Source: Washington Post Address: 1150 15th St. NW Address: Washington DC 20071 0001 Pubdate: Tue, 16 Sep 1997 Page Z10 `Crack Baby' Fears May Have Been Overstated Children of CocaineAbusing Mothers Are No Worse Off Than Others in Urban Poverty, Study Says By Susan FitzGerald Special to The Washington Post The little boy was curious about the big wooden box with 10 tiny doors. Behind one door, he discovered a compartment with two plastic bugs. Behind another, there was a doll's bottle. The boy, 4 1/2, smiled each time he found something new a ball of clay, a snow globe, a music box. With all its tricky locks and secret compartments, the box at the Albert Einstein Medical Center here was certainly a magical toy. But this was not ordinary child's play; it was designed to show a child's problemsolving skills and ability to stay focused. It is part of a research project seeking to determine if cocaine damages the brains of babies whose mothers use the drug during pregnancy. Starting in the mid1980s when the crack cocaine epidemic hit America's inner cities, many doctors and researchers made gloomy predictions about what would happen to babies of women who used cocaine. They said that these "crack babies" did not act like other infants in the nursery and warned that schools should brace for an influx of children with learning problems. There are animal studies that suggest that cocaineexposed children could be at risk for attention and behavior problems. Some even went so far as to write off crack babies as a lost generation. But real life has not proved so definitive. Since 1989, researchers at Einstein hospital have been tracking the development of more than 200 poor innercity children half exposed to cocaine in the womb, half not. Although most of the children are just getting into school, where it is possible more problems may become apparent, the researchers so far have turned up nothing to distinguish the cocaineexposed children from their peers. "The good news is that we don't see anything devastating," said Hallam Hurt, Einstein's chairman of neonatology who directs the governmentfunded study, one of the largest and longestrunning of its kind. "If there is a cocaine effect, it's not a tomahawk between the eyes." At the same time, the study found that neither group of children is thriving compared with the general population. Both groups score well below the norm on IQ tests and other measures taken to assess their cognitive development. These findings suggest that the culprit in slowed development is not one single factor such as prenatal exposure to cocaine but all the deleterious effects associated with poverty. Cocaine is an addictive centralnervous system stimulant that acts on chemical messengers, particularly dopamine, in the brain. The drug also increases blood pressure and speeds up the heart. Some users have suffered seizures and died from stroke or heart attack. In pregnancy, it is thought, a mother's use of cocaine could take a toll on the fetus two ways. It could cross over the placenta and directly affect the fetus's developing brain and other systems. There could also be an indirect effect. Animal studies have shown that because cocaine causes blood vessels to constrict, there can be a reduction in the flow of the mother's blood to the uterus, which would hinder the supply of oxygen and nutrients to the fetus. "Cocaine really is a powerful drug. It's sort of hard to believe that something as powerful as it doesn't have a profound effect on the fetus," said Keith Scott, a University of Miami researcher who is director of the Linda Ray Intervention Center, an early intervention program in Miami for children whose mothers used cocaine during pregnancy. Cocaine researchers from around the country are meeting here this week to assess the latest findings on what happens to children exposed before birth to cocaine. John A. Harvey, a cocaine researcher at Allegheny University of the Health Sciences in Philadelphia, which is cosponsoring the conference with the New York Academy of Sciences, said studies involving rats, rabbits and primates make a strong case that there are deleterious effects of cocaine, but "there is not a clear consensus as to whether these animal models are predictive of what is happening in the human situation." Much of the early thinking on cocaine's effects on neurological development grew more out of anecdotal reports than scientific studies. Nursery workers told stories of "crack babies" who were small, had tremors, were inconsolable and easily agitated, cried oddly, avoided eye contact and didn't like to be held. But early studies attempting to pin down some of these things tended to involve too few babies or were so poorly designed that it was impossible to draw any meaningful conclusions. The picture was complicated by the fact that women who use cocaine during pregnancy are also likely to smoke marijuana, drink alcohol, smoke cigarettes, have sexually transmitted diseases, neglect medical care and eat poorly all of which can be harmful to the developing fetus. Still, the crack baby became a powerful symbol as the nation marched forward on its war against drugs. "All this frenzy took place," said Donald Hutchings, a research scientist at New York State Psychiatric Institute who spent his career studying the toxic effects of drugs on fetal development. "Everybody bought the story of the crack baby and that just snowballed and took on a life of its own." Much of the current research is aimed at tracking the development of children over the long haul, looking not only at their intellectual status, but also at their behavioral, emotional and social development. In a major effort funded by the National Institute on Drug Abuse (NIDA) and other agencies, researchers are following the progress of 1,400 children up to the age of 7. Federally funded studies similar to the one in Philadelphia are proceeding in Miami, Boston, Chicago and elsewhere. Ira Chasnoff, a University of Illinois School of Medicine researcher who has been studying crack babies since the 1980s, will be reporting at the conference on a study of about 170 children, half of whose mothers used cocaine and other drugs during pregnancy. He said that at age 6 the drugexposed children did not differ in intelligence from children who were not exposed. Nevertheless, behavior remains a concern. "Their cognitive development is normal when you control for the environment and other factors," he said. "But we are finding some differences in behavioral measures more impulsivity, shorter attention spans and more trouble concentrating." What's more, Gale Richardson, a University of Pittsburgh researcher who also will be part of the meeting, has found that "at 3 years of age, the children who were cocaineexposed are rated by their mothers as being more difficult children. They are more temperamental, they cry more and they are not as easygoing." She said that the cocaineexposed children on average perform slightly poorer on IQ tests than a similar group of unexposed children. In the Philadelphia study, researchers check their 200 children every six months. All the children come from poor innercity neighborhoods with similar family backgrounds. Researchers assess their general development, language ability, attention and intelligence. The average IQ of the cocaineexposed children at 4 years of age was 79. For children in the control group, it was virtually the same: an average of 81.9. The average IQ in the United States ranges from 90 to 109. These findings underscore the importance in childhood development of the early years from birth to the start of school, the researchers point out. Meanwhile, they worry that cocaine babies will be stigmatized as they enter the school system. One of the first women to sign on to the Philadelphia study was Geraldine Young, who was high on crack cocaine when her son David was born on Sept. 14, 1989. The boy lived with a foster family for 3 1/2 years, until Young completed a drug rehabilitation program. She said that when she was in the drug recovery program, a speaker told her and the other women that even if their children were born with all their parts intact, not to rest assured. They were warned that the cocaine would "alter our children's learning ability, that they would be slower than the other kids." Philadelphia's Hurt is troubled by such generalizations about cocaineexposed children. She said she worries that teachers, and even parents, won't invest as much energy in a child whom they perceive as braindamaged or hopelessly behind. "Our fear is that these children won't be given a fair chance," she said. Susan FitzGerald is a journalist who spent a year with the Kaiser Family Foundation's media fellowship program studying child health issues. _ Copyright 1997 The Washington Post Company