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Introduction to Diagnosis and Prevention

Fetal Alcohol Spectrum Disorders. Introduction to Diagnosis and Prevention. Roger J. Zoorob, MD, MPH, FAAFP Frank S. Royal Sr. Professor and Chair Department of Family & Community Medicine Meharry Medical College. FASD Southeast RTC. Objectives. Give an overview of FASDsoutheast RTC

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Introduction to Diagnosis and Prevention

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  1. Fetal Alcohol Spectrum Disorders Introduction to Diagnosis andPrevention Roger J. Zoorob, MD, MPH, FAAFP Frank S. Royal Sr. Professor and Chair Department of Family & Community Medicine Meharry Medical College

  2. FASD Southeast RTC Objectives • Give an overview of FASDsoutheast RTC • Present diagnostic criteria for FAS • Review diagnostic criteria FASDs • Discuss screening and brief intervention

  3. FASD Southeast RTC FASD Regional Training Centers 2011-2014 Washington Maine Montana Vermont Minnesota North Dakota Michigan New Hampshire Oregon Wisconsin Massachusetts South Dakota Idaho New York Wyoming Michigan Rhode Island Connecticut Pennsylvania Iowa Nebraska New Jersey Nevada Ohio DC Indiana Delaware Illinois Utah Maryland West Virginia Colorado California Virginia Kansas Missouri Kentucky North Carolina Tennessee Arizona Oklahoma Arkansas South Carolina New Mexico Mississippi Georgia Alabama Texas Florida Louisiana Alaska Arctic RTC, Univ of Alaska Anchorage Midwestern RTC, Saint Louis Univ Great Lakes RTC, Univ of Wisconsin Hawaii Southeastern RTC, Meharry Medical College Frontier RTC, Univ of Nevada Reno

  4. FASD Southeast RTC Covers the states of AL, FL, GA, KY, LA, MS, NC, SC, TN, TX, VT & U.S. Virgin Islands

  5. FASD Southeast RTC FASD Southeast Structure 2011-2014

  6. FASD Southeast RTC Southeast RTC Numbers Trained by State“All Activities”- Oct. 2008 – Sept. 2011 1,549 2,536 185 444 401 103 187 191 58 U.S. Virgin Islands - 42

  7. FASD Southeast RTC Southeast RTC Numbers Trained by State“All Activities” - Sept. 2011 – Sept. 2012 28 146 577 318 206 25 20 92 224 117 U.S. Virgin Islands -

  8. FASD Southeast RTC Healthcare Professionals Trained Sept. 2011 – Sept. 2012

  9. FASD Southeast RTC Students TrainedSept. 2011 – Sept. 2012

  10. FASD Southeast RTC Residents TrainedSept. 2011 – Sept. 2012

  11. FASD Southeast RTC Criteria for DiagnosingFetal Alcohol Syndrome (FAS) With or w/o confirmed fetal exposure to alcohol, diagnosis requires documentation of: All three dysmorphic facial features (smooth philtrum, thin vermillion border, small palpebral fissures) Prenatal or postnatal growth deficit in height or weight CNS abnormality: structural, neurological, or functional Bertrand J, Floyd RL, Weber MK. Guidelines for Identifying and Referring Persons with Fetal Alcohol syndrome. Morbidity and Mortality Weekly Review. October 28, 2005/54;1-10

  12. FASD Southeast RTC Facial Abnormalities Of FAS • Smooth philtrum • Thin vermillion • Small palpebral fissures Photo courtesy of Teresa Kellerman

  13. FASD Southeast RTC Lip-Philtrum Guide • Developed by University of Washington FAS Diagnostic & Prevention Network • Guide 1 – Caucasians Guide 2 – African Americans • Back side provides face & height-weight tables from the FASD Diagnostic Guide (2004) • Order from http://depts.washington.edu/fasdpn/htmls/order-forms.htm http://fasdcenter.samhsa.gov/educationTraining/courses/CapCurriculum/competency2/facial2.cfm

  14. FASD Southeast RTC Palpebral Fissure Measurement Palpebral Fissure Length endocanthion to exocanthion www.fasdpn.org

  15. FASD Southeast RTC Photo courtesy of the University of Louisville Fetal Alcohol Spectrum Disorders (FASD) Clinic - WeisskopfChild Evaluation Center, and the FASD Southeast Regional Training Center at Meharry Medical College Department of Family and Community Medicine: FASDsoutheast.org Any use of this photo requires written permission from the University of Louisville FASD Clinic - Weisskopf Child Evaluation Center and the proper acknowledgement as written in this caption. 

  16. FASD Southeast RTC #2 Growth Deficits in FAS Timing • Prenatal or Postnatal • At any one point Degree • ≤ 10th percentile for age and sex adjusted for gestational age • Height or Weight (or Head Circumference)

  17. FASD Southeast RTC #3 CNS Abnormalities of FAS Documentation of any of the following • Structural Abnormality • Head circumference ≤ 10%’ (adjusted for age, sex) • Clinically meaningful brain abnormalities observed through imaging (reduction in size or change in shape of corpus callosum, cerebellum, or basal ganglia) • Bertrand J, Floyd RL, Weber MK. Guidelines for Identifying and Referring Persons with Fetal Alcohol syndrome. Morbidity and Mortality Weekly Review. October 28, 2005/54;1-10

