ADDICTION SHADOWS CRACK-EXPOSED KIDS

From the moment Brandon and Bianca Martin were born nearly eight years ago,
they have struggled against the lingering effects of their biological
mother's addiction to crack cocaine.

The twins endured the shuddering torture of withdrawal from the drug when
they were just weeks old. Within a few years, according to their adoptive
parents, the children showed signs of being unable to focus their attention
or control their anger, sometimes lashing out by peeling off the wallpaper
in their suburban Chicago home and tearing it to shreds.

Although the siblings have grown to become bright, even gifted kids, they
require counseling and medication to curb temper tantrums that give their
parents increasing anxiety as Brandon and Bianca approach adolescence.

"When they go to sleep, sometimes I look at them and just cry, because it's
not their fault," said the twins' adoptive mother, Janet Martin.

The Martins' concerns are shared by hundreds of thousands of other families
with children who were exposed to cocaine prenatally--the so-called crack
babies who first gained notoriety as the crack epidemic hit in the late
1980s. Scientific uncertainty--and controversy-- has surrounded the young
victims, from early fears that they had suffered extensive brain damage to
claims in the early 1990s that cocaine has few lasting effects on infants.

Those conclusions are being revised again with a new wave of reports on
some of the oldest crack-exposed children.

The research gives hard evidence for what the Martins had already guessed,
that early doses of cocaine can change the developing brain in small yet
significant ways that affect behavior and self-control more than intelligence.

Good homes and early intervention such as Brandon and Bianca received can
go a long way toward fixing those problems, experts say. Yet the research
forecasts more challenges ahead for cocaine-exposed kids from disadvantaged
backgrounds, including ominous hints from animal studies that prenatal
exposure could make the children more vulnerable to cocaine addiction.

"Many of these kids are at risk for a double hit from their drug exposure
and the environments where they grow up," said Dr. Barry Kosofsky, a
professor of neurology at Harvard Medical School, who studies the brain
areas most affected by cocaine.

It has taken researchers a decade to accumulate enough data on
crack-exposed children to start distinguishing the drug's influence from
the effects of upbringing. Factors such as poor access to health care,
continued drug abuse by the children's parents and the likelihood that
birth mothers abused alcohol or other drugs besides cocaine make diagnosing
the precise source of an individual's problems virtually impossible.

The big picture is getting clearer, however. One of the oldest studies on
the long-term effects of cocaine on children is being conducted by Dr. Ira
Chasnoff, director of the Chicago-based Child Study Center and professor of
pediatrics at the University of Illinois at Chicago Medical Center.
Chasnoff recently finished analyzing data tracking nearly 100
cocaine-exposed kids from birth to six years--the most extensive such
report to date.

His results, published in the current issue of the Annals of the New York
Academy of Sciences, challenge the notion that cocaine significantly
impairs IQ or general cognitive ability--a hypothesis that Chasnoff himself
entertained in the late 1980s. The best predictor of high IQ for children
was a supportive home environment.

Yet children exposed to cocaine on average are more anxious and aggressive
and show more delinquent behavior, notwithstanding their situation at home,
according to Chasnoff.

"Even among the children who were adopted, we're seeing more behavioral
problems," Chasnoff said.

Janet Martin and her husband Robert got a glimpse of those effects the
first night they took Brandon and Bianca home as foster parents. Unaware
that their nine-month-old babies had crack in their histories, Janet and
Robert panicked when the children started having violent convulsions that
woke them up several times during the night.

"Their eyes would be wide open, but you couldn't get a reaction," Janet
said. "We'd never dealt with drug-exposed babies before, and here we were
with two of them."

The twins' birth mother would later tell Janet that she had been smoking
crack on the day she went into labor, having no recollection that she
delivered the infants.

The window for gravest harm from cocaine and other drugs begins around six
weeks after conception, as the tissue templates that guide brain
development are being laid down. Biologists try to get a more detailed look
at the effect of cocaine on the growing brain by giving the drug to mouse,
rabbit or monkey embryos, effectively producing "crack baby" animals.

