TIME: Almanac 1993/TIME Almanac 1993.iso/time/051391/0513130.000

Text File | 1992-08-28 | 17.9 KB | 384 lines

                                                                                HEALTH, Page 56

COVER STORIES

Innocent Victims


Damaged by the drugs their mothers took, crack kids will face
social and educational hurdles and must count on society's
compassion

By ANASTASIA TOUFEXIS -- Reported by Mary Cronin/New York,
Melissa Ludtke/Boston and James Willwerth/Los Angeles


    AT A HOSPITAL IN BOSTON lies a baby girl who was born
before her time -- three months early, weighing less than 3 lbs.
Her tiny body is entangled in a maze of wires and tubes that
monitor her vital signs and bring her food and medicine. Every
so often she shakes uncontrollably for a few moments -- a legacy
of the nerve-system damage that occurred when she suffered a
shortfall of blood and oxygen just before birth. Between these
seizures, she is unusually quiet and lethargic, lying on her
side with one arm draped across her chest and the other bent to
touch her face, sleeping day and night in the comfort of her
cushioned warming table. At best, it will be three or four
months before she is well enough to leave the hospital, and even
then she may continue to shake from time to time.



    AT A THERAPY CENTER IN NEW YORK CITY, the saddest child
brought in one morning is three-year-old Felicia, a small bundle
of bones in a pink dress, whose plastic hearing aids keep
falling off, tangling with her gold earrings. She is deaf, and
doctors are not sure how much she can see. She functions at the
capacity of a four-month-old. Like a rag doll, she can neither
sit nor stand by herself: her trunk is too weak and her legs are
too stiff. A therapist massages and bends the little girl's
legs, trying to make her relax. Next year her foster mother will
put Felicia in a special school full time in hopes that the
child can at least learn how to feed herself.



    AT A SPECIAL KINDERGARTEN CLASS IN THE LOS ANGELES AREA,
a five-year-old named Billie seems the picture of perfect health
and disposition. As a tape recorder plays soothing music in the
background, he and the teacher read alphabet cards. Suddenly
Billie's face clouds over. For no apparent reason, he throws the
cards down on the floor and shuts off the tape recorder. He sits
in the chair, stony faced. "Was the music going too fast?" the
teacher asks. Billie starts to say something, but then looks
away, frowning. The teacher tries to get the lesson back on
track, but Billie is quickly distracted by another child's
antics. Within seconds, he is off his chair and running around.



    These children have very different problems and prospects,
but they all have one thing in common: their mothers repeatedly
took crack cocaine, often in combination with other drugs,
during pregnancy. That makes them part of a tragic generation
of American youngsters -- a generation unfairly branded by some
as "children of the damned" or a "biologic underclass." More
often, they are simply called crack kids. A few have severe
physical deformities from which they will never recover. In
others the damage can be more subtle, showing up as behavioral
aberrations that may sabotage their schooling and social
development. Many of these children look and act like other
kids, but their early exposure to cocaine makes them less able
to overcome negative influences like a disruptive family life.

    The first large group of these children was born in the
mid-1980s, when hundreds of thousands of women began to get
hooked on the cheap, smokable form of cocaine known as crack.
The youngsters have run up huge bills for medical treatment and
other care. Now the oldest are reaching school age, and they are
sure to put enormous strain on an educational system that is
already overburdened and underachieving.

    Their plight inspires both pity and fear. Pity that they
are the innocent victims of society's ills. Pity that the odds
will be stacked against them at home, on the playground and in
school. Fear that they will grow into an unmanageable multitude
of disturbed and disruptive youth. Fear that they will be a lost
generation.

    The dimensions of the tragedy are staggering. According to
the National Association for Perinatal Addiction Research and
Education (NAPARE), about 1 out of every 10 newborns in the U.S.
-- 375,000 a year -- is exposed in the womb to one or more
illicit drugs. The most frequent ingredient in the mix is
cocaine. In major cities such as New York, Los Angeles, Detroit
and Washington many hospitals report that the percentage of
newborns showing the effects of drugs is 20% or even higher.

    The cost of dealing with these children is rapidly
escalating. In California drug-exposed babies, many of whom are
born prematurely, stay in the hospital almost five times as long
as normal newborns (nine days, vs. two days) and their care is
13 times as expensive ($6,900, vs. $522). And that is only the
beginning, since many of the crack kids are placed in foster
care. In New York City annual placements of drug-affected babies
run to 3,500, compared with 750 before the spread of crack. That
brings the city's foster-care tab to about $795 million (up from
$320 million in 1985). The New York State comptroller's office
expects that New York City will spend $765 million over the next
10 years on special education for crack kids.

    Among the most visible victims are black and other
minority children born into crack-plagued ghettos. It is bad
enough that the drug assaults children in the womb, but the
injury is too often compounded after birth by an environment of
neglect, poverty and violence. "I sometimes believe that babies
are better protected before they are born than they are after,"
says Dr. Barry Zuckerman, head of the division of developmental
and behavioral pediatrics at Boston City Hospital.

