The Silent Epidemic: A Child Psychiatrist’s Journey Beyond Death Row

Understanding, Treating, and Preventing Neurodevelopmental Disorder Associated with Prenatal Alcohol Exposure

The Silent Epidemic addresses a critical public health problem in America – the leading preventable cause of birth defects, neurodevelopmental disorders, and intellectual disability: prenatal alcohol exposure.

From her work in community health, forensic psychiatry, and private practice, Dr. Rich provides insight into the prevalence of neurodevelopmental disorder associated with prenatal alcohol exposure (ND-PAE) among juveniles accused of violent crimes, in neighborhoods where America’s “least valued” citizens reside, and even in upper middle class communities.

The problem develops as early as the first three weeks of pregnancy, when many women are unaware that they are pregnant. With appropriate diagnosis and treatment, affected individuals can avoid a lifetime of lost potential from substance use disorders, incarceration, unemployment, and homelessness.

Case studies underscore the widespread nature of the problem and its social ramifications as an invisible disability among corrections populations, foster care and internationally adopted youth, as well as school-aged children once labeled “emotionally disturbed.” Dr. Rich advocates for screening of young children for ND-PAE, appropriate interventions for affected individuals, parental substance abuse treatment, and other supportive services.

She seeks a revolution in public policy aimed to provide prevention through preconception care, family planning, education, as well as appropriate systems of care for these misunderstood, disabled citizens to become productive members of society through community-based educational, medical, vocational and housing programs. Her call to action would hold the alcohol industry responsible to fund school and community-based ND-PAE prevention programs, develop housing and treatment services for affected individuals, and accountable to inform sexually active drinkers to use contraception and couples not to drink when pregnant or planning a pregnancy.

From her broad psychiatric, forensic, and public health experience, Dr. Rich has crafted a reasoned, passionate argument for communities and professionals to unite in ending an epidemic that currently affects one in twenty American children, and shows no signs of letting up.

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