Cocaine acts primarily on a substance in the brain called dopamine, a
neurotransmitter that ferries chemical signals from one part of the brain
to another. Dopamine is an essential part of the brain's reward circuitry,
helping produce the feelings of pleasure associated with eating, sex and
various forms of addiction.

Studies of pregnant rats have shown that the amount of cocaine in the fetal
brain may accumulate to 1 1/2 times the levels found in the mother's blood.
Recent research suggests that cocaine delivered in the womb may overload
and disconnect some of the developing brain cells that process dopamine
signals in proportion to the amount of cocaine present.

"If you alter these developmental patterns in the womb by drug exposure,
you can throw the whole thing off," said Harvard's Kosofsky. "Everything
that follows may be altered."

Experts are quick to point out that legal drugs such as alcohol and
nicotine can produce far more drastic effects than cocaine, lowering birth
weight and sometimes causing severe physical deformities. But the damage
cocaine seems to inflict on the developing neural reward system could have
especially wide-ranging consequences later in a child's life.

Studies in the last two years have demonstrated that rats who were
administered cocaine as fetuses are more prone to repeatedly push a bar
that sends the drug into their bloodstream than animals who did not get the
drug early on.

Researchers such as Chasnoff and Kosofsky also believe it's harder for
children who had cocaine exposure to make appropriate mental connections
between actions and their consequences. They may not respond to traditional
forms of discipline because the brain pathways that motivate most children
to avoid unpleasant consequences don't work properly.

That's the theory. In practice, it's impossible to reduce a complex
individual such as Brandon Martin to the sum of his neurotransmitters.

A child of clear intelligence, Brandon is ebullient and boisterous compared
to his shy yet bright twin sister. He brings an irrepressible energy to
everything he does, whether it's counting the number of hoops he makes with
his back-yard basketball set or rattling off his favorite dinosaur species.

"The teacher said I'm the smartest kid in the class," Brandon says
matter-of-factly.

"She told him, God forbid," his mother murmurs. "Brandon is as close to a
genius as I've seen in a child. But when he gets angry, it's scary."

The change usually comes in the afternoon, as the Ritalin Brandon takes for
hyperactivity begins to wear off.

He starts to run and hop, frantically drumming his thighs with his palms.
His eyebrows turn down and his nose wrinkles, as if from a bad smell.

Janet Martin tells harrowing stories of days and weeks when Brandon or
Bianca have had to come off their medicine. At those times, the slightest
provocation can bring tantrums in which the children rip apart mattresses,
VCRs or entire bathrooms.

"You ask Brandon why he does it, and he always says the same thing," Janet
Martin said. "He says, `I didn't want to do it, I don't know why I did it.' "

In many ways the children of the crack epidemic now have more reason for
hope than ever.

Advancing knowledge about the dopamine receptors that get unhinged by
prenatal cocaine are giving scientists such as Kosofksy hints about the
kinds of drugs that could counteract those effects.

Such treatment would be especially welcome because children with cocaine
exposure show less response to drugs such as Ritalin than kids with
attention deficit disorder.

Researchers also are striving to formulate therapies and discipline plans
that fit the special needs of cocaine-exposed children.

"We have to get more creative," said Amy Anson, a clinical psychologist who
works with Chasnoff. "We have to help these kids understand how they can
push themselves to do things they don't know they can do and give them the
rewards until the capacity is built in. You can build that capacity, you
really can."

Janet Martin has witnessed the possibility of change in her children's
lives, starting the first time they slept through the night without
convulsions or seizures. She has faith that the tantrums and restlessness
also will end.

"I pray for that change daily," she said. "I pray that one day they'll wake
up and won't need their medicine, and that Brandon will go to college.
Prayer is a constant thing in this house."

Checked-by: Mike Gogulski