Infant Mental Health for the Pediatric Nurse Practitioner

Autism Spectrum Disorder
Autism Spectrum Disorder (ASD) is a behavioral, communication, and social disorder identified in one in 91-154 children (Voigt, 2011). Specific disorders included within ASD are: autistic disorder, Asperger syndrome, Heller syndrome, pervasive developmental disorder – not otherwise specified, and Rett syndrome (Voigt, 2011).  

Earlier identification of ASD and earlier intervention is believed to lead to better outcomes in affected children (Zeanah, 2009). Controlled studies providing 25-40 hours each week of one-to-one Applied Behavioral Analysis (ABA) helped children with autism improve their IQs and scores on the Autism Diagnosis Observation Scale (Allen, Vessey, & Schapiro, 2011).

Wetherby and Prizant’s Communication and Symbolic Behavior Scales Developmental Profile Infant-Toddler (CSBS-DP-IT) Checklist is a 24-item questionnaire that is used to screen for autism risk as well as global developmental delay risk and global language delay risk (Pierce, Carter, Weinfeld, Desmond, Hazin, Bjork, & Gallagher, 2011). The CSBS-DP- IT checklist can be administered by parents or health care providers in approximately two to 10 minutes (Pierce et al., 2011). The CSBS-DP-IT checklist is validated for stand-alone use in young children nine months of age through 24 months of age. The CSBS-DP-IT checklist, available only in English, has a specificity of 0.84 and a sensitivity of 0.78. In a recently published study, Pierce et al. (2011) demonstrated the efficient usefulness of the CSBS-DP-IT checklist to identify autism and other disorders earlier and to aid in initiating treatment sooner.

Some parents are reluctant to immunize their young children due to concerns about a purported relationship between autism and the measles-mumps-rubella vaccine. There is no evidence that supports such a relationship. In fact, the original research that suggested such a rel ationship has been completely discredited and found to be based on scientific fraud.

As with all infants, it is important to reinforce safety issues with parents of children who may be autistic. Wandering behavior is common in older children with autism and represents an important safety concern. 

References and Resources:

Autism signs appear in baby’s brains as early as six months of age: http://vitals.msnbc.msn.com/_news/2012/02/17/10436904-autism-signs-appear-in-babys-brains-as-early-as-6-months#.Tz8Ap8Vo9ZE.twitter

CDC: Autism affects one in 88 children  http://www.cbsnews.com/8301-504763_162-57406450-10391704/cdc-autism-more-common-than-once-thought-affects-1-in-88-children/

Pierce, K., Carter, C., Weinfeld, M., Desmond, J., Hazin, R., Bjork, R., & Gallagher, N. (2011). Detecting, studying, and treating autism early:  The one-year well-baby check-up approach. The Journal of Pediatrics, 2.