This article highlights unthinkable social injustices and human rights discrimination against children and adolescents at their most vulnerable time – during a psychiatric emergency. Individuals with ND-PAE are often misdiagnosed with or have co-occurring mental illness as a result of their neurodevelopmental disabilities. When they do have need of inpatient psychiatric services, most are ill-equipped to treat their complex neurodevelopmental issues. Because they have a hard time understanding consequences and avoiding peer pressure, they are at high risk of delinquent behavior and may end up in detention centers or jail. There is need for more comprehensive, specialized programs and services for adolescents with ND-PAE and other neuropsychiatric conditions, not just warehousing them away from society.
Early intervention programs to identify exposed infants and toddlers with ND-PAE, as well as raising awareness about how early in pregnancy these problems happen (therefore primary prevention includes preconception health and family planning for alcohol users). Individuals with ND-PAE are at much higher risk of teen pregnancy, poor parenting skills, and subsequent child welfare issues because of low adaptive functioning skills. Often, the way they were parented leads to their parenting style being harsh and punitive. Their limited coping skills, poor frustration tolerance, and lack of resourcefulness leaves them at much higher risk of neglect and abuse of their own children. It is important for them to have access to injectable, implantable, and other long term, effective contraception to improve their life skills and community supports prior to pregnancy.
Putting a child in jail to await a psychiatric evaluation is like putting an elderly person with a broken hip in jail while waiting for a bed at a rehabilitation program. When are we going to start valuing the emotional well being of our most precious resource? The children are our future and we must protect them at all cost!
More information on ND-PAE and criminal justice issues on our blog
Dr. Susan D. Rich has given Grand Rounds at the University of Minnesota Department of Psychiatry on November 12, 2014 and at Georgetown University Medical Center on Tuesday, January 6th about the topic of Neurodevelopmental Disorder associated with Prenatal Alcohol Exposure (ND-PAE), the diagnostic term in DSM-5 for Fetal Alcohol Spectrum Disorder.
In an article in Psychiatric News in 2005, Dr. Rich said: “I was furious when I first heard the term ‘funny-looking kid,’ or FLK, almost 12 years ago. A rural pediatrician was describing how doctors overlook the possibility of fetal alcohol syndrome (FAS), the physical and neuropsychiatric effects of prenatal alcohol exposure. He said, ‘They look at the parents and say – `They’re pretty funny looking, too.. .so, I guess it’s genetic.’ My passion for prevention of alcohol-related birth defects has been fueled by such attitudes.”
Dr. Rich has been speaking widely about her clinical work with patients who have ND-PAE and the clinical link between autism and FASD. In November, she also spoke at the Minnesota Organization on Fetal Alcohol Syndrome’s annual conference: “FASD and Human Rights.” During October, she chaired an all day Etiology, Diagnosis, Treatment, and Prevention in an Era of DSM-5 at the American Academy of Child and Adolescent Psychiatry annual conference in San Diego, California.
DSM-5 includes the diagnosis of “Neurodevelopmental Disorder Associated with Prenatal Alcohol Exposure” (ND-PAE) under “Specified Other Neurodevelopmental Disorders” (315.8). The Centers for Disease Control and Prevention estimates that as many as 1 in 20 (or 2-5%) of school aged children in middle class communities have some degree of this preventable disorder. Up to 85% of individuals with ND-PAE have a lifetime prevalence of moderate to severe mental illness.
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In the spirit of prevention and enlightenment, our goal for 2015 is to raise awareness about how early in pregnancy ND-PAE happens. As little as 4-5 drinks exquisitely timed before you know you’re pregnant can cause brain wiring changes and even full Fetal Alcohol Syndrome. It only takes one Long Island iced tea or a hand full of shots to cause a lifetime of struggles for your child. Your unborn child is also not immune to the harm of beer and wine.