`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