SPEAKER_00: 0:30

My name is Dr. Susan Rich, and my business is Therapeutic and Learning Centers, PLLC. I serve a range of children, adolescents, and mostly young adult, although I do have some adult patients. Most of my patients have some degree of neurodiverse conditions like ADHD, high-functioning autism. These are kids who are highly intelligent but have some degree of social communication issues, fetal alcohol spectrum disorder, which happens to children when their birth moms or dads, believe it or not, drink alcohol for the dads before they may even be pregnant. And for a lot of the kids in my practice, they're adopted or have some degree of trauma in their history. It could be a birth parent died, or they had some other kind of divorce problem that led to trauma in their childhood.

SPEAKER_01: 1:31

That's amazing. I can't wait to learn more about everything you do to help with all these things. So first, take me back to how you got started in all of this. Tell me how you got to where you are today.

SPEAKER_00: 1:43

It took a lot of education. So I started out after being the first person to graduate college and my family. I went on from NC State University, where I studied microbiology, and uh graduated at the School of Agriculture and Life Science. I worked then four and a half years in pharmaceutical research. I had paid my way through uh my undergrad working in labs like the National Institutes on Environmental Health Science and Research Triangle Park, and uh did an honors research project in virology at NC State. Then I went on, worked in the pharmaceutical industry and research for four and a half years. And along the way, I read a book called The Broken Cord, which is a book about a Native American man who had adopted some children with fetal alcohol syndrome before they even knew what that was. It was like 1973. And the book completely changed my perspective. I saw what alcohol had done to generations of people since colonization. And it really compelled me, and probably because of my interest in science and embryology and just how could this possibly happen? And I was a sexually active, you know, young woman at that time in my 20s, uh, having been a college graduate, traveling a lot with my job and occasionally drinking, right? It was okay, it was legal, but nobody had ever told me that this problem happens before you find out you're pregnant. And so it kind of lit me on fire. I wrote a letter to the author of the book, and I decided to begin teaching in Native American communities about this problem. I reclaimed my roots in the Native American community by enrolling with the Tuscara tribe of North Carolina and went back to school. I did a master's of public health and health policy at the University of North Carolina at Chapel Hill. And uh on weekends, I would go to powwows and festivals teaching about how birth defects happen and a lot happens before you find out you're pregnant, and teaching the grandmothers and the aunties and the women in the community. And then this led to me joining forces with the March of Dimes in North Carolina and the ARC of North Carolina to develop a program called Planning for the Seventh Generation. We went on from there to um teach in Native American communities and distribute a brochure that we developed with these organizations. And along the way, I got my master's of public health and began working in a rural community with a community health consortium called Robison Healthcare Corporation. And there we developed additional programs for women in recovery and their dependent children. One of these was a um basically a$1.8 million project we built from the ground up in about two years, where the women in recovery could live with their children and be reunited, with the children having been placed in foster care, but the court would reunite them with their children, where they could live for up to two years in this gated community, beautiful apartments. And along the way, developing that project, I decided to go back to school. So at the age of 30, I went to medical school at the University of North Carolina at Chapel Hill and completed the uh project called Grace Court along around my second year of medical school. And then that program, believe it or not, has now been replicated. There are eight of these now in the state of North Carolina. We don't have any in Maryland. But in 2001, after graduating medical school at UNC Chapel Hill and going into residency at Georgetown University Medical Center in psychiatry, I moved to Maryland and saw all the beautiful farmland, much like here in Leesburg, lots of horse farms. Most people don't realize that one of the biggest industries in Maryland is equine. So around the time that I moved to Maryland in 2001, I came up with this idea. There must be a farm that I can get for a dollar, somebody donating, because I'd been in the nonprofit world for a number of years. Somebody may donate a farm. Little did I know, people are not so philanthropic. So I kept on with that uh idea. I finished residency at Georgetown in psychiatry, then did a two-year fellowship at Children's National Medical Center in uh child psychiatry, child and adolescent, and then opened my practice. But because I had paid my way through medical school, I had three degrees worth of student loans. So after that five years of residency and fellowship, it took me nine years to pay off three degrees worth of student loans doing a private practice in a home office. And um after paying off my student loans, getting close to it, I finally decided I'm gonna establish my nonprofit. So that's seventh generation foundation. And right after establishing my nonprofit, I um incorporated my practice as therapeutic and learning centers in 2015. And then in 2016, uh I actually moved to the farm, which is we call it Dreamcatcher Meadows. But um, my practice, therapeutic and learning centers, operates on one acre of the farm. And I lease over for zero dollars five and a half of the six and a half acres. We've been able to get a state bond bill and two county grants to rehab the nonprofit farm. And uh we've rehomed a number of baby animals and injured animals that otherwise would have had to be put down, many of them, or they just weren't thriving where they were. And those animals then become, in a way, like therapists for children with trauma and attachment issues, as well as neurodevelopmental issues who come to my uh practice. Um, but that's how I got started. It took me from 2001, though, till 2016 to realize this dream of starting this farm. And I always tell kids just hang on to your dream. If it's big enough and strong enough, it's gonna power you through whatever it takes. For me, it was uh getting through medical school, then residency and fellowship. But also my public health degree was because I had, you know, this yearning to help the issue of prenatal alcohol exposure, which I've written a book about, by the way.

