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

Susan D. Rich, MD, MPH, DFAPA

Publisher: Lulu Publishing Pages: 322 Price: (hardcover) $44.99 ISBN: 9781483448817 Reviewed: September, 2021 Author Website: Visit »

With compelling research and stories from her personal practice, child psychiatrist Susan D. Rich urges broader awareness of the causes, consequences, and ways to prevent Neurodevelopmental Disorder associated with Prenatal Alcohol Exposure (ND-PAE).

Rich calls ND-PAE, affecting an estimated 1 in 20 children, a “silent epidemic” because medical personnel and alcohol retailers don’t adequately communicate the impact even moderate alcohol use can have on the crucial first three to four weeks of fetal development—damage done before a woman even realizes she’s pregnant. Even a few alcoholic drinks can cause “faulty neuronal wiring,” Rich explains, resulting in a spectrum of cognitive delays, learning disabilities, and difficulties with executive functioning and adaptive behaviors.

Worse, the “multi-hit” combination of ND-PAE, trauma, and drug use can spiral an adolescent or young adult into a life of violence and crime; she uses Adam Lanza, who killed 26 people at Sandy Hook Elementary, as a devastating example of untreated Fetal Alcohol Syndrome (FAS).

Early diagnosis and effective treatments, Rich shows, can “cocoon” a child and create supports for them to live a satisfying, productive life. Given that 50% of U.S. pregnancies are unplanned or mistimed, Rich suggests that the best way to limit the impacts of alcohol use on the unborn is to encourage child-bearing women who drink to use contraception. She rounds out the book with a description of her personal background and appendices that further explain ND-PAE and offer guidance for parents.

Rich’s writing is thoughtful, although sometimes overly detailed, slowing momentum. Her voice is earnest, compassionate, and assured, and the stories of those she’s worked with are descriptive and affecting. However, frequent redundancies of facts and metaphors make the book feel poorly structured, and digressions into technicalities that might help the practicing professional will lose general readers.

Rich’s commitment is persuasive, but the breadth of the problem and the daunting nature of her proposed solution ultimately leave readers unsure of how they can take appropriate action.

Also available in paperback and ebook.

Author's Current Residence
Potomac, Maryland
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