    Even after they give birth to drug-impaired children, many
mothers go right on smoking crack. Melinda East, a former crack
addict now in treatment in Long Beach, Calif., supported her
habit as an often barefoot street prostitute. Her first baby was
born with "the shakes," she says, but that did not turn her
away from crack. She remembers selling milk and Pampers back to
the grocery store for drug money.

    Local governments often take crack kids away from still
addicted mothers, but that does not guarantee stability for
troubled children. Charlie, a five-year-old Los Angeles-area boy
with severe behavioral problems, went through three foster
homes before an elderly couple became his guardians. He seems
to be making prog ress, but his prospects appear limited. He
sometimes erupts into frenzied episodes of thrashing about,
pulling his hair, biting and banging his head against a wall.

    While poor, black ghetto children have attracted the most
attention, they are far from being the only members of the crack
generation. Cocaine abuse is common among members of the white
upper and middle classes, but it is hidden better. Their babies
are usually born at private hospitals that rarely ask mothers
about drug use or screen them and their children for illegal
chemicals. A 1989 Florida study found similar rates of drug use
among pregnant white and black women of equal socioeconomic
status, but only 1% of white abusers were reported to
authorities, compared with nearly 11% of blacks.

    Billie, the kindergartner, is a white child whose mother
was addicted to crack, among other drugs. Soon after birth,
Billie was whisked away from her and given to wealthy adoptive
parents. Growing up in a stable environment, however, has not
prevented him from being kicked out of four preschools for
disorganized, rowdy behavior. Only when he started at this new
school, where his teachers are trained to handle drug-exposed
children, did he begin to calm down.

    The crack kids are not the first children to be devastated
by drugs while their mothers were pregnant. For many years, the
unborn have been exposed to opiates, barbiturates, inhaled
cocaine and a panoply of other drugs. And fetal alcohol
syndrome, brought on by drinking during pregnancy, is believed
to be a leading cause of mental retardation in the young.

    But the coming of crack made a bad situation worse. This
readily available, easily ingested chemical has lured far more
women into addiction than any other hard drug has. By the latest
estimates, more than 1 million U.S. women use cocaine. Moreover,
crack has spurred the use of other drugs. Women who take cocaine
are likely to use heroin to prolong a high, then tranquilizers
and alcohol to come down. They may indulge in marijuana, PCP
and amphetamines. As a result, many crack babies steep in a
stew of drugs while in the womb.



    AN UNCERTAIN FUTURE

    How badly are they damaged? In most cases, no one knows
for sure. The question has sparked a fierce debate among
doctors, social workers, educators and law-enforcement
specialists. On one side are those who fear that most of the
children are irredeemably harmed; on the other are those who
firmly believe that with enough early treatment for babies and
their mothers and special education, the large majority of crack
kids can lead normal lives.

    Among those who think the damage may be permanent is Kathy
Kutschka, a director at the Speech and Language Development
Center in Buena Park, Calif. Her department works with 45 crack
kids, up to kindergarten age. When she observes them having
trouble sitting in a chair or picking up a pencil, she despairs
for their future. "Of the children we see," says Kutschka,
"none will be able to function in a normal life-style without
some kind of sheltered living arrangement."

    An increasing number of medical experts, however,
vehemently challenge the notion that most crack kids are doomed.
In fact, they detest the term crack kids, charging that it
unfairly brands the children and puts them all into a single
dismal category. From this point of view, crack has become a
convenient explanation for problems that are mainly caused by
a bad environment. When a kindergartner from a broken home in
an impoverished neighborhood misbehaves or seems slow, teachers
may wrongly assume that crack is the chief reason, when other
factors, like poor nutrition, are far more important.

    Even when crack is responsible, the situation is rarely
hopeless. "This is not a lost generation," says pediatrician
Evelyn Davis of Harlem Hospital in New York City. "These
children are not monsters. They are salvageable, capable of
loving, of making good attachments. Yes, they present problems
that we have not dealt with before, but they can be taught."



    THE COST OF COMPASSION

    Help is possible if society will pay the price -- a very
big "if" in these days of tight budgets. Will taxpayers foot
the bill to provide the best treatment and schooling to all the
crack kids? In Boston a year of special education for a
drug-exposed child can cost $13,000, compared with $5,000 spent
per youngster at a regular school.

    Experts agree that the most vital first step in helping
crack kids is to get their mothers off the drug, preferably
before birth. Yet only 11% of pregnant addicts get into
treatment. Many detox programs do not accept the women because
they are not equipped to deal with prenatal medical needs. And
very few programs are designed to help drug-dependent women who
already have children.

    The failure to spend more money for early rehabilitation
of crack addicts and their babies may be a social and financial
disaster in the long run. Contends T. Berry Brazelton, the
noted Harvard pediatrician: "If we worked with these infants
from the first, it would cost us one-tenth or one-hundredth as
much as it will cost us later. To educate them, to keep them
off the streets, to keep them in prisons will cost us billions."



    WHAT THE DRUG DOES

    Cocaine causes blood vessels to constrict, thus reducing
the vital flow of oxygen and other nutrients. Because fetal
cells multiply swiftly in the first months, an embryo deprived
of a proper blood supply by a mother's early and continuous use
of cocaine is "dealt a small deck," says Zuckerman of Boston
City Hospital.

    Such babies look quite normal but are undersized, and the
circumference of their heads tends to be unusually small, a
trait associated with lower IQ scores. "Only the most intensive
care after birth will give these babies a chance, but many won't
receive it," Zuckerman points out.

    Occasionally, heavy maternal cocaine use during the later
months of pregnancy can lead to an embolism, or clot, that
lodges in a fetal vessel and completely disrupts the blood
supply to an organ or limb. The result: a shriveled arm or leg,
a missing section of intestine or kidney, or other deformities.
Such glaring defects, however, are extremely rare.

    Cocaine exposure affects brain chemistry as well. The drug
alters the action of neurotransmitters, the messengers that
travel between nerve cells and help control a person's mood and
responsiveness. Such changes may help explain the behavioral
aberrations, including impulsiveness and moodiness, seen in some
cocaine-exposed children as they mature.

    Ultrasound studies of 82 drug-exposed infants by
researchers at the University of California at San Diego
revealed that about a third have lesions in the brain, usually
in the deeper areas that govern learning and thinking. While a
similar percentage of babies who are ill but have not been
exposed to drugs have such lesions, only 5% of healthy newborns
do. The long-term significance of this finding is uncertain,
since the brain continues to develop during a baby's first year.
If there is damage, it may not surface until a child takes on
such complex tasks as learning to talk.

    At birth, cocaine babies generally perform poorly on tests
measuring their responsiveness. And at one month, some of the
infants still do not perform at the level of normal
two-day-olds. Cocaine-exposed babies are easily overstimulated.
When that happens, some turn fussy for a while and then doze
off; others tense up and squall for hours.

    Caring for such infants is frustrating. "You don't do
things that come naturally," notes Diane Carleson, a foster
mother in San Mateo, Calif. "The more you bounce them and coo
at them, the more they arch their backs to get away. Their poor
mothers want so badly to make contact, yet they are headed for
rejection unless they learn how not to overstimulate them."

    Doctors at Harlem Hospital studied 70 such toddlers just
under age 2 and found that almost all were slow in learning to
talk and that more than half had impaired motor and social
skills. An inability to distinguish between mothers and
strangers is another hallmark of crack-exposed youngsters.

    As the children reach school age, it becomes more
difficult to separate the impact of drugs from the effects of
upbringing and other influences. Yet many teachers think they
can see the lingering legacy of crack. Beverly Beauzethier, a
New York City kindergarten teacher, agonizes over some of her
pupils. "They have trouble retaining basic things. They are not
sure of colors or shapes or their names." Their behavior is also
out of the ordinary. "Some are passive and cry a lot; sometimes
they just sit in a heap in the corner," says Beauzethier. Even
worse, "they can be very aggressive with the other children so
that they are hard to stop, and I have to hold their arms," she
says. "This is very scary. We don't know a lot about handling
these children."



    HELPING HANDS

    Doctors and educators are only beginning to design the
programs needed to help the crack kids. One notable pilot
project is Zuckerman's Women and Infants Clinic at Boston City
Hospital, which uses what Zuckerman calls the "one-stop
shopping" technique. While pediatricians and child-development
experts work with babies, addicted mothers get help in kicking
their habits and learn how to care for their children. The first
eight babies in the program, tested at age 1, all fell within
the normal range on the Bayley scale of infant development; this
means they can play pat-a-cake, walk unassisted, jabber
expressively and turn pages in a book.

    One of the leading organizations working to help older
children is the Salvin Special Education Center in Los Angeles,
which conducted a three-year pilot program with 50 drug-exposed
kids, ages 3 to 5. Salvin's educators cite several elements of
a successful school program: small classes (eight pupils to one
teacher), fixed seat assignments and a rigid routine, and
protection from loud noises and other disturbing stimulation.
Activities are emphasized over paper-and-pencil exercises.
"We'll read a story and bring it to life with hand puppets,''
explains school psychologist Valerie Wallace. Generous warmth
and praise help youngsters achieve an emotional equilibrium. Of
all Salvin's drug-exposed children, more than half have been
able to transfer to regular school classes, with special
tutoring and counseling.

    Whether such success can be replicated on a large scale is
uncertain, but the evidence is encouraging. A study by Dr. Ira
Chasnoff and his staff at Chicago-based NAPARE followed 300
cocaine-exposed babies who, along with their mothers, received
intensive postnatal intervention. Of 90 children tested at age
3, 90% showed normal intelligence, 70% had no behavioral
problems, and 60% did not need speech therapy.

    That may be less than complete success, but considering
the horrible blow these children suffered before birth, it is
remarkable that so many can be helped so much. The studies
suggest that early intervention can give the children a fighting
chance of leading reasonably normal lives. Such a payback seems
more than enough to justify a far greater investment in
treatment and rehabilitation. Today's crack kids may be a
troubled generation, but they do not have to be a lost
generation -- unless society abandons them.