SPEAKER_01: 8:42

Okay, awesome. I can't wait to hear hear more about it. And I I'd like to say, you've definitely been around the block the the amount of years of experience you have into this, it's very fascinating. But you're doing and especially the integration of animals into these therapeutic practices. So, to get started, your practice focuses on helping neurodiverse kids and teens recognize their strengths and tap into their unique superpowers. What inspired this mission and how do you bring that vision to life at your practice? I know we kind of got in got into this, but if we could dig in a little more.

SPEAKER_00: 9:17

Yeah. Really, how I came to be uh working with kids who have neurodiverse conditions is that I had a real passion for helping these children who have been prenatally exposed to alcohol. And at that time, there were two camps, one with feto alcohol spectrum disorder and trying to hammer that as a diagnosis. And along the way, we were able to convince the DSM committee, which is the Diagnostic and Statistical Manual Committee around 2005 to put neurodevelopmental disorder associated with prenatal alcohol exposure in DSM. And when the new DSM came out in 2013, it redefined all childhood mental disorders, what we used to see as childhood mental disorders as neurodevelopmental. So my love for these children and my understanding that they are born in some way with unique, I call them superpowers. Um, whereas a lot of people see it as challenges or conditions that we need to label and we need to stigmatize them, or we need to um, you know, maybe medicate the symptoms. I try to help parents see, well, if you change the environment and you change your approach, it can help the child. Um, with the reframing of DSM, you know, I had opened my practice in 2006. And by 2013, with the reframing of DSM, looking at childhood mental disorders as neurodevelopmental, then it I was already, you know, kind of riding that wave as it came in and helping parents, you know, see the strengths in their child, not necessarily that they have disabilities. These are different abilities. And, you know, whereas a kid might be hyper focused and very intense on certain topics, okay, let's go with that. Maybe they're going to become a geologist if they know every type of rock and mineral. And, you know, how many 14-year-olds know that? I mean, it's usually somebody who graduates with their PhD that knows all that, you know, information or dinosaurs, like some kids being like incredibly knowledgeable about dinosaurs, even at the age of six, seven. Okay, let's go with that. Let's keep working with that skill and ability. And it may be by the time they're in uh high school or college, like they are an expert on that. Instead of like dinging them because they don't put their shoes in the proper place when they come in the door. Okay, what about putting a place there that say shoes and, you know, labeling it? Hey, this is Jimmy's shoes or this is Susie's shoes. Let's put them there. And repeating over and over the same sort of rituals and habits, you know, daily habits to help with their executive functions and having the parents help scaffold that. So that's kind of how I evolved, you know, what I'm doing. I mean, it just happened along the way with all the education. And every two years, we physicians have to do 50 credits. That's 50 hours of continuing medical education. So I would make sure that the medical education credits I did were related to topics that really would help improve the lives of the kids and my practice.

