March 3 – Birth Defects Awareness Day

With today being Birth Defects Awareness Day, I decided to reduce the price of my book about the leading preventable cause of physical and functional birth defects – our social drug of choice: alcohol.  My book is The Silent Epidemic: A Child Psychiatrist’s Journey to Death Row – Understanding, Treating and Preventing Neurodevelopmental Disorder associated with Prenatal Alcohol Exposure.  Though I had the book in my heart and mind to write for the first 20 years of my journey, I put pen to paper in December 2012 in the aftermath of the Sandy Hook tragedy in Connecticut.  The book is my hope to provide the science about how alcohol-related birth defects happen and illuminate society’s duty to the 5-10% of American children who are affected by the $220 billion dollar product of the Big Alcohol industry.

As a former pharmaceutical researcher, I know first hand what it takes to get a drug approved – from bench science through clinical trials and FDA approval.  Even life-saving cancer drugs would not be allowed to cause brain damage in children.  If a woman needs to be on a chemotherapy drug before she has children, often she’ll be given the opportunity to freeze her ovaries to avoid mutations in the eggs.  For acne medications created from Vitamin A derivatives (Retin-A, Accutane),  dermatologists will put childbearing age patients on contraceptives and conduct a pregnancy test before they give the patient their monthly prescription.  The patients also sign a waiver that they will not become pregnant.  It is very easy to prevent birth defects if a person needs a medication – contracept!

Many years ago, I was awarded a small grant from the March of Dimes to produce a preconception health information brochure for the Iroquois community.  The brochure, “Planning for the 7th Generation,” is a culturally relevant brochure for Native American men and women to become educated that birth defects happen as early as the first few weeks after conception.  Preconception health includes healthy nutrition, exercise, multivitamins, sleep, and avoiding alcohol/tobacco/other drugs of abuse as well as minimizing stress.  Even though being healthy during the few months prior to pregnancy doesn’t guarantee a healthy baby (or even that you’ll get pregnant), we can reduce exposures and improve the chances of a healthier outcome.  Preconception health is for both women and men!

Since most major organ systems, the skeletal system, and the nervous system has rapid development in the first 8 weeks after conception, physical birth defects occur very early during pregnancy – before most women know they are pregnant. In addition to physical birth defects, “neurotoxins” can cause “teratogenesis” (the origin of birth defects) of the brain and nervous system.  These chemicals are known as “neuroteratogens.”  Heavy amounts of alcohol early in pregnancy can cause physical birth defects such as cleft lip or palate, “lazy eye,” inner or outer ear defects, joint deformities, and unusual but subtle changes of the face (asymmetry, wideset small eyes, thin upper lip, small head, etc.).  As little as 4-5 drinks in one sitting as early as the 3rd week after conception can cause mild to moderate brain damage (“functional birth defects”), leading to learning disabilities, executive functioning problems, attention deficits, social communication issues, and a variety of other “neurodevelopmental” disorders.  Children can have sensory issues ranging from hypo- to hyper-sensitivities of hearing, seeing, smelling, tasting, touching, vestibular, propriocetion, or interoception. Most women don’t know they are pregnant when many of these problems are starting to happen!

The solvent ethanol dissolves the fatty insulation around neurons and kills neurons as they are migrating in the embryo to become the brain and nerve cells communicating between the body and the brain.  These changes begin to occur very early in the 2nd to 3rd week after conception.   One of the major problems affected children have is being unable to regulate their emotions and having difficulty managing their discomfort.  As babies, they are difficult to soothe, have difficulty suckling (due to nerve damage going to the facial muscles, lips, tongue, mouth, and throat), and have problems with sleep-wake cycle, developmental delays, and poor “attachment” behaviors. As toddlers and children, they are easily frustrated, overstimulated, overwhelmed, sensitive, and can have rages that are provoked by very minimal provocation. They also may have speech/language disorders, fine/gross motor or coordination problems, difficulty learning to read or do math, and other issues achieving age appropriate tasks.  Parents feel they are “walking on eggshells” to avoid the “land mines” that will set off the child’s “Hulk attacks” and may become so traumatized by the child’s “fight or flight” reactions that they develop symptoms of post traumatic stress disorder.  As their brains go through changes of adolescence, they may develop gender dysphoria, worsening mood/anxiety problems, and difficulties relating to their chronological age peers.

The beautiful image of the baby immersed in a frosted glass of beer with the umbilical cord wrapped around and inserted in the bottle of beer was created by the award winning artist, Angela Mele.  Many of the websites, logos and books written about prenatal alcohol exposure depict a baby in a bottle of alcohol, wine or beer.  In many ways, I wanted to open the bottle and share this knowledge with alcohol consumers instead of it being a “message in a bottle.”  Angela used her creative intuition to paint a picture of a well developed infant that looks relatively normal to depict the “hidden” damage to the baby in the womb.  Only 10-15% of the children have any visible signs of the full Fetal Alcohol Syndrome, which includes the facial features, small size, and neurodevelopmental problems.  A majority have brain damage invisible to the naked eye but detectable as developmental disabilities, learning disabilities, and other deficits on neuropsychological testing.

Even though most parents of toddlers or school age children would not connect prenatal alcohol exposure with the learning, mood, motor, social skills, or attention problems their child may eventually develop, science teaches that these problems begin within the womb as early as the first few weeks after conception.  There is much to be learned from dentists who taught children to brush and floss to prevent cavities.  So too can we psychiatrists teach patients to avoid cavities in their offsprings’ brains by deciding if and when to become pregnant, contraception until ready or able to become healthy, and preconception planning to prevent birth defects.

Please share this article with anyone you know who drank during their pregnancy and has a child with neurodevelopmental problems. By improving the parenting strategies, early and accurate diagnosis, academic supports, and appropriate treatment, the child can grow into a healthy, happy individual with adequate life skills and social supports to live a fulfilled, meaningful life.

Resources:

https://www.cdc.gov/ncbddd/fasd/facts.html

http://www.lulu.com/spotlight/TheSilentEpidemic

https://www.aap.org/en-us/advocacy-and-policy/aap-health-initiatives/fetal-alcohol-spectrum-disorders-toolkit/Pages/default.aspx

https://store.samhsa.gov/shin/content/SMA13-4803/SMA13-4803.pdf

https://www.niaaa.nih.gov/research/major-initiatives/fetal-alcohol-spectrum-disorders

https://www.acog.org/About-ACOG/ACOG-Departments/Tobacco–Alcohol–and-Substance-Abuse/Fetal-Alcohol-Spectrum-Disorders-Prevention-Program

http://www.oregon.gov/ode/educator-resources/2016fallconference/fasd.pdf

https://www.nofas.org/

 

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
Recording password: (This recording does not require a password.)

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.

Global Prevalence of Prenatal Alcohol Exposure – A Call to Action

Let’s congratulate and commend Tracey W Tsang and Elizabeth J Elliott on their important publication of “High global prevalence of alcohol use during pregnancy and fetal alcohol syndrome indicates need for urgent action” in The Lancet, [http://www.thelancet.com/journals/langlo/article/PIIS2214-109X(17)30008-6/fulltext].  This publication mirrors the historical, epidemiological, and societal implications presented in my book, “The Silent Epidemic:  A Child Psychiatrist’s Journey beyond Death Row – Understanding, Treating and Preventing Neurodevelopmental Disorder associated with Prenatal Alcohol Exposure” [www.prenatalalcoholexposure.com]; as well as a an international book chapter in Fetal Alcohol Spectrum Disorders in Adults: Ethical and Legal Perspectives [https://link.springer.com/chapter/10.1007/978-3-319-20866-4_3].  The authors clearly call for global paradigm shifts in public perception of alcohol’s effects on society – through advocacy efforts, the media, the alcohol industry, advertising and public policy.
 
I have just returned from Vilnius and Alytus, Lithuania where I gave two lectures daily for three days to large audiences of clinicians, social workers, public health professionals and policy makers (as well as the entire class of first year medical students at the Medical University of Vilnius) about this topic.  Here is a video of the talk at the Ministry of Health to a multidisciplinary group of professionals in the Center for Mental Health [https://www.youtube.com/watch?v=ZNc_RL5Z5Vo].  The introductions were given by the Director of Mental Health for the Ministry of Health who spoke about the epidemic created by alcohol abuse during the former Soviet occupation of the Baltic country.  I was moved and impressed by the city of Alytus’s efforts to end the mass institutionalization of children from alcoholic families, opting instead to offer the entire family therapeutic care with farming families where they are allowed to live in a safe, agrarian setting while learning adaptive functioning skills and vocational skills as well as parenting training.  [My trip was sponsored by a nonprofit family foundation dedicated to improving the lives of Lithuanian children.]
 
