Tens of thousands of babies are born each year to mothers who abused opioids when they were pregnant.
Now, a new study offers a snapshot of the educational impact of that early trauma—and a hint of what schools are already facing and may have to grapple with for years to come.
Researchers examined the educational status of a group of Medicaid-eligible children in Tennessee ages 3 to 8. Some of those children were born with neonatal abstinence syndrome, meaning that they spent their earliest days coping with the health effects of opioid withdrawal. The other children were not diagnosed with the syndrome.
The children who faced opioid withdrawal as babies were more likely to be evaluated for special education services and, once evaluated, were more likely to be found eligible, according to the report, published in August in the journal Pediatrics. Most of the children’s disabilities were in five categories: autism, developmental delay, “other health impairment,” specific learning disability, and speech and language impairments.
“Educators will not be surprised by these findings where there have been high rates of [neonatal abstinence syndrome], but I think it’s always important for teachers to be aware and on the lookout,” said Mary-Margaret Fill, a medical epidemiologist for the Tennessee health department and one of the report’s authors. “They’re a really important safety net for this population.”
Melissa Massie, the executive director for student-support services for the Knox County, Tenn., district, said her system also has anecdotal evidence of young children affected directly by opioids.
She noted that not every child with neonatal abstinence syndrome needs special education services, which was borne out by the Pediatrics study.
“But some can have pretty significant behavioral and emotional issues,” Massie said.
All the schools in the 61,000-student district have implemented multi-tiered support programs that are intended to provide help to all students, with extra efforts steered toward those with the most needs. Schools have also implemented what are known as restorative practices—alternatives to the traditional school discipline practices of suspension and expulsion that focus instead on such processes as group conflict resolution and peer mediation.
One of the important lessons for these children is learning how to deal with sensory overload, Massie said. “We can teach them, rather than act out, here’s how you take a break.”
Increasing numbers of babies nationwide are being born with the effects of exposure to opioids in the womb. The U.S. Centers for Disease Control and Prevention says that the number of children with a condition known as neonatal abstinence syndrome increased fivefold between 2000 and 2013. Nearly 22,000 babies were born with opioid exposure in 2013, according to the CDC.
The syndrome produces a range of effects for infants. They generally show up two to three days after birth, and may include tremors, high-pitched crying, vomiting, diarrhea, and difficulty in maintaining a stable temperature. At the mild end, those symptoms can be treated by soothing babies, swaddling them, and keeping them in quiet, dark rooms until the drug leaves their systems. Babies with very severe cases can be treated with methodone or morphine and then slowly weaned off those drugs.
Linda Palenchar, the director of special education in Fayette County, W. Va., said that she’s also seeing preschool children identified with the syndrome who are hard to soothe and who kick, bite, and lash out, sometimes without any obvious trigger.
“We’re seeing things in preschool classrooms that we’ve never seen before,” said Palenchar, who is also the director of preschool services for the 6,300-student district.
Palenchar added that the school system is working on training teachers on trauma-informed strategies, because even children who have not been exposed to drugs in utero could be dealing with the chaos of living in a home where a parent or other family member is abusing drugs.
“It’s very eye-opening to see how these little babies are living,” said Palenchar, who has visited Capitol Hill to advocate in favor of more special education funding.
The plight of children born to opioid-using mothers has been a growing concern among medical researchers, but relatively little is known about these children and their later needs.
The U.S. Centers for Disease Control says that the number of children with this syndrome increased fivefold between 2000 and 2013. In 2012, the center estimated that a child was born every 25 minutes showing the effects of opioid exposure in the womb, for a total of nearly 22,000 babies that year.
Those births are concentrated in particular areas, however. In West Virginia, for example, 33 out of every 1,000 infants was born with the opioid-withdrawal syndrome in 2013. That was among the highest rates in the 28 states tracked by the CDC that year, which did not include Tennessee. Other states with particularly high rates were Maine and Vermont, both of which reported more than 30 out of 1,000 children born with neonatal abstinence syndrome.
Tennessee is among four states that require cases of neonatal abstinence syndrome to be reported to the state health department, which is how the researchers were able to track these cases and the children’s later educational needs.
Fill, the author, noted that the study is not meant to show how fast the special education population might grow in the future.
Another study, however, has shown that the effects of neonatal exposure to opioids last beyond the early years. A 2017 study of youths in Australia showed that those born with neonatal abstinence syndrome had poor scores on standardized tests that progressed over time: Children with the syndrome had lower scores in grade 7 than children without the syndrome had in grade 5.
That said, federally-funded research on people born during the 1980s epidemic of cocaine use—so-called “crack babies"—has shown that the long-term effects of exposure to that drug are relatively small. Cocaine, however, is not an opioid.
Fill said that it’s important for all the organizations that work with young children—special education, early-intervention services, Head Start, and others—to come together to support these children. And both Massie in Tennessee and Palenchar in West Virginia noted that this is not a problem that can be tackled by schools alone.
“We have a really committed community-wide effort,” Massie said. “A lot of various stakeholders are at the table,” including community groups, legislators, law enforcement partners, and others.
Palenchar also sounded a cautionary note. “I hope that we’re moving toward some solutions,” she said. “I feel like we’re not at the solutions yet.”
A version of this article appeared in the September 19, 2018 edition of Education Week as Opioid Epidemic Raising Concerns in Special Education