SPEAKER_01: 12:50

Absolutely. And I love your term superpowers. And I I just think it's a great thing that you're standing for in kind of trying to change the opinions on the stigma that it's an obstacle. It's more of something that they can unlock and see where it leads them. Yeah, it's a gift.

SPEAKER_00: 13:09

These are gifts. We're all born with unique gifts. And I tell my patients, look, my gifts is that I see you when you're 24 years old. I see you when you've already launched into your life and you're living this bountiful life with joy and goodness. And that's one of my superpowers. I don't see them for the deficits they have. I see them for their strengths. And by helping them unlock that in themselves and really own their gifts instead of shunning from them and being ashamed that, oh, I know every gem and every mineral, you know, on the eastern seaboard. And, you know, or, you know, I know the name I was talking before about dinosaurs, because some kids are really locked in on that. Or trains is another one. Some kids are like so fascinated by trains and engines and motors. But it's it's really great to see kids and how they progress. And I've been in practice, I'm gonna tell you in March, it'll be 20 years. Wow. 20 years I've been in private practice. So I started medical school when I was 30. I graduated residency and fellowship when I was 40. And I started my farm when I was 50. I bought my farm. So, and I'll be 60 next year. And my next phase is going to be to do what I wanted to do since 2001. So it will have been 25 years, but I'm going to launch a new, a new program under my practice.

SPEAKER_01: 14:46

Okay. Well, that's super exciting. I cannot wait for this for you. And also something I wanted to touch on was your motto, strengthening mind, body, and spirit for life captures such a powerful vision. What does it mean to you to treat the whole person rather than just the symptoms?

SPEAKER_00: 15:05

Well, I mean, we humans, we ourselves are so neurodiverse, like all humans are. And I feel like it's strengthening the person so that they can embrace that part of themselves that is good and is uh happy and confident and hopeful. So it's strengthening our mind, our body, and our spirit. So we we have like multiple dimensions of ourselves. We're not just what we see, we're not just the biochemicals that make us up or our genetics. Um, we're also partly the environment we put ourselves in. We're the things we think about. We, you know, we can shift our thoughts from negative to positive. And it's just about helping empower the person to live their authentic self, to be authentic with others instead of pulling within and being afraid to express who they are. Sometimes that means understanding yourself in a different way from a mind point of view, like perspective, yes, like looking at, you know, what their thoughts are and when emotions come up, what they make those emotions mean with those uh automatic thoughts and shifting from automatic thoughts to positive self-talk. So that's one aspect that's very CBT-oriented cognitive behavioral therapy. Another approach is uh looking at the biology or the body, right? And uh sometimes it means doing genetic testing for kids who are neurodiverse. That's what we will uh recommend, which is these microarrays. And now the American Academy of Child and Adolescent Psychiatry, American Academy of Pediatrics, and American Academy of Neurology all recommend this type of genetic testing for uh microarray analysis for individuals who have uh neurodiverse conditions. The other aspect is genetic testing to see if the medications they're taking are maybe not the best ones for them. And there's actually a whole series of tests we can do that I won't name any companies out there, but there's a company I I uh refer people to get testing through, which does these analyses of their CYP450 enzymes and like looking to see if their serotonin receptor or transporter are variants in a way that they're not going to be able to use serotonin, which is one of the filling good chemicals in their body. There's also lab tests for looking at whether or not they have certain deficiencies of nutrients, micronutrients, you know, minerals. There's uh certain vitamins that we can see in their blood tests, whether or not they may need supplements for. Sleep is very important. I have an acronym, which is SNOW with the E on the end. And it's sleep. We need, you know, adults need eight hours, but kids, even through college, still need 9.25. And sleep is medicine. Nutrition is medicine, three healthy meals a day. Sometimes college students leave out, or even high school students leave out, they don't eat breakfast, and then they're wondering why their energy is running out by say lunchtime. They eat a big lunch, but then they're tired, and then they go back and they go to sleep, and then that ruins their nighttime sleep. Um, oxygen, the breath. Calming yourself, right, with the breath. It gets oxygen to your brain faster by breathing through the nose. And it helps relax and calm. Water. We need six to eight, eight-ounce cups of water a day. Most people don't get that much. It's about 48 to 64 ounces. A lot of students are uh highly trained athletes. Their parents have them in multiple um different kinds of sports. They need more than that. I have one girl who swims like two, three hours a day, every day of the week. She's in the junior Olympics. Her coach told her she needs 120 ounces a day, right? Even though she's in the water. Exercise. In our area, not a lot of kids are in the category of needing more exercise, except for those who are really not exercise and sports oriented. So you get some kids who are stuck on video games a lot of the day. They get, you know, they come home from school, maybe do their homework, maybe not. And then they they get very little exercise. So getting the family dog, going out for walks, teaching the family to do these regular exercise routines is helpful. And then the last two things are sunlight and nature for your body, but it's also really good. Sunlight and nature have been shown to be great for your mental uh well-being and your uh physic, your spiritual well-being as well. So strengthening mind, body, and spirit for life. Uh, spirit would be like, what is your faith? What is your faith?

