The Knotted Cord: An Update on Transgenerational Alcohol


Kieran D. O’Malley
Child & Adolescent Psychiatrist, Slievemore Clinic, Dublin, Ireland

Series: Alcohol and Drug Abuse
BISAC: MED105000
DOI: 10.52305/EZEV9040

“This book will be of great interest to a range of practitioners and students working with children, adolescents and their families. This includes those working in medical, psychology, social work and educational settings. It addresses a much under recognised condition: Neurodevelopmental Disorder Prenatal Alcohol Exposure (NDPAE), that is only now being given the attention it deserves. NDPAE may impact on the lives of so many young people who have learning difficulties, behaviour issues and problems in school and residential settings, yet it is often not thought about or considered. Dr. O’Malley has updated his earlier work to include the latest thinking and research on NDPAE. He has vast experience internationally in diagnosing and treating the condition. He is one of the foremost practitioners and thinkers in the field. He promotes a “systems of care” approach which involves parents and a multidisciplinary range of professionals which is very practical and helpful. As a forensic psychologist specialising in working with children and adolescents in the child care systems of Ireland and the UK I have found his work most illuminating and his advice invaluable. I warmly recommend this up-dated edition and believe it is a “must read” for anyone who wishes to learn about NDPAE.” – Dr. Bill Lockhart, PhD, OBE, Forensic Psychologist

“This impressive overview covers much that is presently understood about the deleterious impact a pregnant mother’s alcohol consumption has on her developing fetus.  An updated and expanded survey, this is much broader in scope than the original text…O’Malley’s offering is a rich trove of information and insight about an urgent public health, economic and societal crisis..” READ MORE>> – Joe Martin, Co-Founder of both the homeless rescue Downtown Emergency Service Center and the Pike Market Medical Clinic, Seattle, Washington, USA

The Knotted Cord: An Update on Transgenerational Alcohol is a follow up to the original book, The Knotted Cord, published by Nova Science in 2014. It is written as a conversation between myself in 2014 and then in 2019.

The conversation is structured around the chapters of the initial book. Thus Ireland’s toxic romance with alcohol, the stigma of transgenerational alcohol and the ethical dilemma of diagnosing and managing Neurodevelopmental Disorder prenatal alcohol exposure offer the beginning thrust to the book showing what has changed in the intervening five years and what has not changed.

Overall the book is a critical and academic update on the complexities of understanding transgenerational alcohol and its impacts on societies worldwide.

Management has clearly been placed in a Systems of Care paradigm, which is consistent with the 2014 book. However the intervening five years have produced a new clinical instrument, the Early Childhood Service Intensity Instrument (ECSII). The clinical emphasis on mothers and children under five years of age has become the entry into decreasing the impact of transgenerational alcohol.

At the moment, the teratogenic effect of alcohol on the developing fetus remains frozen in being only related to a dysmorphic face. This is far from the truth as this prenatal acquired brain injury causes a mainly hidden, non-IQ, non-Face driven Global neurodevelopmental disorder, now more correctly diagnosed as Neurodevelopmental Disorder prenatal alcohol exposure, NDPAE, DSM 5.Code 315. Lastly, the challenge of approaching transgenerational alcohol and its impacts is a challenge to traditional medical practices of child and adult care. This disconnected model of care does not fit as medical, nursing, addiction and social workers need to move out of their silos and communicate with health professionals across the age range and accept this ‘orphan’ condition.
(Imprint: Nova Medicine and Health)

Table of Contents

Brief Biography of Dr. Kieran D O’Malley

Synopsis (Update)

Chapter 1. Prologue (Update)

Chapter 2. Ireland’s Toxic Romance with Alcohol (Update)

Chapter 3. The Stigma of Transgenerational Alcohol (Update)

Chapter 4. The Ethical Dilemma of Diagnosing and Managing ARND (Update)

Chapter 5. The Scientific Thinking That Underpins Transgenerational ARND (Update)

Chapter 6. Where Do You Begin the Diagnostic Process? That’s The Question (Update)

Chapter 7. The Phenotype of Alcohol-Related Neurodevelopmental Disorder (ARND) (Update)

Chapter 8. The Natural History of ARND: A Window into the Future (Update)

Chapter 9. A Broader Approach to Management (Update)

Chapter 10. Multimodal Management No. 11: Medical Medication Management (Update)

Chapter 11. The Systems of Care Approach to Management (Update)

Chapter 12. Postscript (Update)

Chapter 13. Epilogue (Update)


Practical Strategies for Managing Children/Adolescents with Neurodevelopmental Disorders Including FAS or ARND
(Kieran D. O’Malley and Michele Savage)

Author’s Contact Information


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