In my humble opinion, a medical journal as world renown as The Lancet taking on this issue will surely help awaken others to the devastation on developing brains caused by our western society’s social drug of choice: alcohol.  Just as the British Parliament took on the Gin epidemic in the 1750s, so too can our modern societies choose to urge doctors to encourage their patients (both male and female) to contracept if using alcohol.  After all, these problems occur as early as the 3rd week post conception – well before many know they are pregnant.  Methylation effects to sperm DNA occur up to three months prior to conception, and are transmitted through histone modifications for generations, resulting in familial anxiety, depression, addictive disorders, obesity, and a plethora of other conditions hidden within our tightly wound genome. 
There is no excuse that alcohol is allowed to cause 1 in 20 American children to be born with preventable neurodevelopmental deficits, deformities, and lifelong lost potential.  If the solvent ethanol was as important to mankind as a life-saving antitumor medication, it would not be allowed to cause 1 in 1,000 babies to be born each year with brain damage and birth defects.  We prescribe contraceptives and pregnancy testing to all patients receiving pharmaceuticals that have any potential for causing negative reproductive outcomes.  Just as condoms are promoted for HIV prevention, let’s agree that alcohol and unprotected sex don’t mix and promote contraception and preconception health for alcohol consumers. [https://www.cdc.gov/ncbddd/fasd/alcohol-use.html].   
In the spirit of prevention, identification, and treatment – Kudos to Drs. Tsang, Elliott, Horton and The Lancet.  Perhaps one day you all will be granted well-deserved knighthood!

Taking Farm Animal Therapy to Lithuania

Last fall, I was honored to have a pediatrician and her husband, a neurologist, from Lithuania visit Dream Catcher Farm to learn more about our therapeutic farm animal sanctuary for children with Fetal Alcohol Spectrum Disorder (FASD) / Neurodevelopmental Disorder associated with Prenatal Alcohol Exposure (ND-PAE).  They spoke about their challenging work moving Lithuanian children from orphanages into foster care homes in the community.  Unfortunately, many foster families are unable to care for the children who have short attention spans, are impulsive, are triggered into “fight or flight” (emotional reactivity) very easily, are sensitive to ordinary environmental stimuli and have difficulty learning new information.   As a result, many children are returned to the orphanages. After I explained the 4 domain model of working with these children and told them about a novel program for women and their dependent children in North Carolina, they returned to Lithuania with renewed hope for families suffering from alcohol abuse.  Little did I know they would be sending me to Lithuania this fall to help build a farm program.

Parenting children with FASD/ND-PAE can be frustrating, overwhelming, and nearly impossible for those who are not trained to understand that these children can’t follow directions, and perform daily activities without continuous reminders and prompting.  They also have difficulty attuning to parents and caregivers because of wiring differences. It turns out that children respond well to and are eager to learn how to care for animals.  Farm animal therapy incorporates gentle stroking, petting, cuddling, and grooming animals in addition to feeding and watering them daily.  Hand raised animals like mine are eager to be touched, nurtured, and cared for and seek people out rather than running away.  For this reason, children are drawn to the gentle goats, rescue pig, and barn cats at Dream Catcher Farm.