  18. FASD Southeast RTC #3 CNS Abnormalities of FAS 2. Neurologic Abnormality • Motor problems or seizure NOT from a postnatal insult or fever • Other soft neurologic signs outside normal limits 3. Functional Abnormality • Global cognitive or intellectual deficits (IQ <3rd percentile) • Substantial developmental delay in younger children • Functional deficits (<16th percentile) in at least 3 domains: Cognitive or developmental deficits Executive functioning Abstract concepts Problem solving Motor functioning Attention problems/hyperactivity Social skills Other (sensory, memory, language) • Bertrand J, Floyd RL, Weber MK. MMWR. October 28, 2005/54;1-10

  19. FASD Southeast RTC What are FASDs? “Fetal Alcohol Spectrum Disorders” is NOT a diagnostic category, but rather an umbrella term describing a range of effects that can occur in a person whose mother drank alcohol during pregnancy Bertrand J, Floyd RL, Weber MK. MMWR. October 28, 2005 / 54;1-10

  20. FASD Southeast RTC From FAS Diagnostic Criteria to Life with an FASD… • IQ averages 60, range 20 -110 • Poor Judgment • Problems with • Behavior • Motor Skills • Social Interactions • Excessive body contact • Impulsiveness • Intrusiveness • Lack of stranger anxiety www.cdc.gov/ncbddd/fasd/videos/Iyal/long/Iyal_long.html

  21. FASD Southeast RTC Beyond Early Childhood Difficulties Socializing • Maintaining Friendships • Depression and Anxiety • Inappropriate Sexuality

  22. FASD Southeast RTC …. Even Beyond Early Childhood Disrupted Schooling • 43% of teens with FASDs are at high risk of having school interrupted by suspension, expulsion, or from dropping out Conduct Problems • Antisocial Behaviors • Inability to follow rules, lying, and stealing • GOAL Independent Living

  23. FASD Southeast RTC Socialization Issues Excessive body contact (Do not understand personal space) Impulsiveness Intrusiveness (Miss social cues for making/keeping friends) Lack of stranger anxiety (Easily victimized/sexually abused)

  24. FASD Southeast RTC No known safe amount of alcohol to drink while pregnant Brain Nerves Brain Placenta Stomach Fetus Breast Heart Organs Muscles Liver Kidneys

  25. FASD Southeast RTC Alcohol Consumption Rates for the Southeast Region • Among women of childbearing age, 42% consumed any alcohol and 26% reported binge drinking in the past 30 days • Among pregnant women, 24% reported any alcohol use and 6% reported binge drinking in past 30 days State-Specific Weighted Prevalence Estimates of Alcohol Use Among Women 18–44 Years of Age, Behavioral Risk Factor Surveillance System, 2010

  26. Ask Assess Advise Assist Alcohol Assessment and Intervention in Primary Care

  27. FASD Southeast RTC Alcohol AssessmentKnow what a Standard Drink is?

  28. FASD Southeast RTC At-Risk Drinking!

  29. FASD Southeast RTC Alcohol AssessmentFrequency and Quantity First AskDo you drink alcohol, including beer, wine or distilled spirits? • On average, how many days per week do you drink alcohol? • On a typical day when you drink, how many drinks do you have? • What’s the maximum number of drinks you had on a given occasion in the last month?

  30. FASD Southeast RTC

  31. FASD Southeast RTC

  32. FASD Southeast RTC

  33. FASD Southeast RTC Brief Intervention Ask and Assess Risk Level • Raise the subject: Alcohol Assessment Test “I like to ask all my patients about their drinking patterns” • Does the patient have alcohol-related problems? (Medical, behavioral, social, familial) • Provide feedback about alcohol risk level: Relate health concerns / pregnancy risks to alcohol use “I am very concerned about how your drinking may affect your health” “There is no known safe limit for drinking during pregnancy. You need to stop drinking completely b/c when you drink, your baby drinks.”

  34. FASD Southeast RTC Brief Intervention: Advise and Assist • Engage the patient in the process: Assess, enhance motivation and patient responsibility “How do you feel about your drinking?” • For alcohol-risk, establish drinking goals: Advise and negotiate cut down “Are you ready to set a drinking goal? What do you think will work best for you?” (give brochure materials) For alcohol dependence, advise abstinence and refer to specialized treatment. • Follow up: review progress, commend effort, reinforce positive change, reassess motivation National Institute on Alcohol Abuse and Alcoholism and Office of Research on Minority Health, Identification of At-Risk Drinking and Intervention with Women of Childbearing Age. NIH Publication No. 99-4368 (Printed 1999)

  35. FASD Southeast RTC Brief Intervention Treatment • Found to be effective with women problem drinkers in primary-care clinics • 5-10 minute counseling session has been found to reduce alcohol use in women by 20-30% • … is not difficult Wallace P, Cutler S, Hains A. Randomized controlled trial of general practitioner in patients with excessive alcohol consumption. British Medical Journal. 1988;297(6649):663-668. Fleming MF, Barry KL, Manwell LB, Johnson K, London R. Brief physician advice for problem alcohol drinkers: A randomized controlled trial in community-based primary-care practices. JAMA. 1997;277(13):1039-1045.

  36. FASD Southeast RTC In Summary • Asses alcohol intake in pregnant and women in the child bearing age • Use brief intervention techniques to help pregnant women who consume alcohol • FASDs are 100% preventable—if a woman does not drink alcohol while she is pregnant • Early Recognition and multidisciplinary intervention of FASDs will decrease the impact

  37. FASD Southeast RTC ?QUESTIONS? Thank you!

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