UNEXPECTED FINDING ON BABIES AND DRUGS

A long-running study of children whose mothers used cocaine during
pregnancy suggests that poverty may have a bigger impact on their mental
development than exposure to drugs in the womb.

Since 1989, researchers at Albert Einstein Medical Center in Philadelphia
have been tracking the neurological development of 200 children from some
of the city's poorest neighborhoods, half of them exposed to cocaine and
half not.

So far, the researchers have turned up no evidence of a devastating cocaine
effect.

But they have made a disturbing finding: Both groups of children, whether
exposed to cocaine or not, are as a whole lagging behind.

"We went looking for something about cocaine," said Hallam Hurt, who is
chairwoman of Einstein's neonatology department and heads the study. "What
we found was a far more massive, devastating problem of the inner-city child."

Hurt and her team have come to see their drug study as a window on the many
stresses facing poor, urban children - regardless of whether their mothers
ever abused drugs.

A decade ago, many experts were predicting that cocaine would do
irreparable damage to babies, but Hurt said her team's findings are instead
showing "how bad poverty can be."

Although some other studies have found subtle effects in children exposed
to cocaine, the Einstein researchers have found, in assessments done every
6 to 12 months, no significant differences between their two groups.

At age 4, for instance, the average IQ of the children exposed to cocaine
in the study was 79, well below the average of 90 to 109 for that age group
in the United States. But the average IQ for the control group's
4-year-olds was barely better at 81.9.

And when the children were tested at age 6 for such school-readiness skills
as arithmetic and letter and word recognition, more than 25 percent from
each group scored in the abnormal range. As it turned out, nearly one out
of every five of the children in the study had to repeat first grade or was
placed in special education.

"No matter what the effects of cocaine are, we know from this cohort that
the inner-city child faces enormous challenges," said Hurt, who is to
present her team's latest findings in May at a meeting of the Pediatric
Academic Societies and the American Academy of Pediatrics.

Violence is beginning to emerge as a big factor in the children's lives.

Hurt's team will report that an evaluation of 113 of the children at age 7
found that 74 percent had heard gunshots, 19 percent had seen a dead body
outside, and 60 percent worried that they might get killed or otherwise die.

Those children who were found to have "high exposure" to violence were not
doing as well in school, were absent more often, had lower self-esteem, and
showed more signs of depression and anxiety than those children who had
"low exposure."

"It is overwhelming to think that a child goes to school with that in their
repertoire of life experiences," Hurt said.

When hospital nurseries began filling up in the late 1980s with babies born
to cocaine addicts, the issue of so-called "crack babies" quickly became
contentious. No one disputed that the drug could trigger premature labor,
and babies born too soon and too tiny are at risk of a lifetime of medical
and developmental problems. But what was not known was whether cocaine
exposure in utero had long-term consequences for neurological development.

Initially, nurses and doctors reported the babies seemed agitated and oddly
aloof. And a flurry of small, often poorly designed, studies prompted some
experts to predict that so-called crack babies were destined for problems.

Animal studies also pointed to trouble ahead. Some policymakers, alarmed by
the reports, suggested that women using cocaine should be forced to give up
their babies - and perhaps be thrown in jail.

Since then, research has presented a murkier picture.

Although Hurt's study, which until recently was funded by the National
Institute on Drug Abuse, has turned up no ill effects, she said she
believed "the question is still open."

"We have no way closed the door on there being subtle differences" that
could affect learning, she said.

Also, children growing up in homes where parents abuse drugs are likely to
have chaotic lives. "We are finding that [a mother's] continued drug use
appears to be compromising the child's development," Hurt said.

"None of us would argue that a mother's drug use is not a sign of a child,
or family, at risk who should receive additional support or services," said
Deborah Frank, a pediatrician at Boston University who has been tracking
170 children for more than eight years. "But that's different from saying
cocaine is an instrument of catastrophic impairment."

Her team found that the best predictor of verbal IQ at age 4 was not
whether the child had been exposed to cocaine in the womb but whether the
child was in preschool or a program such as Head Start. The findings, she
said, speak "against any assumption of hopelessness for these kids."

She and other researchers also are beginning to differentiate between
babies born to heavy or light cocaine users. Using ultrasound exams, Frank
has found that babies of heavy users are more likely to have tiny
hemorrhages in the brain at birth, although she does not know the long-term
effects.

Gale Richardson, a researcher at the University of Pittsburgh who has been
tracking more than 400 children for about a decade, said her data point to
more behavior problems at age 7 and more attention problems among children
exposed to cocaine.

"The findings we have and other people have are subtle," she said, "but
they do have implications for the long-term functioning of the child."

All the children in the Einstein study were born at the hospital in North
Philadelphia, and most still live nearby.

When the study was started in 1989, about one of six babies born in city
nurseries had mothers who used cocaine. One of those women, Sharon Murray,
arrived at Einstein in labor in July that year after a night spent smoking
crack.

"When she came out, I saw she had 10 fingers, 10 toes; I figured it might
be OK," said Murray, whose daughter, Haniyyah, is part of the Einstein study.

Murray said she went right back to smoking crack and eventually landed in
jail. Released in 1997, she took her daughter and enrolled in Gaudenzia
House, a drug-rehabilitation program in West Chester. She now works there.

Like all children in the Einstein study, Haniyyah has undergone regular
evaluation for intellectual, behavioral and social development. Murray said
her daughter, now in fourth grade, is a C student and gets tutoring in
reading.

But one of Murray's nagging worries is that as her daughter gets older,
she, too, might take up drugs. So she talks openly with her about the dangers.

"Mom was in jail," she tells her, "and all that came about because Mommy
was using drugs. If Mommy wasn't using, she wouldn't do the things that led
to jail."

Karen Robinson, whose daughter, Karlene, is in the study, remembers crying
as she lay in the Einstein labor room in January 1990, a fetal monitor
measuring her baby's heartbeat. She had made a halfhearted attempt to give
up cocaine while pregnant.

"When I had her, I just cried," Robinson recalled, "because I thought:
'Would she have all her limbs? Would she come out retarded?' "

Karlene seemed fine, and Robinson took her home.

"As soon as I got to my mother's house, I gave the baby to her and left and
got high," Robinson said.

About 10 months later, she checked into the detox unit at Eagleville
Hospital in Montgomery County. She has been clean ever since.

And despite Robinson's early fears, Karlene is thriving. She earns straight
A's, shares her mother's love of reading, and plans to attend Girls High
School.

"I want to be a judge or lawyer," Karlene says.

She is one of the children whom the Einstein researchers call "high
achievers." In one paper, they posed this question: What is it that has
made these children succeed?

Once again, the study defied stereotypes. Looking at 32 children with IQs
of 90 or above, it found that those who were exposed to cocaine in the womb
and those who weren't were equally represented.

The achievers, however, were found to have two things in common: They were
all being reared in stimulating, nurturing home environments, and they all
had positive interactions with their caregivers.