Nature versus Nurture – or Both!

As a child psychiatrist specializing in children with prenatal alcohol exposure – many of whom have been adopted from foster care, I was struck by the number of basic human needs this innocent little boy wrote for his Christmas list. It seems strikingly similar to Maslow’s hierarchy of needs:  food/clothing/shelter; safety and security; love, belonging and connection to community; self-actualization/self-esteem (meaning and purpose); and finally, enlightenment.

Like the boy whose biological father and step-monster chained him intermittently for three months in a 2’x2’ bathroom closet (, the fact that children are forced into such deprived and inhumane circumstances is a human rights issue of the highest priority.

Our great nation has helped cure nearly every communicable disease on the planet and many rare and deadly cancers. Surely we can all agree on how to fix the #childwelfare crisis and end the cycle of #abuse.

After all, we do not inherit the earth from our ancestors, we borrow it from our children.

Women Physician’s Voices Count in Prenatal Alcohol Exposure Awareness

The first female physician in the United States, Dr. Elizabeth Blackwell, would turn 196 today.  In her honor, a group of physicians established February 3 as National Women Physician’s Day.  Inspired by her maverick spirit (after all, how dare a woman in the mid-19th century think she could be a doctor?!) and participation in the recent Women’s March, I envision a paradigm shift when we female doctors are going to end the ignorance surrounding prenatal alcohol exposure.

As a pioneer in medicine who graduated medical school in 1849, Dr. Blackwell may well have been at the forefront of the Temperance Movement, which occurred in the late 1800’s to early 1900’s.  At that time, medical doctors understood the devastating effects of alcohol on reproductive outcomes, low birth weight, prematurity, child/family mental health, and infant/child morbidity and mortality.  Public health statistics abounded, fueling the fire for Prohibition in 1920.  What a pity we lost all that knowledge after its repeal in 1933.

At that time in history, mostly men called the shots in society because they were the main holders of wisdom in science.  Professional papers were written, published in high brow journals, read by a handful of intellectuals and scientists, then put on shelves to collect dust.  There was no Internet for information sharing.  If one did not make it to college, medical school, or professional school (i.e., law school, doctorate programs, etc.), then most scientific advancements and knowledge about medical matters were hidden within academic institutions.

Today, only those of us motivated, bright, and resourceful can endure the rigors of 4 years of college, another 4 years of medical school, and another 3-6 years of residency in our desired field.  In many ways, our knowledge is as hidden from plain site as ever.  One of the key areas of my interest has been in raising awareness about the leading known and preventable cause of neurodevelopmental disorders, birth defects, and developmental delays – which can occur as early as the third week after conception.  Since this time frame is often before a woman may know she is pregnant, our society can and must do more to encourage sexually active alcohol consumers to contracept  to avoid unintentional exposure of their offspring.

It is my hope to help childbearing age alcohol consumers understand that they should stop using alcohol if pregnant or planning a pregnancy and to use contraception until they have stopped using alcohol.  Their partners should support them in this effort – after all, it takes sperm 3 months to develop, and alcohol methylates the sperm DNA.  These methylation effects last for several generations, passing silently through the genome into unsuspecting offspring.

Theodore Geisel, also known as Dr. Seuss, once wrote – “Unless someone like you cares a whole awful lot, nothing’s going to get better, it’s not!”  Unless we speak up about what we know about prenatal alcohol exposure happening early in pregnancy so the lay public understands, people will not hear our message.  As a change agent and spirit sister of Dr. Elizabeth Blackwell, I am determined to get this message across.

Susan D. Rich, MD, MPH, DFAPA

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And the Emmy goes to…”A LONG JOURNEY HOME”

” A Long Journey Home” (in Romanian…”Lungul drum spre casa”), a documentary about Dr. Ron Federici and his three adopted sons, reveals their traumatic history and the terrible conditions in Romanian orphanages. The film won an international award for journalism with NY Film festivals and was nominated for an Emmy. It has been shown worldwide receiving great acclaim. Ron Federici, his sons, and the documentary producers were courageous in shedding light on the human rights atrocities in Romanian orphanages.  The film will bring tears to your eyes and hope will fill your heart in learning about Petric who Dr. Federici rescued from an orphanage and went on to graduate from the George Washington University Medical School.
Dr. Ronald S. Federici is a Board Certified Clinical-Developmental Neuropsychologist and a member of CEO-Care for Children International, Inc.

The Story of 10 year old Annie Who Lives with FASD

Recently, states have been restructuring the departments of health and human services to provide more comprehensive, consolidated care in a systematic way rather than through disjointed bureaucracies of the past half century.  Departments of Mental Health, Public Health, Substance Abuse Services, and Developmental Disabilities – all essentially serving the 12% of the population in the socially disenfranchised underclass – are being reorganized to provide a holistic approach to better serve the underserved populations and disadvantaged.

With change comes concern that even the best intentions may lead to more people falling through the cracks. One mother is fighting to raise awareness about the risk that children like her adoptive daughter with FASD will be lost in the remodeling of health and social service agencies.  “Her little world got robbed. She doesn’t experience things like everybody else does.”

Let’s all join our voices together to ensure that this restructuring actually helps to fill the gaps between service agencies by eliminating some of the bureaucracy and make it easier for families to access services.

“Living With FASD” offers 22 free webinars throughout september to parents, families and professionals to help support those with FASD

Living With FASD 2014 Summit: Building a Bridge to Adulthood
25+ hours of online training for families & professionals living and working with those with Fetal Alcohol Spectrum Disorder (FASD)
September 9th – 20th, 2014

Though this year’s theme is “Building a Bridge to Adulthood” the information given is as important to those caring for individuals with FASD who are younger than their teen years. It is important to be familiarized with systems and specific services and have them put in place as early as possible.

Experts will share practical approaches to prevention, and support strategies—from their professional and personal experience. The webinars will provide up to date training in the following 7 topics:

  1. Independence vs. Interdependence: Those with FASD will require external support for their lifetime (systems and other people acting as an external brain), thus interdependence is a more realistic goal rather than full independence;
  2. Substance Use and Treatment: 46% will face issues of substance use in their lifetime;
  3. Mental Health: 90% will experience some kind of mental health issue (suicide, depression, ADHD, etc.);
  4. Legal Issues: 60+% will have trouble with the law or be confined, mainly due to a lack of understanding between cause and effect;
  5. Vocation and Employment: Understanding the difference between personal and work relationships, being “on time”, and handling money;
  6. Sex: Engaging in inappropriate sexual behaviour (either as victim or perpetrator) and not understanding all responsibilities involved when having children of their own;
  7. New Research: Prominent FASD researcher Dr. Ed Riley speculates that brain maturation in those with FASD can occur 10 years later than their peers (find out why this is good news!).

A huge advantage of these series of webinars is that they are easily accessible from the comfort of your home, workplace or even on the road.

– See more and register at: