(5 of 6)
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.