Joseph H. Miller

A Practical Clinical Approach to Diagnosis of Fetal Alcohol Spectrum Disorders: Clarification of the 1996 Institute of Medicine Criteria

Background. The adverse effects of alcohol on the developing human represent a spectrum of structural anomalies and behavioral and neurocognitive disabilities, most accurately termed fetal alcohol spectrum disorders (FASD). The first descriptions in the modern medical literature of a distinctly recognizable pattern of malformations associated with maternal alcohol abuse were reported in 1968 and 1973. Since that time, substantial progress has been made in developing specific criteria for defining and diagnosing this condition. Two sets of diagnostic criteria are now used most widely for evaluation of children with potential diagnoses in the FASD continuum, ie, the 1996 Institute of Medicine (IOM) criteria and the Washington criteria. Although both approaches have improved the clinical delineation of FASD, both suffer from significant drawbacks in their practical application in pediatric practice. Objective. The purpose of this report is to present specific clarifications of the 1996 IOM criteria for the diagnosis of FASD, to facilitate their practical application in clinical pediatric practice. Methods. A large cohort of children who were prenatally exposed to alcohol were identified, through active case-ascertainment methods, in 6 Native American communities in the United States and 1 community in the Western Cape Province of South Africa. The children and their families underwent standardized multidisciplinary evaluations, including a dysmorphology examination, developmental and neuropsychologic testing, and a structured maternal interview, which gathered data about prenatal drinking practices and other demographic and family information. Data for these subjects were analyzed, and revisions and clarifications of the existing IOM FASD diagnostic categories were formulated on the basis of the results. Results. The revised IOM method defined accurately and completely the spectrum of disabilities among the children in our study. On the basis of this experience, we propose specific diagnostic criteria for fetal alcohol syndrome and partial fetal alcohol syndrome. We also define alcohol-related birth defects and alcohol-related neurodevelopmental disorder from a practical standpoint. Conclusions. The 1996 IOM criteria remain the most appropriate diagnostic approach for children prenatally exposed to alcohol. The proposed revisions presented here make these criteria applicable in clinical pediatric practice.

Reducing alcohol use in college students: a controlled trial of two brief interventions.

This study tested two forms of alcohol reduction programming for college students. Thirty-seven moderate to heavy drinkers completed measures of quantity/frequency, drinking consequences, and attitude questionnaires. Participants were randomly assigned to one of three groups: 1) a two-hour information and motivation session plus mailed personal feedback on their drinking; 2) mailed feedback only; or 3) no treatment. At a 6-week follow-up session, the feedback-only group decreased drinks per month as compared to control. No other differences were statistically significant, though decreases favored the treatment conditions about equally over control. Implications for research and treatment are discussed.

A Theory-Based Motivational Approach for Reducing Alcohol/Drug Problems in College

The Campuswide Alcohol and Drug Abuse Prevention Program (CADAPP) was implemented and evaluated over a 1.5-year span at the University of New Mexico (UNM). Drawing on self-regulation theory as a basis for understanding motivation for change, the program was designed to increase risk perceptions and thereby reduce the use of alcohol and other drugs among university students. The program was evaluated from 1988 to 1989 through repeated anonymous random sample surveys of all enrolled students on the UNM campus and on a similar control campus not implementing newprevention efforts during the same period. As predicted, relative to the control campus, students on the CADAPP campus after the program showed significantly higher perceived risks from substance use and significantly reduced levels of alcohol and marijuana use. These findings provide encouraging evidence for this theory-based approach to primary and secondary prevention.

Relationship of early inhalant use to substance use in college students

This study examined the relationship between early inhalant use and later substance use in a sample of college students. Data were taken from four campus-wide surveys that assessed changes in rates of substance use over time at a large Southwestern university. Within these surveys, a group of students (n = 187) who reported early use of inhalants (i.e., before age 18) was identified and examined in terms of their substance use behavior while in college (i.e., during the year and month prior to the survey). These students were compared to two other groups of students: those who reported early use of marijuana but no early use of inhalants (n = 1271) and students who reported no early use of either inhalants or marijuana (n = 1479). Results show that early use of either inhalants or marijuana substantially increased risk of frequent drinking, binge drinking, smoking, illicit drug use, and substance-related consequences during the college years. However, the early use of inhalants conferred the greatest risk and was associated with twice the rate of binge and frequent drinking and significantly greater rates of tobacco and drug use than early marijuana use alone. Implications of these findings for intervention and prevention with college students are discussed.

Early findings from a disciplinary program to reduce problem drinking by college students

This article describes an intervention for college students cited for alcohol-related infractions of the student code of conduct. First-time offenders are required to attend a three-hour class that includes educational, attitudinal and skills-based activities. Students also complete self-report measures of quantity/frequency of consumption and are mailed personalized drinking feedback one week following the group session. A preliminary evaluation of the program is described and the intervention is discussed in relation to other programs available on campus.

The Color Atlas of Intestinal Parasites

This small volume is intended by the authors to be a “completely practical” aid to the laboratory diagnosis of intestinal parasitic infections. This is accomplished by means of a certain amount of textual material but primarily by an original collection of 232 color photomicrographs of the diagnostic stages of intestinal parasites. The book, after a short foreword by E. C. Faust, Ph.D., is divided into five chapters. Chapters 1 and 2 (Introduction and Laboratory Methods) are entirely textual in nature whereas the remainder (The Intestinal Protozoa, The Intestinal Helminths, and Confusing Objects Found in Feces), although presenting some general information concerning the individual parasites grouped in the chapter headings, are primarily a detailed description of the diagnostic stages presented in the collection of color photomicrographs. In Chapter 1 (Introduction), the authors present the case for accurate and careful diagnostic work in clinical parasitology and describe the evolution and use of the Atlas.