SPEAKER_01: 20:20

I would be Christian. Okay. You're asking you. Well, okay.

SPEAKER_00: 20:23

Yeah. So so asking people, do you have faith? Do you have faith in in something? And it could be faith in the love that you have with your parents. It could be faith that, you know, things are gonna work out for you. Or it could be your your faith-based tradition based on your religion, right?

SPEAKER_01: 20:41

Absolutely.

SPEAKER_00: 20:42

And um, so what is your belief? Meaning and purpose, we know if you have meaning and purpose in your life, you have a healthier mental frame of reference, and you have uh a healthier physical frame of reference. If you faith can give that to you, it can give you meaning and purpose, but so can kind of like the idea that you have uh a purpose here on the planet. So teaching kids to look for that, teaching parents to help honor that in their kids and help support that along the way with all the check boxes they're doing in this race to nowhere to be at the best college or to get a scholarship to go to college, that kind of thing. I think it's important to honor these um these callings that kids might have or these special gifts. And and it is different when you're working with an adult versus when you're working with a child uh in these ways.

SPEAKER_01: 21:42

Absolutely. I love how you mentioned having those core building blocks and also just having those family ties in to really help support the child and and and set them up for for the best.

SPEAKER_00: 21:52

And success, yeah. Yes. Setting them them up for success in the future, exactly.

SPEAKER_01: 21:57

For sure. And you've highlighted that prenatal alcohol exposure is a leading cause of neurodevelopment disorders impacting one in 20 children. Why is this public health issue so underrecognized? And what steps can we take to increase awareness and prevention?

