New Research Finds Little Lasting Harm For 'Crack' Children
The widely held belief that children born to cocaine-using mothers are forming a permanently damaged '"biological underclass" may be largely a myth, according to a growing number of researchers in the field.
New studies published in medical and psychiatric journals, and some that are now in press, suggest that, for the most part, young children who were exposed to cocaine in the womb appear to have few impairments distinct from those common among children born of poverty.
These researchers say that while many cocaine-exposed children may require a little extra attention once they reach school, the majority of this population, once labeled a "lost generation," will not require full-fledged special-education services.
"What we are finding is that, over all, these children are not retarded," said Ira Chasnoff, a Northwestern University medical researcher who has followed a group of 300 such children since 1986. "Over all, they're within the normal developmental range, and a great majority--at least 70 percent--of the kids are mainstreamed and doing well in general public education."
Dr. Chasnoff, who did some of the earlier work identifying problems among cocaine-exposed children, will publish his newest findings next month in the Journal of Pediatrics.
He said in an interview that he has found that, at ages 3, 4, and 5, more than 90 percent of the cocaine exposed children enrolled in a special early-intervention program he directs continue to test "within the normal range" on standard intelligence and cognitive tests.
About 30 percent to 40 percent of the children in the study continue to display delays in language development or problems in concentrating and focusing attention, according to Dr. Chasnoff, who is also president of the National Association for Perinatal Addiction Research and Education.
Earlier studies by Dr. Chasnoff and other researchers, in contrast, pointed to much greater problems for these children. (See Education Week, Oct. 25, 1989.)
They suggested that cocaine exposed babies stood a greater risk of being born prematurely or with anatomical malformations. At birth, such children were found to be smaller and weigh less than other infants and had small head circumferences--a characteristic, experts say, that is often a marker for developmental disabilities. The studies suggested cocaine exposed children also were prone to neurological damage, seizures, and sudden-infant-death syndrome.
In the hospital nursery, the earlier research found, these children, known as "the inconsolables," were often highly irritable, shrinking from the caresses that might calm other infants. At age 2, one followup study indicated, the children still had problems interacting with others, concentrating, and coping with an unstructured environment.
In Dr. Chasnoffs studies, the researchers sought to counter some of the negative effects they saw by teaching mothers strategies for comforting and nurturing their children and by directing the mothers to drug treatment programs. The children were also given periodic medical examinations as they grew older, and, when necessary, were referred to physical or speech therapists and to Head Start or Even Start programs.
"I think the message is that there are going to be some children who are lost in the system until they reach school age, and they're going to require some special interventions," Dr. Chasnoff said this month in commenting on the newest findings, "but they are going to be interventions they respond to."
Even without special help, however, children whose mothers used cocaine during pregnancy may be better off than was previously thought.
The problem with the earlier studies, Dr. Chasnoff and a growing number of other researchers are now saying, is that they failed to take into account other factors that might have contributed to these children's medical problems.
For instance, they note, cocaine use rarely occurs in a vacuum. Mothers who use cocaine are also likely to have used alcohol, tobacco, marijuana, and other harmful drugs during pregnancy. And few studies controlled for that possibility.
"Many people noticed a lot of problems in children and said, 'Aha, cocaine,' "said Claire D. Coles, the director of clinical and developmental research at the human-genetics laboratory at Emory University. "They didn't control for babies being born preterm, sexually transmitted diseases, drugs, the effects of poverty, poor medical care, lifestyle."
"It is a combination of factors that is causing the problems," she said.
Newer studies by Ms. Coles and other researchers have begun to plug in some of the gaps in previous research. As a result, they are finding that, in infants at least, cocaine by itself has had a much smaller effect than some of the previous studies indicated.
A soon-to-be-published study by Ms. Coles of 178 cocaine-exposed infants linked the drug only to lower birthweight and smaller head circumferences in the newborns studied.
"In the absence of other complicating factors, like preterm birth, such infants do not appear to be otherwise impaired physically or behaviorally in the neonatal period," the study concludes.
"Most of this in the [news]paper is just made up out of whole cloth," Ms. Coles said. "The vast majority of the children are fine, and many others, given an adequate environment, are fine, too."
'Degrees of Risk'
A similar study published recently by Nancy Day, a University of Pittsburgh researcher, found "no effect whatsoever" of moderate cocaine use by the mothers of 300 newborns studied. Ms. Day said another study in which she is participating, which includes 600 infants whose mothers used the drug more frequently, also suggests maternal cocaine use has had little effect on infants.
"A woman should avoid exposure to any chemical during pregnancy, but there are degrees of risk," said Donald Hutchings, the editor of the Journal of Neurotoxicology and Teratology, which is publishing some of the newer studies.
In terms of physiological effects and sheer prevalence, for example, alcohol may turn out to be a far more dangerous drug for unborn children, according to the researchers.
News Media, Experts Faulted
The researchers said the attention surrounding the earlier studies has led to exaggerated perceptions about the outlook for cocaine exposed children. They say the publicity about the problem, illustrated in newspaper headlines calling the children "crack babies" and labeling them "born to lose" or a "generation of sociopaths," has led to widespread perceptions that these children are doomed to fail in school.
"Teachers are already assuming they are problem children and will treat them differently," said Ms. Day, who is an associate professor of psychiatry and epidemiology at the University of Pittsburgh. "Unless we step back and look at the root causes of their problems, we can't cure them."
"Two or three years ago, when people in schools began to identify what the potential was out there, there was a desire to make sure the funding agencies understood the problem," observed Allan Shedlin Jr., the executive director of the Elementary School Center, a New York City-based organization that has sponsored several institutes designed to provide accurate information on the issue. "In a way, we did too good of a job ."
Some researchers also accuse the popular media of painting a much grimmer picture of the situation than was indicated even by the earlier studies.
Ms. Coles said the exaggerations were easy to believe, in part because the epidemic of "crack" cocaine use that began in the mid-1980's has affected primarily poor, inner-city blacks.
"It's easy for society to say, "This is going on with people who are not like the rest of us,'" she said.
But Mr. Hutchings of the Journal of Neurotoxicology and Teratology lays some of the blame at the feet of the professionals in the field.
"A lot of this information has come right from clinicians' mouths," he said. "They invited reporters into the nursery and showed them very sick children who were portrayed as 'crack babies.'"
Added Ms. Day of the University of Pittsburgh: "I think the politicians also distorted it, because it's easier to attack cocaine than poverty."
Despite the hyperbole surrounding cocaine-exposed youngsters, the researchers caution, one aspect of public perception about the problem has been on target: There are growing numbers of children entering school who have more health and behavioral problems than ever before.
An estimated 375,000 children are born exposed to drugs each year, according to one conservative estimate. But the number of children who may need some extra attention in school because they are hungry or homeless, or are being raised by brothers and sisters who are children themselves, among other risk factors, is much larger and growing.
"Their numbers are increasing, not from the drug problem, but from the general environment in which children are being raised today," Dr. Chasnoff said.
"What schools need to do," Ms. Day added, "is stop talking about crack babies and talk about what they've really got--a bunch of kids living in poverty."
"The good news about that," she said, "is that we know how to deal with that."