28, 2009

Most of the post masters certificates I have found are within the departemts of education. Do a google search for post masters certifcate Autism. If you have this additional training addd to your up comming NP education it may help you with the creation of an interdisiplinary clinic.

PNP is the easiest fit, but FNP could also work and increase your options later in your career.

I like this idea, this is an area where NP can have a strng influence over the traditional system. One thing to look at is how will you get funding for the practice, E+M codes only rehablitation codes, grants ect....

Jeremy

mwboswell · May 28, 2009

Question for the group...

All the talk about autism, yet I have, as of yet, seen adults with "autism"....

In other words, what happens to all these kids with autism when they grow up? I don't get young adults or adults coming in telling me they have a history or current diagnosis of autism???

Sheri FNP-C · May 28, 2009

Question for the group...
All the talk about autism, yet I have, as of yet, seen adults with "autism"....
In other words, what happens to all these kids with autism when they grow up? I don't get young adults or adults coming in telling me they have a history or current diagnosis of autism???

Professionally, I don't know the answer to this. Other than autism was rarely diagnosed in years past.

My husband is a contractor. He is building a house for a young man (mid-30s) that was diagnosed with MR and treated as such as a child/adolescent. His father is a family practice MD. More recently, his father felt he was misdiagnosed and had him re-evaluated....the results...NOT MR but autism. Unfortunately, the current thinking (according to the MD father) is that if caught early and treated with intensive therapy these children can and most will grow up to be productive members of society that may be considered a bit "quirky" or "eccentric" but still functional. However for this man, it is too late. You can not teach pragmatic language and social skills to someone that has been set in their ways per se for over 30 years, gosh it is hard enough with a preschooler!!!!

So anyway, that is my guess...mild cases in years past were not recognized and severe were misdiagnosed as MR. Depending on the family dynamics the patients with severe forms may very well be living in group homes. I think this father that is still supporting and caring for his adult son is the exception rather than the rule.

This has turned into a very, very interesting post!!!!

I am jealous of the original poster. I thought I wanted to work in neurodevelopmental peds due to my experiences with my son, however the one practice in my geographical area does not use NPs :crying2:

morte, LPN, LVN · May 28, 2009

Professionally, I don't know the answer to this. Other than autism was rarely diagnosed in years past.
My husband is a contractor. He is building a house for a young man (mid-30s) that was diagnosed with MR and treated as such as a child/adolescent. His father is a family practice MD. More recently, his father felt he was misdiagnosed and had him re-evaluated....the results...NOT MR but autism. Unfortunately, the current thinking (according to the MD father) is that if caught early and treated with intensive therapy these children can and most will grow up to be productive members of society that may be considered a bit "quirky" or "eccentric" but still functional. However for this man, it is too late. You can not teach pragmatic language and social skills to someone that has been set in their ways per se for over 30 years, gosh it is hard enough with a preschooler!!!!
So anyway, that is my guess...mild cases in years past were not recognized and severe were misdiagnosed as MR. Depending on the family dynamics the patients with severe forms may very well be living in group homes. I think this father that is still supporting and caring for his adult son is the exception rather than the rule.
This has turned into a very, very interesting post!!!!
I am jealous of the original poster. I thought I wanted to work in neurodevelopmental peds due to my experiences with my son, however the one practice in my geographical area does not use NPs

i believe that they also used the dx of "childhood schizophrenia"....

BJ_RichardsBSN · May 28, 2009

Thank you for all of your replies. I thought about going ahead with the FNP degree and then arranging for my clinical time to be with a pediatric neurologist. I'm rather frustrated with the local groups of actual pediatric physicians here in this area. They are so behind the times. The practice that my son was at initially was horrible. No on wanted to believe me when I kept telling them that something was wrong.

My husband took our son to their practice when he was sick one time. He saw a different partner in their group, as our usual doc was out. Evan had a meltdown and a terrible experience. The doctor looked at my husband and said, "Oh, he looks like he has some splintered traits of Autism". He handed my husband some papers about Autism and out the door they went. I was hurt and angry. I felt so betrayed. This practice is one of the largest peds practices in town. If they are not forward thinking about Autism, vaccinations, and treatment plans...then what kind of support could I expect during a clinical rotation? I think finding an independent peds practitioner might be the way to go there. I also considered Indianapolis as well. My son's psychiatrist is also interested in bio-medicine and has a background in biochemistry. We are having much success treating his inflammatory issues and chemical processing issues with him. He has a great interest in Aspergers/PDD-NOS etc.

My hope is that through early intervention, my children with flourish and need very little support as they grow into adults. I just want to have something in place, and myself prepared in case they don't and we need to help them later in life.

Someone mentioned Autistic Adults. There are very few services available for these people. I was also thinking about the addition of some sort of "transitional living" for teens graduating from high school who might not be going to college, but want to look into living independently. Give them a place to live and teach skills they may not have learned at home or at school and give them a safe place for them to see what living on their own would be like. Just a thought. Who knows what might really come of all of this.

Funding will be my greatest challenge. My hope is that with the "Buzz word" being Autism, that I could get some grants or funding from someone somewhere when the time is right.

Please pray for me and my endeavor.

Thanks for listening!

