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COSIG CONFERENCE BROCHURE.pdf - Drexel University College ... COSIG CONFERENCE BROCHURE.pdf - Drexel University College ...

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COSIG Co-Occurring Disorders Conference, Hershey PA, May 15-17, 2006 Regions of the Brain Most Commonly Affected By Prenatal Alcohol Exposure Frontal Lobes Parietal Lobes Corpus Callosum Basal Ganglia Cerebellar Vermis EEG Findings • Down’s and FAS compared – EEG used to measure alpha waves – Lower alpha wave activity in both groups – Pattern was different however –Down’s •Slower • Posterior cerebral cortex –FAS • Weaker wave activity • Left hemisphere of the cerebral cortex O’Malley, 2000 Central Nervous System Effects of Prenatal Alcohol Exposure Hope derives from new concepts of treatment: – Psychopharmacology (improving cognition, reduction of anxiety and mood problems) – Psychotherapy (family support, repetitive messages) – Environmental manipulation (structure, mentoring, etc.) – Parenting therapy – Speech and Language (social skills practice) – Occupational Therapy – Behavioral Therapy (reward systems) – Energy therapy (reduction of anxiety) Diagnosing the Patient with FASD • Get as much background information as possible before the appointment (OT, S and L, previous psychiatrics, educational records) • Presenting complaint (evaluate historians) – Let the caretakers ventilate for part of the session – Look for anger, frustration, “burn-out”, or giving up Diagnosing the Patient with FASD • Elements of the HPI – Check for usual Axis I major mental illness and Axis II disorders but also check for the following: – executive functioning problems (ability to organize, insight, ability to shift attention, “cause and effect” reasoning, short term memory) – adaptive living skills problems (ability to be alone, taking care of oneself) – Social Skills problems (boundaries, treating other children properly, touching, hitting, biting, etc.) – Motor Skills Problems (fine and or gross motors skills i.e. graphomotor skills problems) – Speech and Language problems (pragmatic speech, receptive and expressive language) – Environmental stress and expectations (chaos, abuse, neglect, etc.) – How long the child was in every placement – Parent expectations and attitude towards the child-quality of attachment Development History • Birth history( type of exposures, quantity, concentration, timing, frequency) • Stress and nutrition of the mother (prenatal care?) • Birth conditions (non-traumatic, traumatic or high risk, prematurity, meconium staining, Apgars) • NICU, “Billy” lights, feeding problems, height and weight parameters) • Quality of acquisition of developmental milestones • Easy or difficult baby (colic, quality of sleep, appetite, allergies, infections) 10

COSIG Co-Occurring Disorders Conference, Hershey PA, May 15-17, 2006 Mental Status Exam • Presence or absence of dysmorphic features (palpebral fissues, mid facial flattening, lip and philtrum appearance, HC, palmer crease, hair whorl) • Tremors • Ability to engage/Eye contact • Quality of play • Motoric activity • Ability to maintain boundaries • Presence of hallucinations or delusions • Insight/ability to understand right and wrong • Working memory and short term memory • Concentration • Ability to read facial expressions and body language Sample Diagnostic Work Up • Dysmorphology evaluation • Possible genetic testing • Lead level • MRI • EEG • Neurological evaluation • Neuropsychology Evaluation • Speech and Language Evaluation • Occupational Therapy Evaluation • Behavioral Psychology Evaluation Diagnosis of FASD • Diagnosis of Exclusion • Can have major Axis I diagnosis/es but features of FASD may also appear like bipolar disorder, autism, conduct disorder, etc. • Important to look at the quality of the symptoms and how close they are to DSM IV criteria • Facial dysmorphic features are suggestive of FASD but also rule out presence of a genetic disorder • Growth retardation needs to be ruled out (chart growth-are there any reasons for non-alcohol associated growth problems) • Contribution of psychosocial problems to the symptoms • What are the protective factors Diagnosis of FASD • Individuals with FAS and ARND will of course appear different • But these individuals may be equally cognitively and behaviorally disabled • Because individuals with ARND are usually not identified early they have endured more environmental distress and may have more secondary symptoms Prevention is the Key to Complete Elimination of this Very Serious Public Health Problem Practice prevention in your own lives and that of family, friends and social contacts 11

<strong>COSIG</strong> Co-Occurring Disorders Conference, Hershey PA, May 15-17, 2006<br />

Mental Status Exam<br />

• Presence or absence of dysmorphic features (palpebral<br />

fissues, mid facial flattening, lip and philtrum appearance, HC,<br />

palmer crease, hair whorl)<br />

• Tremors<br />

• Ability to engage/Eye contact<br />

• Quality of play<br />

• Motoric activity<br />

• Ability to maintain boundaries<br />

• Presence of hallucinations or delusions<br />

• Insight/ability to understand right and wrong<br />

• Working memory and short term memory<br />

• Concentration<br />

• Ability to read facial expressions and body language<br />

Sample Diagnostic Work Up<br />

• Dysmorphology evaluation<br />

• Possible genetic testing<br />

• Lead level<br />

• MRI<br />

• EEG<br />

• Neurological evaluation<br />

• Neuropsychology Evaluation<br />

• Speech and Language Evaluation<br />

• Occupational Therapy Evaluation<br />

• Behavioral Psychology Evaluation<br />

Diagnosis of FASD<br />

• Diagnosis of Exclusion<br />

• Can have major Axis I diagnosis/es but features of FASD<br />

may also appear like bipolar disorder, autism, conduct<br />

disorder, etc.<br />

• Important to look at the quality of the symptoms and how<br />

close they are to DSM IV criteria<br />

• Facial dysmorphic features are suggestive of FASD but also<br />

rule out presence of a genetic disorder<br />

• Growth retardation needs to be ruled out (chart growth-are<br />

there any reasons for non-alcohol associated growth<br />

problems)<br />

• Contribution of psychosocial problems to the symptoms<br />

• What are the protective factors<br />

Diagnosis of FASD<br />

• Individuals with FAS and ARND will of course appear<br />

different<br />

• But these individuals may be equally cognitively and<br />

behaviorally disabled<br />

• Because individuals with ARND are usually not<br />

identified early they have endured more<br />

environmental distress and may have more<br />

secondary symptoms<br />

Prevention is the Key to Complete<br />

Elimination of this Very Serious Public<br />

Health Problem<br />

Practice prevention in your own lives<br />

and that of family, friends and social<br />

contacts<br />

11

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