Kaiser Permanente California Pediatric Grand Rounds

“The Silent Epidemic of Neurodevelopmental Disorder associated with Prenatal Alcohol Exposure (ND-PAE)”
Pediatric Grand Rounds – Susan D. Rich, MD, MPH, DFAPA 
Wednesday, February 21, 2018 
12:30 -1:30p – SMOB LL A/B
WebEx Recording Link
PLAY RECORDING (1 hr 8 min)
https://kponline.webex.com/kponline/ldr.php?RCID=4333df8ba428d533275a9f833a28749e
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Earlier this week, I had the rare opportunity to present Pediatric Grand Rounds on Fetal Alcohol Spectrum Disorder (FASD) – described in DSM-5 as Neurodevelopmental Disorder associated with Prenatal Alcohol Exposure (ND-PAE) at the “mother ship” hospital of Kaiser Permanente in the East Bay area of California.  Dr. Margaret Desler, Chief of Continuing Medical Education, said it’s the first time in the past 10 years that she’s been in her position that Kaiser has had a CME on the topic.  What an honor!  The presentation was sent via WebEx to the Department of Psychiatry at other sites as well.

With as many as 5-10% (up to 1 in 10) school age children affected by prenatal alcohol exposure, this epidemic of mild to moderate brain damage is hidden behind terms of “learning disabilities,” ADHD, sensory integration issues, mood dysregulation disorder, some instances of autism spectrum disorder (see O’Malley and Rich, 2012), and a myriad of adult psychiatric diagnoses.  One of the biggest problems we as child psychiatrists and pediatricians face is the “cliff” that we send our patients off to as they transition into adulthood.  A big problem for transitional age individuals with neurodevelopmental disorders (e.g., IDD, autism, FASD/ND-PAE) is that their services decrease dramatically in the adult system of care and there are limited adult providers with subspecialty training in NDs; hence, patients are seen as having “outgrown” their childhood diagnoses.  For these reasons, in the adult system of care, patients who had lifelong supportive services through Individualized Educational Plans, Wrap-around Services, and “supported housing” in their parents’ homes are left to fend for themselves.  As a result, they miss appointments, are unable to keep track of medications, misplace prescriptions, and/or have other reasons for seeming “noncompliant.”

I encourage parents of my patients with NDs to seek out guardianship shortly after they turn 18.  This is a long-term preparatory process for the patient and their family to get to the point that they realize that the young adult will need more systems of care brought to bear than sometimes is affordable to them with a low wage job.  By recognizing their ability to work in a meaningful way, providing a sense of purpose to their lives, they can be a more productive, autonomous member of society, albeit with supports.  They can also self-advocate to let adult clinicians know that they have “neurodevelopmental” disorders stemming from brain damage (i.e., faulty brain wiring) rather than garden variety “mental illness.”

Hopefully this will be the first in a series of talks to inform Kaiser physicians about this important issue affecting so many of our Nation’s children.  By early intervention and services through adulthood, there is hope that individuals with FASD/ND-PAE can have improved outcomes and better quality of life than without the diagnosis.  I am currently working with a 17 Emmy Award Winning Health Education Documentary Producer, Tom Conrad, to produce a CME and patient education materials about this prevalent, preventable, and misunderstood condition.

Here are a list of some of the American Academy of Pediatrics resources on FASDand related topics available on the AAP, Pediatrics, and PubMed websites. They include clinical reports, special articles, and policy statements.

 FASD Toolkit: aap.org/fasd

AAP Clinical Reports and Special Articles

o   Fetal Alcohol Spectrum Disorders

o   Neurobehavioral Disorder associated with Prenatal Alcohol Exposure (special article)

o   Caring for Patients with Prenatal Alcohol Exposure: A Needs Assessment

o   Families Affected by Parental Substance Use

o   Promoting Optimal Development: Screening for Behavioral and Emotional Problems

o   Substance Use Screening and Brief Intervention Implementation Guide

For more information about FASD programs through the AAP, contact:

Josh Benke; Program Manager, Fetal Alcohol Spectrum Disorders
jbenke@aap.org | 847/434‐7081
Rachel Daskalov; Manager, Screening & Public Health Prevention Programs
rdaskalov@aap.org | 847/434‐7863

As a result of this education, participants will be able to:

  1. Inform clinicians about prevalence of intellectual and neuropsychiatric sequelae of prenatal alcohol exposure, affecting up to 1 in 10 (5-10%) of school aged children in the US.
  2. Review a screening and diagnostic tool for Neurodevelopmental Disorder associated with Prenatal Alcohol Exposure.
  3. Highlight a 4-domain model for evaluation and treatment planning (i.e., social/communication, neurocognitive, sensory & motor, and mood regulation/autonomic arousal).
  4. Provide preconception health and contraceptive approaches for alcohol consumers to prevent prenatal alcohol exposure in practice settings using neuroteratology education.Disclosure:

    The Kaiser Permanente East Bay Oakland Medical Center has determined that the speakers and the planning committee for this program do not have affiliations with any corporate organizations that may constitute a conflict of interest with this program.  Kaiser Permanente does not endorse any brand name products.

    East Bay Area – Oakland is accredited by the Institute for Medical Quality/California Medical Association (IMQ/CMA) to provide continuing medical education for physicians.

    East Bay Area – Oakland designates this live activity for a maximum of1.0 AMA PRA Category 1 credit(s)TM.. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

    Nurses may report 1 hour of credit towards the continuing medical education requirements for license renewal by the California Board of Registered Nurses.

Questions?

Contact Sheila Drennen, Quality Specialist – Continuing Medical Education, at 510-752-6389 or sheila.g.drennen@kp.org.