On their return to Lithuania, the visiting physicians said, “We have children and we have animals.”  Yet what the idea they developed was to put the entire family on a farm with a farming family who would give the parents meaning and purpose living a substance free life, allowing the children to remain in their family of origin.  I feel blessed though maybe a little naive that  my farm may inspire others like it to help children with prenatal alcohol exposure and their families live happier, healthier lives.

http://www.hpenews.com/life/former-archdale-resident-expands-work-with-children-prenatally-exposed-to/article_21a9e4b2-8bf6-11e7-9200-6f73d686f4eb.html?utm_medium=social&utm_source=twitter&utm_campaign=user-share

Media Responsibility for Prevention

When I wrote my book, The Silent Epidemic: A Child Psychiatrist’s Journey beyond Death Row, I naively thought that I could stem the tide of public awareness about alcohol use during childbearing years – helping unknowing young women understand the importance of contraception if using alcohol.  Articles like this one recently in the Washington Post are a big reason people are missing the message that a lot of damage happens to babies before you find out you’re pregnant.   And alcohol doesn’t just cause Fetal Alcohol Syndrome! https://www.washingtonpost.com/opinions/five-myths-about-pregnancy/2017/05/12/7cf6e12a-3666-11e7-b373-418f6849a004_story.html?nid&utm_term=.fddddfca9788#comments

cover-art

Ilustration by Angele Mele, Coverart for The Silent Epidemic: A Child Psychiatrist’s Journey beyond Death Row.

I can’t help but wonder what responsibility the media has for creating the confusion and societal ambivalence about alcohol use during reproductive years.  Like some other drugs, alcohol is a neuroteratogen – a chemical solvent that causes birth defects of the brain and nervous system.  Yes, it’s a solvent.  Like household cleaning supplies, dry cleaning solution, gasoline, paint thinner, and rubbing alcohol.  Alcohol kills the tiny cells migrating out of the neural tube as early as the 3rd week after conception – well before most women know they are pregnant.

In my book, I indicate the role of the alcohol industry, the medical community, and the government in preventing brain damage caused by our social drug of choice in 1 in 20 American children.  The article in the Post reminds me of the media forces keeping the waters muddy about use of alcohol for women who are pregnant or planning pregnancy.  So much more can and should be done to help them as well, as women who are sexually active and using alcohol but not preventing pregnancy.

One risk of the “Five Myths” article and the book is that women will become confused by the stance that a little alcohol is okay. What is a little alcohol to one woman is a long island iced tea to another (equivalent of 6 shots). As a board certified child/adolescent and adult psychiatrist, I see patients adopted from foster care in the U.S., Eastern Europe, South/Central America, China, and Southeast Asia with a range of neurodevelopmental problems (learning, attention, memory, anxiety/arousal, mood, sensory, motor, social/communication, etc.) stemming from prenatal alcohol exposure. Psychiatrists see these patients, not obstetricians. The condition is called “Neurodevelopmental Disorder associated with Prenatal Alcohol Exposure” (ND-PAE, ICD-10 code F88).

Most people know that alcohol abuse during pregnancy can cause “The Fetal Alcohol Syndrome” (FAS). What is less known is that as little as 4-5 servings of alcohol mistimed in the late 3rd week post conception is enough to cause the full FAS. Most women don’t know they are pregnant then. Our genetics, health factors, nutrition status, and other lifestyle behaviors can protect us and our babies or make the situation worse. We also know that a man’s sperm DNA is methylated by alcohol consumed up to 3 months prior to conception (it takes 3 months for sperm to develop from the earliest stages to “fertile”). Methylation of DNA has been linked to a variety of mental health, learning, medical, and other conditions.

I am a believer in educating alcohol consumers about the risks of unintentional prenatal alcohol exposure before knowing you are pregnant and to use contraception (prevent pregnancy) if using alcohol. Preconception health is the best way to prevent ND-PAE. I believe it’s time for the alcohol industry to be held accountable that our social drug of choice (alcohol) has caused brain damage in 1 in 20 U.S. children (CDC, 2015).

For more information about Neurodevelopmental Disorder associated with Prenatal Alcohol Exposure, check out my book at www.prenatalalcoholexposure.com.

Guest of Potomac-Bethesda Rotary

brian-feldman-susan-rich-bob-fuhrman-aruna-miller-091516-dsc_0635

Pictured from left to right: Senator Brian Feldman, Susan Rich, Bob Fuhrman – Rotary Pres., and Representative Aruna Miller.

It was a remarkable honor to speak last night to the prestigious group of service-oriented citizen members of the Potomac-Bethesda Rotary Club.  As a public health entrepreneur, I’m grateful to have the support of State Senator Brian Feldman and District 15 Representative Aruna Miller, who attended the Rotary club dinner presentation about my new book – The Silent Epidemic: A Child Psychiatrist’s Journey beyond Death Row.*   Sharing my journey with these remarkable legislators and the imminent Rotary scholars and community leaders was truly humbling.

