Drug-Exposed Children Pose Special Problems
Los Angeles--Watching the 4-year-old leave the school bus, Vicky Ferrara could tell that something was wrong.
The boy was agitated. He leaped to a bench, then onto a nearby wall. A word with the bus driver disclosed that he had also misbehaved on the way to school.
What could have been a small, familiar vignette for most preschool teachers became then, for Vicky Ferrara, cause for gentle probing and extra emotional support.
Hers is a special preschool class, a pilot program serving some of this city's youngest drug victims: the children of drug-using mothers. And here, even the smallest event can take on layers of added significance.
In this boy's case, the agitation had been prompted, Ms. Ferrara learned, by a morning spat with his foster mother. "That's why I didn't want to come to school," he admitted.
As a baby, the boy had been abandoned for stretches that could last from two hours to two days while his natural mother searched for drugs. Even in his current, loving home environment, Ms. Ferrara said, he is still afraid he will not find a mother at home when he returns--especially if he has made her angry.
The boy's anguish was easily soothed this day with a reassuring telephone call to his foster mother. But Vicky Ferrara wonders whether others among the estimated 375,000 children born each year to mothers who take drugs will be so lucky.
Her school program, among the first in the country designed expressly to deal with the little understood problems of prenatally drug-exposed youngsters, puts Ms. Ferrara in a better position than most to pick up on the subtle cues to their distress.
But how, she wonders, would a typical kindergarten teacher have handled the boy from the bus?
"If you've got 28 or 30 kids in your class, and a couple of them have separation anxiety, and you've got one 35-minute lunch break, it's difficult" to find time to nurture, she said.
Yet nurturance and understanding is what a growing number of experts say may be crucial to helping these front-line casualties in the nation's drug war become productive citizens.
New research studies and the experience gained in a handful of programs similar to the project here indicate that children born with traces of such illegal drugs as "crack" cocaine in their system pose special problems for schools.
Like the boy in Ms. Ferrara's class, many carry the emotional scars of a home life devastated by drugs. But, perhaps more significantly for educators, recent research has also opened the possibility that neurological impairment may be an additional legacy of their mothers' drug use.
New studies show that children exposed to crack cocaine in the womb have difficulty relating to their world, are easily distracted, and have trouble performing some of the tasks that come easily to other children their age.
"It looks like we are going to need some special interventions for these kids," said Dr. Ira Chasnoff, a Northwestern University medical researcher who has been among those leading the study of children exposed to drugs before birth.
"The teachers are calling this to the attention of school systems," he said. "But the school systems are not ready to deal with it."
The existence of babies exposed to drugs in the womb is not a new phenomenon. What is new is the recent and sudden explosion in their numbers.
The National Association for Perinatal Research and Addiction estimates that 11 percent of all babies born this year will have some trace of drugs in their bodies. And 15 of 18 major hospitals surveyed last summer by the House Select Committee on Children, Youth, and Families reported that the number of drug-exposed births at their hospitals this year was three to four times higher than in 1985. Experts say similar increases can be found in hospitals nationwide.
And New York State health authorities just last week predicted that, if current drug-abuse patterns continue, 5 percent of all babies born in New York City in 1995 could be sick enough to require intensivecare. The figure for nonwhite babies could approach 10 percent, the officials said.
"It's not to say that schools wouldn't have the trained people that could begin to work with these kids," said Valerie Wallace, a psychologist who works with Ms. Ferrara in the Los Angeles program. "It's that we're not ready for the numbers."
Impact of 'Crack'
At the root of the rapid growth in this population, experts say, is the emergence of crack. Cheap, easily available, and highly addictive, this smokable cocaine derivative has been used by increasing numbers of both men and women since the early 1980's. But the effects of the drug can be especially devastating for pregnant women and their unborn children.
Of the estimated 375,000 children being born each year with drug exposure, approximately 200,000 are thought to have traces of crack in their systems, according to experts.
"The word on the street is that if you smoke lots of crack, you'll have a miscarriage," said Trish Magyari, director of a March of Dimes prenatal substance-abuse education program in Washington. "Sometimes that works and sometimes it doesn't, but the risk to the baby is severe retardation."
Moreover, she and others point out, women who use crack tend to use other drugs as well. Experts say they often take alcohol, sedatives, and other "downers" to ease the emotional crash that follows a crack high.