BJRichardsBSN-Indiana

allnurses Guide · May 28, 2009

Just one more comment, and please keep in mind that this is only one person's experience at one school......please arrange to talk to faculty at the school you're planning on attending, and see if you will be allowed to have the majority of your focus on peds, and specialize in ped. neurology. At my school, the FNP was viewed as a "generalist" who would provide primary care, and we had to divide our clinical time among adult, gero, women's health, and pedi. The majority of our time was spent with adults, and mostly in internal medicine practices, not in specialty practices. Again, this is just my experience and your school may be more flexible.

You have such a wonderful plan in mind and I'm rooting for you!!!

SoundofMusic · May 28, 2009

Hi there -- was really interested in your post. I am a nurse also and thinking of becoming a NP, and also have a 7 year old son with PDD-NOS. We have gone the DAN route with a lot of success, but now are following a protocol through a Dr. Amy Yasko out of Massachusets.

Anyway, pediatricians ARE very behind the times. The American Academy of Pediatrics I don't think even acknowledges that vaccines have any role in autism, and they don't prescribe to any sort of biomedical intervention. I think a lot of it has to do with politics and money -- and it isn't on the side of the children.

I know personally of parents whose children have lost their autism diagnoses through much early intervention in terms of biomedical and therapeutic intervention. It IS possible.

My theory is that the interventions aren't all that complicated, don't really cost a lot or generate much revenue, so they aren't interested. No drugs really need to be involved -- perhaps some anti fungals for yeast or whatever. The money IS is therapy, but so far, only ABA is used.

I, too, would LOVE to work at a clinic like you talk about.

Look into http://www.holistichealth.com and read about Dr. Yasko. You will find it really interesting.

I think a general background in pediatrics would be helpful -- but perhaps look at the backgrounds of some of the DAN's and see. I know of one, Dr. Neubrander in NJ. WE've got to him and he employs PA's in his practice.

Sheri FNP-C · May 28, 2009

SoundofMusic...

I tried to send you a friend request but it wouldn't go through

Whenever the vaccine/immunization debate comes up I always feel obligated to share my story. I do think there is a component of allergy or other intolerance that causes or exacerbates autism, which could be vaccines. As I became more educated, I also became more concerned about vaccine safety. My little man was cared for at home-no daycare so I decided to hold off on his immunizations. Once he started at 6 or 9 months we got only one vaccine every few months and only singles not the vaccines with more than one antigen. Anyway, he is the aspie not my daughters that were formula fed and fully vaccinated according to schedule!

My son and daughter that were exclusively breastfed also are the ones with asthma and allergies...not my formula fed children! Of course, I am still a big breastfeeding advocate. I have a feeling that future research will prove vitamin D deficiency can be implicated in some cases such as these. Remember, breastmilk is the perfect food only lacking vitamin D. Living in the north with not nearly enough sun and a sunscreen fanatic, I am sure my kids were deficient. Once I made this hypothesis recently I started them on supplementation, we will see if it helps!

I am just trying to say that sometimes things happen regardless of what you do. It breaks my heart to hear the emotional suffering some parent's put themselves through thinking that they caused the autism. I think we do the best we can and sometimes fate takes over regardless of our best attempts!

BJ_RichardsBSN · May 28, 2009

I have read about her in the past while pouring through the internet during the initial phases of dealing with my son's diagnosis. I just knew there was someone, or something out there that could help us.

We see Dr. Ralph Waldo MD. He is a psychiatrist and we took Evan there because we were told he had ADHD and Anxiety issues, not PDD-NOS or Autism. Go figure. We discovered his extremely high B12 levels quite by accident, iron deficiency and other amino acid levels way off. I began to read about his test results to find out that he has a condition called hypomethiolation. I wonder if this is something that could be screened for as we do infants for PKU and Hypthyroidism etc. Imagine if I was supplementing him from birth? Now, we supplement him with a lot of different things. We have tried an oral chelation product. We are now doing food allergy IGE IGG testing. We have tried the diet with both kids. I think my 3 year old responded better than my son.

We are starting my daughter's treatment plan in July. The cost for both of them has been tremendous. The monthly supplementations are very expensive and our doc is out of network, we go to Indianapolis to see him. It's about 2 hour drive. All of the inital labwork was out of pocket for us, up to our $1500.00 deductible. On top of that, our insurance is privately held and they cannot be held accountable to the Autism Insurance Mandate for Indiana. That stinks!

I just cannot believe the little amount of resources available to our community regarding Autism. I can't believe that the American Academy of Pediatrics is not pushing for more education of their physicians. I think this is the best reason that nurses who are interested in this field could make a HUGE difference. As nurses we treat the WHOLE person...not just the obvious illness or disability. Autism is a disorder that is influenced by every factor of a child's life. Financially, nutritionally, emotionally, socially, physically, economically...I could go on and on.

I would also like to have a chance to visit some other Autism Centers and talk with them about how they got started, what works and what doesn't work. I have no background in billing, coding etc and I know that business end of things would be something I would need help with.

Anyway, I could talk forever... :) Feel free to email me anytime if you want to talk. I'm also on Facebook. :)

I love my children and I want to be able to give HOPE to other mothers out there. I want them to know that Autism is not the end of the world, it's not a death sentence...there is a way to move through and to live a happy, successful, fufilling life with your child.

Barb