My main points were to let them know much about the public health warnings and efforts leading up to Prohibition, and the reasons why our society seems deaf to the damage caused to our future generations from a chemical so ubiquitous as alcohol.  None of the Rotarians knew that as little as 4-5 standard servings of beer, wine or liquor exquisitely timed late in the 3rd week post conception can cause the Fetal Alcohol Syndrome (FAS), or that only 10-15% of children with effects of prenatal alcohol exposure have the identifiable facial characteristics.  They also didn’t know that a Long Island Iced Tea contains nearly 1.5 times the amount of alcohol (6 shots, no tea) to cause FAS.  Since 50% of U.S. pregnancies are unplanned and 13.5% of childbearing age women drink alcohol, we have an epidemic (1 in 20) of affected school-aged children in this country.

They were  dismayed that future generations could be impacted by a process known as “methylation” – the addition of “CH3-switches” placed on DNA’s histone proteins to interfere with the process of translation of the DNA/RNA into protein.  Not only is a child’s neuronal wiring affected by a mother drinking alcohol (i.e., killing the progenitor brain cells that will form important structures of the midline especially), the child’s gonads are affected (their “germ cells” – eggs and sperm) by effects of methylation.  This process affects future generations – even if the mother does not drink.  Since it takes 3 months for the process of spermatogenesis (sperm development) in the male, his use of alcohol can also potentially “methylate” his sperm DNA.   These permanent switches created by preconceptional alcohol exposure are transmitted for generations into the future. Thus, conditions such as alcoholism, chemical dependency, anxiety disorders, and neurodevelopmental disorders are carried down generation after generation – silently within the replication process of DNA.

The fact that most people don’t know that their children and grandchildren may be affected by their inebriated sperm is a problem our society should begin to face. The Better Safe Than Sorry Project, as well at the CDC and the US Surgeon General, recommend for alcohol consumers to avoid alcohol if pregnant or planning pregnancy (for males, this should be 3 months prior to conception); and to avoid pregnancy (i.e., contracept) until they are ready to abstain from alcohol.

In an effort to stem the tide of unintentional prenatal alcohol exposure (and prior to pregnancy recognition), we are hoping to work with the state legislature this fall on a state bill to require “point of purchase” messaging where alcohol is sold.  Forty-one states already have such signage, indicating that those who are pregnant or planning to be should avoid alcohol.  I would hope that we Marylanders would go one step further with an additional statement – “Alcohol consumers should avoid pregnancy (i.e., contracept), since problems can occur with exposure before knowing one is pregnant.”

Remember – alcohol and unprotected sex don’t mix!

*http://www.lulu.com/spotlight/TheSilentEpidemic; http://www.PrenatalAlcoholExposure.com.

We welcome comments from readers about this blog, as well as any others.

Housing for individuals affected by Prenatal Alcohol Exposure

Since I moved to the Washington, D.C. area in 2001, I have wanted to develop a community for individuals affected by prenatal alcohol exposure – also known as Fetal Alcohol Spectrum Disorder (FASD).  Two years ago, I founded 7th Generation Foundation, Inc. in order to begin the development process, including identifying a property to relocate my private practice and have a “home base” for 7th Generation to live and grow.  We now have Dream Catcher Farm in Potomac, a therapeutic farm animal sanctuary where children, adolescents and adults with effects of prenatal alcohol exposure can be evaluated, treated, and receive vocational skills while interacting with gentle farm animals.  While Dream Catcher Farm is still evolving, our board is on its way toward establishing a therapeutic community for young women affected within the womb by our social drug of choice, alcohol.

This article from Canada makes it clear that we are on the right track.  Individuals with FASD require supportive, safe, affordable housing with the opportunity to assist with job training and coaching, life skills, time management, organization, household responsibilities, grocery shopping, and other daily living skills that many of us take for granted.  Looking forward to an article like this being posted one day about the therapeutic community we will build!

Edmonton housing for people with fetal alcohol spectrum disorders first of its kind in Canada