And few such heavy drug users receive adequate prenatal care.
Many women believe the placenta acts as a shield protecting the fetus from the harmful effects of the drugs they take. Researchers say the opposite is true with cocaine; the placenta acts as a sponge absorbing the drug. And cocaine circulates in the fetal system for up to seven days--five days longer than it does in an adult, Ms. Magyari said.
Called "the inconsolables" by some maternity-ward nurses, the babies born addicted to crack are often highly irritable, shrinking from the caresses that calm other infants.
Studies of them, which have focused so far on the infants of addicts rather than casual users, show that these babies are at greater risk of being born prematurely or with anatomical malformations. Many may also carry the virus for acquired immune deficiency syndrome and other infectious diseases.
Smaller and lighter than drug-free babies, the cocaine-exposed infants also tend to have smaller head circumferences, a characteristic that experts say is sometimes a marker for developmental disabilities. Some stand an increased risk for strokes or sudden infant death syndrome.
"Many cocaine-exposed infants feel stiff when their limbs are moved," added Dr. Chasnoff, who is president of napare and associate professor of pediatrics and psychiatry at Northwestern. "Tremors are common, especially in their arms and hands, when they reach for objects."
Distracted and Passive
In an effort to determine the longterm effects of the drug, Dr. Chasnoff conducted one of the first studies to track these babies to age 2.
The study, findings from which were released last month, followed the progress of 263 babies whose mothers were being treated for addiction to cocaine and other drugs.
Dr. Chasnoff found that, although the infants seemed to "catch up" with their drug-free peers in terms of weight, height, and cognitive development, there were still significant differences in the drug-exposed babies at the end of two years.
Those children tended to score lower on tests that measured their ability to concentrate, interact with others in groups, and cope with an unstructured environment.
"For example, if they were given one block at a time, they could put it into a cup as easily as other children," Dr. Chasnoff explained. "But, if given several blocks, they have a problem concentrating and they just can't do it."
"One aspect of this is that these are children that are going to have problems in a large classroom environment," said the researcher. "It looks like they're going to need special intervention, small classes, and direct one-on-one intervention."
Findings from a similar study conducted last year by researchers at the University of California at Los Angeles provide clues to additional problems for schools.
The ucla researchers compared two groups of 18-month-old children from similar backgrounds. One group of 18 had been exposed to cocaine and other drugs in the womb. Another 18, used as a control group, had been born prematurely but had not been exposed to drugs.
In both groups, the children were at high risk for developmental disabilities. Their mothers were poor, uneducated, and had had little prenatal care.
Children in both groups were participating in an intervention program at ucla through which they had been receiving regular health care.
When the toddlers were left to play by themselves, the researchers noted, the premature babies played as most children do. They would comb a doll's hair, pretend to stir apot, or sit a doll at a table.
"But play for the majority of drug-exposed children was characterized by scattering, batting, and picking up and putting down the toys, rather than sustained combining of toys, fantasy play, or curious exploration," said Dr. Judith Howard, who led the study.
Dr. Howard, a professor of clinical pediatrics, also said that the drug-exposed children seemed to be more passive than the other children. They did not express joy at the appearance of a novel toy. They showed no distress at the departure of a caregiver.
"The bottom line is: What we're trying to present are children with a pretty consistent environment--they're getting some intervention--and these are still the problems that we're seeing," Dr. Howard said. "What the school systems are going to have to deal with are children coming from very chaotic and violent homes, because wherever there are drugs there is violence."
"They are going to be even less organized and show even more developmental delays," she said.
Moreover, the ucla researcher added, schools will need to interact with the other public agencies that control these children's lives--the court system that has ordered their foster placement or jailed their parents, social-service agencies, or hospitals.
"School systems are going to have to learn to deal with a major thrust of this new kind of student," she predicted.
'Complicated' School Challenge
The Los Angeles Unified School District has been one of the first school systems in the country to heed Dr. Howard's warning.
In March 1987, the district launched the pilot program employing Ms. Ferrara. It is designed to serve children, ages 3 to 6, who have been prenatally exposed to drugs but would not necessarily qualify for special education.
"The situation for these kids is almost more complicated, because they look so good that we expect them to do better than they really are able to do," said Carol Cole, a teacher, who, along with Ms. Ferrara, developed the program.
