‘The Knotted Cord’. Transgenerational Alcohol Related Neurodevelopmental Disorder (ARND)

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

Series: Alcohol and Drug Abuse
BISAC: SEL013000


Volume 10

Issue 1

Volume 2

Volume 3

Special issue: Resilience in breaking the cycle of children’s environmental health disparities
Edited by I Leslie Rubin, Robert J Geller, Abby Mutic, Benjamin A Gitterman, Nathan Mutic, Wayne Garfinkel, Claire D Coles, Kurt Martinuzzi, and Joav Merrick


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The title of the book harks back to Michael Dorris’s seminal work The Broken Cord (1987) which eloquently brought this ‘hidden’ population into the light. However, the metaphorical umbilical cord is not truly broken, and the unique neurodevelopmental disorder resulting from prenatal alcohol exposure will continue to be one ghost in our delivery rooms, nurseries, and lives which haunts us.

Why a different ‘knot’?

Because management becomes knotted with the origins of the infant’s prenatal life, whether they are birthed, fostered, adopted, either same culture or inter-country adopted. The ‘knot’ (as in ‘Not it’), also speaks to medical professionals and society’s continued ambivalence to acknowledging another inconvenient truth.

Maternal drinking in pregnancy causes Alcohol Related Neurodevelopmental Disorder (ARND) whether dysmorphic, called Fetal Alcohol Syndrome (FAS), or non dysmorphic, ARND itself. These are both transgenerational developmental psychiatric disorders.

The prevalence of ARND continues to be under-recognized as it is mainly presented as a faceless ‘hidden disability’ (masquerading as ADHD, Mood Disorder or ASD), rather than a facial dysmorphic disorder. The subtle denial and minimization of transgenerational alcohol abuse is aided only by diagnosing the far less frequent dysmorphic ARND (FAS). This creates a false security across social classes concerning alcohol’s true transgenerational epigenetic effect. Thus, the real financial costs and health care burden of transgenerational ARND, with an international prevalence of 1 in 100 live births, is avoided.

The thrust of this book has come from 25 years of psychiatric clinical and academic work with children, adolescents and their families, all of whom are affected by prenatal alcohol exposure in Canada, USA, UK and now Ireland.

We cannot all escape our collective histories of colonization or abusive violence, and the transgenerational history of alcohol, with trauma and abuse, lies embedded in these stories. It is a story repeated in many different countries and cultures, from Russia to Romania, from South Africa to Southern Alberta. Although I am now working In Ireland, my medical experience has taught me the untold legacies of transgenerational alcohol, in Native Americans, First Nations, disenfranchised minorities, and the seemingly invulnerable gentry.

This book is not an angry polemic on the evils of alcohol, but a passionately written academic treatise on 40 years of alcohol teratology and subsequent human research, which in many ways is still ‘stuck in the moment,’ continuing to pursue the minutiae of physical facial features, neuropsychological or brain deficits. This continued approach avoids the ‘elephant in the room,’ namely the murky uncharted waters of transgenerational alcohol abuse management.

There are no systematic medical management approaches to ARND, and it continues to be managed in a piecemeal fashion with disconnections between the research community and the obstetric, pediatric, psychiatric, social service and alcohol addiction services. Therefore, it is also the author’s hope that in the coming generation the age related phenotypes of ARND will begin to finally be appreciated, and we/society will be better served by their eventual acknowledgement by medical professionals. (Imprint: Nova Biomedical )

Brief Biography of Dr. Kieran D O’Malley


Chapter 1. Prologue

Chapter 2. Ireland’s Toxic Romance with Alcohol

Chapter 3. The Stigma of Transgenerational Alcohol

Chapter 4. The Ethical Dilemma of Diagnosing and Managing ARND

Chapter 5. The Scientific Thinking That Underpins Transgenerational ARND

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

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

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

Chapter 9. A Broader Approach to Management

Chapter 10. Multimodal Management No. 11: Medical Medication Management

Chapter 11. The Systems of Care Approach to Management

Chapter 12. Postscript

Chapter 13. Epilogue

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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Two Key References:

Carpenter B, Blackburn C, Egerton J. (2014) Fetal Alcohol Spectrum Disorders. Interdisciplinary Perspectives. Routledge Publishing, London.

Driscoll CD, Streisguth AP, Riley EP. (1990) Prenatal alcohol exposure:
Comparability of effects in humans and animal models. Neurotoxicity and Teratology:

References: For Strategies

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Published Irish Foster Carers Association News, Summer 2013, No 57, pages 19-20.

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