By Erin Reid P’01,’05
Alexandra “Lexi” Vierling ’15 has dedicated her career to helping individuals with neurodevelopmental differences. Lovingly inspired and motivated by her two brothers, Brendan and Kevin, she is a pediatric nurse practitioner who serves as head of medical services at Soar Autism Center in Denver, CO.
“I have been interested in autism and neurology for a very long time,” says Vierling, MSN, APRN, CPNP-PC, PMHS. “As the oldest of three children with two younger brothers—one has autism and the other has a dual diagnosis of autism and Down syndrome—I have been deeply involved in their care.”
Vierling never imagined herself at boarding school. “It was a foreign concept, but when some of my high school friends chose that route, I did some research and proposed the idea to my parents. They wanted me to have an experience that was my own, because a lot of my childhood was spent worrying about taking care of my brothers.”
Hotchkiss provided the financial aid she needed through the H. Hunter Williams ’26 Memorial Scholarship. “I would not have been able to go without my scholarship. The experience was life-changing and opened many doors.”
Faculty members were her role models. “Jane Herold P'17,'20,'24 helped me with my college essay, which was about one of my brothers and how he inspired me. Charlie Frankenbach P’12,’16 and Charlie Noyes ’78, P’03,’07 also made a very big impact on my life.”
Her long-standing interest in medicine, specifically neurology and brain function, took her to Vanderbilt University as a special education major. “I did research with a neurologist at Vanderbilt Children’s Hospital who specializes in sleep and autism. Through that experience, I met many providers in the Division of Developmental Medicine at Vanderbilt and realized that was what I wanted to do.”
After completing an accelerated nurse practitioner program, she took graduate courses during her senior year to become a nurse practitioner with the goal of specializing in developmental-behavioral pediatrics.
“I completed a multidisciplinary training program called LEND (Leadership Education in Neurodevelopmental Disabilities), which was incredibly impactful, teaching me the importance of working in an interdisciplinary team to provide the best outcomes for patients,” she said. “Developmental-behavioral pediatrics is a very small subspecialty in pediatrics that focuses on the long-term medical and developmental needs of individuals with neurodevelopmental disabilities. There are very few of these specialists in the country, and the wait to see one is often one to two years at academic medical centers. I am very passionate about increasing access for this population.”
Developmental pediatrics provides support for challenging behaviors such as aggression and irritability, diagnoses and manages comorbidities, and assists with toileting, feeding, and sleep concerns. “We also offer genetic testing to help provide additional information to the child's overall profile,” she said.
Vierling points to significant changes in the past 10 years in the approach to some of these challenges. “There is much more information now about autism,” she said, noting that April is Autism Acceptance Month, which celebrates and honors the experiences and identities of autistic individuals with an emphasis on understanding, inclusion, and support. “Some of this increased awareness is helpful, but it also comes with challenges related to misinformation. We follow evidence-based guidelines to help guide care for our kids.”
Soar Autism Center provides play-based Applied Behavior Analysis therapy, occupational and speech therapy, and developmental pediatric medical services. “We’re very collaborative. We work together on every case to make sure we’re seeing the whole child and deliver high-quality care,” she explained. “I saw firsthand how exhausting it is to juggle dozens of therapy and doctor appointments. My mom was constantly trying to coordinate between people who didn’t talk to each other. Fragmented care is hard on the entire family and isn’t conducive to achieving the best possible patient outcomes.”
Vierling emphasizes the importance of finding a provider who dives deep into the root causes of a behavior, rather than just looking at the surface.
“Though much progress has been made in the field of genetics over the past several years, we now know that in some cases, children with autism have a known genetic cause that explains their symptoms. However, the most recent research has not identified a single cause. At the end of the day, there is a mix of genetic and environmental causes for autism and still a lot we don't know.”
She underscores the point: “If you’ve seen one child with autism, you’ve seen one child with autism. Every single kid is different.”
The clinical definitions have changed, too. When the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition came out, it folded Asperger’s and Pervasive Developmental Disorder into the broader Autism Spectrum Disorder diagnosis. “That’s why the spectrum looks so vast now. It ranges from people who are non-speaking and need one-on-one support to highly advanced professionals working in fields like tech. There isn't a ‘one-size-fits-all’ roadmap for everyone on the spectrum,” she said. “A big part of the challenge is that many kids can’t verbally tell us how they’re feeling. Instead, they might show us through irritability or aggression. It’s our job to figure out what those behaviors are trying to say.”
Vierling likens her career to her Hotchkiss experience. “Everyone had their own unique interests, and we were encouraged to pursue them with passion and devotion. Everyone had a special drive that many other people don't have. Hotchkiss has a legacy centered on graduates who inspire you to reach the top of your field, whatever that may be,” she said.
“Hotchkiss was challenging, but it shaped who I am,” she continued. “I made some of my best friends at Hotchkiss and learned to think critically and work hard. If I could go back and give some advice to 15-year-old Lexi, I would say, ‘Don't give up on your goals, and you will reach them.’”