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Making the Rounds at UNLV School of Medicine
 Issue 212 - September 17, 2019

The UNLV Ackerman Autism Center, and its multidisciplinary team of physicians, psychologists, speech and behavioral therapists, provides a standard of care that draws well-deserved plaudits from patients/families, medical professionals and public officials. What we should never forget is that autism spectrum disorder is only one of many conditions seen at the Center -- remember, its full name is the UNLV Medicine Ackerman Center for Autism and Neurodevelopment Solutions -- where everything is done to provide a comprehensive diagnosis, treatment plan, follow-up care and necessary support services. Today’s feature was inspired by the Center’s recent public outreach program on Fetal Alcohol Spectrum Disorders, a group of conditions caused by the effects of maternal alcohol consumption during pregnancy. Center officials note FASD affects more than 10,000 children under the age of 18 in Clark County, making it more prevalent than autism. 
UNLV Medicine Ackerman Autism Center Hosts Fetal Alcohol Spectrum Disorders Awareness Event
UNLV Medicine Ackerman Autism Center Clinical Director Dr. Julie Beasley, right, answers audience questions during the Fetal Alcohol Spectrum Disorders Awareness Event at UNLV on Sept. 9, 2019.
 Fetal Alcohol Spectrum Disorders (FASD) -- an umbrella term used to describe the range of effects caused by prenatal alcohol exposure.

Physicians/scientists note the effects of a woman drinking alcohol during pregnancy may include mental, physical, behavioral and/or learning disabilities with possible lifelong challenges.

While FASD is a public health concern, you see little in the media about the actual scope of the problem. Government studies show FASD is the leading known cause of developmental disability and birth defects in the United States and not confined to any one group. 

In an effort to increase public awareness about the disorders that even draw the interest of criminal justice professionals, the UNLV Medicine Ackerman Center for Autism and Neurodevelopment Solutions held a Sept. 9 public symposium designed to shed light on FASD, which is 100 percent preventable, but challenging to diagnose and treat.

According to Dr. Julie Beasley, Ackerman's Clinical Director and a child psychologist, the effects of FASD may include: abnormal facial characteristics; growth deficits; brain damage, including intellectual disability; heart, lung and kidney defects; hyperactivity and behavior problems; attention and memory problems; poor coordination and motor skill delays; difficulty with judgement and reasoning; and learning disabilities. 

The National Organization on Fetal Alcohol Syndrome (NOFAS) reports FASD affects an estimated 40,000 infants each year, more than spina bifida, Sudden Infant Death Syndrome (SIDS), cystic fibrosis, cerebral palsy and muscular dystrophy combined. Research shows 2-5 percent of younger school-age children in the U.S. have some degree of FASD.

The Ackerman Center estimates 10,000 Clark County children under the age of 18 have FASD. About 27 percent of FASD children treated at Ackerman are in the care of a relative, and many others are in foster care.

Dr. Colleen Morris, a clinical geneticist at the Ackerman Center, says studies show no amount of alcohol use is known to be safe for a developing baby before birth. The federal Centers for Disease Control and Prevention notes that developing babies lack the ability to process or metabolize alcohol through the liver or other organs so the embryo or fetus has the same blood alcohol concentration as the mother. 

UNLV Medicine Ackerman Autism Center Clinical Geneticist Dr. Colleen Morris speaks during Fetal Alcohol Spectrum Disorders Awareness Event.
Clark County Juvenile Court Judge William Voy explains how the juvenile justice system is working to improve the way FASD children are identified and managed.
Whether the drink is beer, wine or a shot of bourbon or other liquor, makes no difference.

The Institute of Medicine reported: “Of all the substances of abuse (including cocaine, heroin and marijuana), alcohol produces by far the most serious neurobehavioral effects in the fetus.”

Given that 50 percent of pregnancies are unplanned and women often don’t know they’re pregnant until they are six weeks along or more, it’s easy to understand how a woman could innocently drink alcohol while expecting.

“This disorder makes a good argument for planned pregnancies and birth control,” said Dr. Beasley, who suggests that women who drink and are sexually active use contraception.

Studies have concluded that it isn’t possible to determine what the exact effects of a certain amount of alcohol will be on a fetus -- essentially, each experience of a woman and her fetus will be different.  

A study published last year in the Journal of Addiction Medicine estimated the annual cost for care per FASD case at $23,000, higher than for a number of other common conditions, including autism ($17,000) and diabetes ($21,000).
"That was a big step in Nevada in the better handling of Fetal Alcohol Spectrum Disorders. Now if we can make more people aware, more children can be helped." Dr. Julie Beasley
Both Dr. Beasley and Dr. Morris point out that only the most severe form of FASD, where a facial characteristic is involved, has sparked much public attention over the years. Yet they also note that less than 10 percent of individuals with FASD have the associated distinctive facial features, including small eyes, an exceptionally thin upper lip, a short, upturned nose, and a smooth skin surface between the nose and upper lip.