Like the children in the ucla study, the children in the program come from what are now relatively stable home environments. Most are being cared for either by foster parents or a relative. A handful live with mothers who are undergoing treatment for their addiction.
The 23 children currently participating are spread over three classrooms in two different schools--the 75th Street Elementary School, located amid the drug-ravaged neighborhoods of south-central Los Angeles, and the Salvin Special Education Center in a part of town known as mid-city.
Each classroom is staffed by three adults, including at least one teacher. A doctor, a psychiatric social worker, and a psychologist are also assigned to the program part time to work with the children and their families. All of the staff make home visits--some to provide4training for the parents, others just to touch base and provide support to the family.
In the beginning, teachers here saw some of the same characteristics identified by researchers who have looked at younger drug-exposed children.
Some of the pupils had difficulty putting a check on their emotions, for example. A giggle would become a scream. And one boy's eagerness to answer a question would cause his spoken response to escalate into a shout.
"I think that goes back to their infancy," Ms. Ferrara said, "when they are unable to be consoled."
Others in the program did not speak clearly or could not solve problems. Some, when asked to copy their printed names with a pencil and paper, could make only letters of varying sizes and shapes.
Some of the children, teachers noted, were also physically awkward for their age.
"They have difficulty perceiving the relationship of their bodies to, say, a chair. And when they try to sit, they fall down," Ms. Wallace explained.
Staff members also found that many children needed adult guidance to play with toys. Ms. Ferrara once observed a girl who whined and rolled about the room, exhibiting almost no attention span. In the space of the 20 minutes she was watched, the child picked up and discarded 20 different toys. All the while, she clutched a doll in her left hand.
One of their challenges, those involved with the program say, has been trying to determine which problems stem from drug exposure and which are products of the children's chaotic early home life. The girl who whined and rolled passively on the floor, for example, had just come to the program following her sixth foster-care placement. She was 3 years old.
Now settled in a more stable foster home, the girl's play has improved, however. On a recent day in class, she sat quietly in a corner of the room, hooking up the cars on a toy train and rolling the train across the floor.
"Her progress is definitely related to her feeling better about herself," Ms. Ferrara said. "It might've been her sixth home, but it was somebody now that she knew was going to be there."
Life at home remains, however, more difficult for these children than for others their age. Some live in foster homes where there are as many as five other foster children, many of them also drug-exposed at birth. Some of the pupils, in addition, have younger brothers and sisters who share their predicament.
The streets where many of the children live also share the common scourge of this city's poor neighborhoods. They are marred with the graffiti of local gangs.
'A Lot To Contend With'
Last year, Ms. Cole observed one child in the program giving the hand signal for the Crips, one of Los Angeles's most notorious youth gangs.
"These kids do have a lot to contend with," Ms. Wallace said.
Over time, however, most of them begin to show improvement in nearly every area in the program. The only deficits that seem to remain, according to Ms. Wallace, who regularly tests the students, are some visual-perceptual problems and difficulty with fine motor skills--the small-muscle coordination needed, for example, to write with a pencil and paper.
Teachers here also note that many of the children continue to have difficulty making transitions. The end of free-play period and the beginning of story-telling time, for example, tends to trigger emotional outbursts. To ease such transitions, teachers try to give the students plenty of warning and preparation time when an activity is about to end.
In addition, some of the children still have occasional tremors.
For the most part, however, the message teachers here want to spread is that these children are more similar to than different from other children their age.
"We're trying to stress that they aren't scary and they don't have green horns," said Ms. Cole. "We don't want educators to give up on them."
"A lot of what works for these kids is what the National Association for the Education of Young Children tells us is good for any preschooler," she added. (See story on this page.)
For educators here as well as in other pioneering projects for drug-exposed children, however, the unanswered question is what will happen to their pupils several years from now, when they enter a regular classroom.
Program staff members here do not know how long the city board of education plans to fund their pilot program. So far, two of the children enrolled have gone on to a regular kindergarten class. A third boy in Ms. Ferrara's class spends one-half to three-quarters of his day in a regular kindergarten class.
And, as teachers here acknowledge, most of their counterparts in regular school programs have neither the time nor the resources to give these students the special attention they may require.
"This is not an inoculation against what will happen when they leave," Ms. Cole said. "What we can do is give them a nurturing experience, with consistent, trusting adults, and show that the world can be a trusting place."
"And also," she said, "I think we can spoil them."