SPEAKER_00: 22:15

I think it comes down to money. I'm gonna be sad to tell you. Um, I've been looking at this issue since 1992 when I found out about April '92, when I told you I read the book, The Broken Cord. And I had a mentor at UNC Chapel Hill, Dr. Kathleen Sulik, whose work went into the original Surgeon General's warning in 1981. She her work was published in the journal Science. She showed that it's the late third to early fourth week post-conception that the major malformations associated with the what's called fetal alcohol syndrome happen. And it's with its little as four to five drinks. So that's one of the problems, is that it's happening so early in pregnancy that most women are unaware they're pregnant. But the label on the alcohol bottle says pregnant women should avoid alcohol because of the risk of birth defects. But if you're sexually active and using alcohol, you could become pregnant and not know it. So that's why with my nonprofit, we started a campaign called Better Safe Than Sorry Project, which is alcohol and unprotected sex don't mix. It's the idea that if you're sexually active and using alcohol, you need to contracept. So I think we need to reframe our policy around alcohol the way we do for search and prescription medications to say that if you're using this product, you need to contracept. The other problem is that we're not including males in this category of public health promotion. So we're not including sexually active childbearing age alcohol consumers in it who may not be thinking about pregnancy, and those are the most vulnerable, as well as young men who are going out there drinking, and up to three months prior to conception, their sperm are being epigenetically modified by um these products. It's a product of the alcohol industry. So if you look at the industry itself, it's a I'm saying all the way back when I wrote my book, it was about a 20, I think it was, I'm not even gonna quote the figures. I I it's coming up as like a$2.2 billion a year industry, but I think that's very low compared to what it really is. So maybe my memory is wrong. I'm gonna have to go back and look. But it's a big industry, let's put it that way, right? Even just in this country, I'm not saying worldwide. Um, the alcohol industry is huge. And the lobby that they have is the same as the cigarette industry back in the 1970s, 80s, and 90s. And I happen to have been at UNC Chapel Hill uh working on my Master of Public Health when a lot of the tobacco industry came crashing down. And there was evidence that they had shredded documents and that they knew about cancer and all of the problems. Well, it turns out Maryland was one of five states that took on big tobacco all the way back in the 80s and 90s. They're still getting payback from the tobacco industry. And they get annual proceeds from the settlements that five states had. And the reason was that the states realized they were paying a lot of money for people who had emphysema and chronic heart and lung disease and cancers because the insurance companies, people were underinsured. And, you know, the state then had to take over to do the payments through like Medicaid, but what the federal government didn't pay. So it became a numbers game. It became financially important for states to take that on. I think part of the issue is that, and I don't want to throw anybody under the bus, but alcohol is our very favorite bedfellow. It is the thing that people for 10,000 years, and I've written a paper on this, have gotten inebriated and then gone to bed with other people. Well, it turns out there is a thing called being in the bed with big alcohol if you're a politician. So you can't actually go to almost any fundraising event. And even I was on the board of the National Organization on Fetal Alcohol Syndrome, it's now called FASD United. I'm not throwing them under the bus. Most nonprofits are like this too. But they represented people who have this condition, and yet they would have alcohol at all of their fundraisers, they would have them at places like the um Embassy of Italy, and then have all this Italian wine and gift baskets to be auctioned for people. I, after 11 years on that board, stepped down because they weren't practicing what they preached. I felt that way. I'm a I'm a physician, I'm a psychiatrist, I'm not allowed to do certain things. I've in fact been dinged by the state medical board for certain things. And I'm not going to defend, you know, that. But you know, as a physician, I can't take money from big pharma. I can't represent a pharmaceutical industry if I don't then go to a conference and say, hey, I took however much money from this pharmaceutical company to promote their product. I can't do that. We have to have full disclosure. Um, I think full disclosure is a big deal. The big alcohol needs to begin being held accountable for. And I've written a paper on that. Uh, the alcohol industry's duty to warn about neurodevelopmental disorder associated with prenatal alcohol exposure. It's the industry has a duty to warn, just like back in the 80s, 90s. Guess what happened? Orange juice labeled fresh squeezed that was from concentrate, had to be changed with the label, right? They had to change it to accurately reflect it is not fresh squeezed, it's from concentrate. I'm talking about orange juice. Very misleading. Ver okay. And how many people died because they drank out orange juice from fresh that was from concentrate, not fresh squeezed? How many people do you think died from that?

SPEAKER_01: 29:16

I don't think anybody did.

SPEAKER_00: 29:18

But it's a misleading advertising. And if you look at big alcohol, I'm just going to start with, and you know, this might be the last thing we talk about, but during COVID, during COVID, the public health community, Centers for Disease Control, like them or not, believe them or not, came out with a mandate that if you use alcohol during and during COVID, it's going to create higher risk because it's an immunosuppressant. But we kept all the liquor stores open, including Montgomery County, Maryland, where I live, and they regulate the sales of their own alcohol. They actually own all the alcohol distributors. Montgomery County, Maryland does. We're one of very few counties in the nation that do. And they make about 37.4 million in the sales of alcohol every year. And they kept the doors open, they closed the schools, causing mental health detriment to children, and they closed the churches, synagogues, and mosques so nobody could go and and practice their faith based beliefs. Okay. So the CDC. Said that. The CDC also said that Native American, African American, and people of Hispanic origin are at higher risk of COVID. We knew that for certain health reasons. But who were the ones that the alcohol industry had on their advertising during COVID? And I'll never forget it. I was sitting there and like everyone else, sometimes watching Netflix, which I never had a subscription for until then. And there would be ads. This, you know, handsome, you know, Hispanic guy saying, Oh, I'm gonna take, you know, alcohol to my grandma, Abuelita. And, you know, how he's got this really great type of rum he's now gifting to his grandma. Well, those are subliminal messages. And African American people then put to the forefront. During COVID, the only industries with enough money, not even cars, because they weren't selling cars then. The only people with enough money to promote advertising was healthcare, pharmaceuticals, and alcohol. Okay. And they weren't having to put right underneath it any type of warnings. I'm not saying let's go back to prohibition. It did not work. I know the data. I have studied the data. I have the data in my book, right? Did not work. What does work? Consumer protection. And if we hold the industry accountable for its duty to warn, which we have not, that little label on the back that on a brown label with gold lettering, you can't even read. If you're two sheets to the wind, certainly not.