“That’s the tip of the iceberg,” said Dr. Morris, mother of the late Matthew LoMastro, for whom an endowment is named at UNLV to continue researching FASD. “We’re talking about people who look totally normal, but many experience lifelong behavioral, intellectual, neurological and mental health challenges. “You can have a 10-year-old with normal intelligence but will have the social maturity of a five year old-year-old. They can be easily manipulated, get in with the wrong crowd.”  

Dr. Beasley says it is not uncommon to come across a youngster with FASD who can be a “delight” one-on-one but who has difficulty in situations with more people involved. “They can be very difficult children to help with behavior. They’re very impulsive, don’t think things through, and subsequently very easy to manipulate.”

To help mitigate FASD, both Dr. Beasley and Dr. Morris say the earlier the intervention, the better. They say interventions have better success when they stress: consistent routines; limited stimulation; concrete language and examples; multisensory learning (visual, auditory and tactile); stable households; environments free of violence and empathetic parental and family supervision. 

“Traditional parenting strategies don’t work well,” said Dr. Beasley, who says tact is especially necessary for medical professionals dealing with mothers whose child may have FASD. While she says no woman sets out to hurt her baby, she does say many women do not fully understand the risks with drinking while pregnant. Research shows one in five women continue to drink alcohol while pregnant. Dr. Beasley says that in discussing a patient’s alcohol use, a non-judgmental tone should be used.  

According to Dr. Morris, most children with FASD are unidentified or go misdiagnosed, often because they present no characteristic physical features of the disorder. Many are not significantly developmentally disabled. In elementary school, students who are hyperactive and impulsive with poor social skills, who have a disregard for rules and authority and who need constant supervision may end up being misdiagnosed as autistic or having Attention Deficit Hyperactivity Disorder (ADHD).

In many cases the ADHD diagnosis is actually the assessment of a secondary problem, says Dr. Beasley, observing that a correct diagnosis of FASD -- it may require psychoeducational testing to identify possible presence of alcohol-induced central nervous system damage -- would necessitate different treatment. Medication, she said, still may be used for the hyperactivity.
Physicians, parents and educators need to become more aware of the symptoms of FASD, Dr. Beasley says, so a correct diagnosis and early intervention may be possible. While brain damage is irreversible, Dr. Morris says many individuals with FASD can advance, improve and function well in life with the proper support, as long as the support continues. 

The Substance Abuse and Mental Health Services Administration says successful strategies for educating children with FASD include: using concrete, hands-on learning methods; establishing structured routines; keeping instructions short and simple; providing consistent and specific directions; repeating tasks again and again and providing constant supervision.

Though studies show students with FASD have IQ scores that range from 29 to 140, their overall ability to perform daily life skills is often much lower than expected, based on IQ.

Unfortunately, many young people with FASD run into trouble with the law. In fact, 35 percent of individuals with FASD have been in jail or prison. Because their social judgement is impaired, Dr. Morris stresses they are vulnerable to manipulation and coercion by others, often repeating the same mistakes multiple times due to their disabilities. 

Clark County Juvenile Court Judge William Voy, who was at the Ackerman symposium, says early diagnosis of the syndrome is paramount. He said children with FASD often end up in the juvenile system at age 10, with the worst case scenario being that they become regulars in the criminal justice system.

At the Ackerman event, Democratic State Sen. James Ohrenschall was recognized for recently passing a bill that allows clinics to pay for non-federal expenditures to screen and treat individuals with FASD up to age 21 through Medicaid and the Children’s Health Insurance Program. The bill, SB370, allows treatments to FASD patients such as applied behavioral analysis (ABA), which is often administered to children with autism. 

“That was a big step in Nevada in the better handling of Fetal Alcohol Spectrum Disorders,” Dr. Beasley said. “Now if we can make more people aware, more children can be helped.”  
 Click to see recent stories about UNLV School of Medicine

Nevada Independent

"UN LV Medicine Hosts Panel to Address Widespread Fetal Alcohol Syndrome Disorder "

KSNV Channel 3

"Renewed Warning to Pregnant Women: Don’t Drink"

Interview with: Dr. Julie Beasley

Telemundo Las Vegas

"Health District: First Serious Illness tied to Vaping in Clark County"

Interview with: Dr. Angelica Honsberg


There are nearly 7,000 rare diseases, with about 80% of them genetic -- effective treatment exists for only a few. Together they affect some 30 million Americans. ALS (Lou Gehrig) Disease, Tourette syndrome, Huntington Disease, and muscular dystrophy are among them.

All previous issues of  Making the Rounds with Founding Dean Dr. Barbara Atkinson , are available on our website.
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