SPEAKER_01: 32:21

You make a great point about holding the industry accountable. And I think that this is knowledge that really needs to be shared and more well-known, especially for the younger generations. Yeah.

SPEAKER_00: 32:32

Yeah. And your generation is doing a great job. I say, say, millennials and the younger or the Gen Z, they're doing a wonderful job because guess what? There are craft breweries having to close doors. And in DC, I read not long ago that they were closing this really big brewery that had a restaurant associated with it. They were closing the brewery part because nobody was drinking the alcohol. Yay, you, you know, yay, your generation. You're learning that alcohol is a mutagen, a teratogen, a neuroteratogen, a neurotoxin, a hepatotoxin, and a toxin, right? Not just affecting your liver, it affects every organ system in the body. It's linked to dementia, early onset dementia, cancers, all kinds of cancers. It causes mutations. And that's one of the ways that it affects um children, babies, is that your genome is actually affected by your use of alcohol. When I I told you I've worked for years in and I paid my way through public health school or actually undergrad, my degree was in microbiology, but uh I worked at a lab and we denature DNA using what? Alcohol, 70% alcohol. You denature DNA using alcohol. So you you immerse all your cells with alcohol, and pretty soon you're going to get some mutations. That's why it's linked to cancer. It's a carcinogen, but it's linked to certain kinds of birth defects because we're actually influencing the genome and the these epigenetic effects that men cause when they drink up to three months prior to conception. That's why the CDC is saying if you're going to plan a pregnancy, start six months before you get pregnant, before you stop your contraception, start six months and don't have any alcohol.

SPEAKER_01: 34:41

Absolutely. I think this is a great, a great few key takeaways for the younger generations, as well as that be informed and be cautious of what you put in your body because it can have lasting effects, not just on yourself, but on your future children and your family. Absolutely. Yeah. Costly. Very costly. Wrapping up, looking ahead, what's your long-term vision for therapeutic and learning centers and for your broader legacy in psychiatry and neurodevelopment health?

SPEAKER_00: 35:11

That's a very good question. So the first answer in the next year, and I'm working, you know, between the Department of Education in the state of Maryland as well as Behavioral Health Administration to figure out where my new venture is going to fit to get licensed. But it is OMSpace, so One Health Mindful Space. And it's a place where neurodiverse, very intelligent children, they're called twice exceptional, meaning they have some degree of either learning challenges or ADHD, but they're very bright. We'll be able to come on a daily basis and have school. So there'll be 10 children who come to, we're calling it OMSpace, so One Health Mindful Space, and taking the resistance out of attending school by having them interact with the animals and learn about nature and restorative agriculture. And particularly for those children who we've now identified as having climate anxiety. So I just finished a CME, continuing medical education on climate anxiety. And it is a new diagnosis in the psychiatric community. I don't like to see it as a diagnosis. I like to see it as a natural consequence of worry about something that we all should be concerned about. So teaching kids about environmental restoration, restorative agriculture, at the same time, they're getting a um homeschool curriculum.

SPEAKER_01: 36:45

These are some amazing things that you're doing. It is such a a breakthrough, I think, for the psychiatric field. And I want to thank you so much for the knowledge that you've shared. And thank you for joining me on the podcast today. It was a pleasure to hear a story and a super inspiring story.

SPEAKER_00: 37:02

Thank you. Thank you so much.

SPEAKER_01: 37:04

Thank you.