Prenatal Drug Exposure

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Faces of Prenatal Drug and Alcohol Exposure
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Prenatal Drug Exposure

• Identification
• Implications
• Intervention

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Prevalence in foster care

• No studies in Texas have definitively concluded
  the percentage of children coming into care with
  family history of substance abuse.
• Anecdotal evidence suggests 50 to 85
• Seasoned case workers and judges will say 99 to
  100

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Two issues raised

• Special needs of the child coming into care
  these kids will never be typical
• Special needs of the parent the Department is
  working with chances are they were not
  typical have limitations that cannot be
  overcome limitations that can be managed

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These children enter care with two risk factors

• Removal
• contributing to emotional and mental health
  issues, academic struggle (or failure),
  dramatically increased risk of referral to
  juvenile probation in the future. (they will
  engage in socially unacceptable, violent,
  delinquent behavior)
• 2. Prenatal or Environmental Substance Abuse
  Exposure
• prenatal exposure to or abuse of legal,
  prescription, illegal drugs or alcohol
• living in an environment created by a caretakers
  use of legal, prescription, illegal drugs or
  alcohol (physical abuse, sexual abuse, neglect,
  chaos, instability, insecurity food, housing,
  material goods, erratic school attendance

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Two variables impact long term outcomes

• Biological (nature) neurological differences or
  health issues
• Environmental (nurture) living arrangement,
  services provided, academic setting, emotional
  and mental health supports

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Growth Issues Infant/Toddler

• Only 25 born with obvious problems
• Low birth weight
• Small head circumference
• Small stature
• Little body fat
• Dysmorphic features
• By school age many of these kids catch up

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Developmental Issues Infant/Toddler

• Hypersensitive
• Sensory integration disorder
• Inability to transition
• Hyperactivity
• Poor sleep patterns
• Poor feeding patterns
• No catching up for these issues

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Developmental Issues Preschool

• Poor self regulation
• Easily over stimulated(or under stimulated)
• Easily distracted
• Low tolerance for frustration
• Short attention span

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Developmental Issues School Age

• High risk for ADHD/ADD
• Impulsive
• Distractible
• Over active
• Organizational difficulty
• Learning difficulties

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Biology of Behavior (Nature)

• Exposure to cocaine, methamphetamine, and other
  drugs causes chemical changes in brain
• Pre-frontal cortex is impacted
• Ability to regulate behavior is effected
• Genetics

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Impact of Environment on Behavior (Nurture)Birth
Family Factors

• Home environment of addict
• Chaotic
• No structure
• Lack of stability
• Erratic schedule
• Exposure to strangers
• All contrary to needs of any child
• Especially contrary to needs of drug exposed child

• Drug addiction effects on women
• Weak or nonexistent social network
• Abusive male relationships
• Mental health issues
• Poor parenting skills
• Result in inability to parent any child
• Even harder to parent drug exposed child

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Impact of Environment on Behavior
(Nurture)Removal Issues

• Separation and loss
• Developmental delays and regression
• Academic regression
• Emotional delays
• Behavior disorders

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Counteracting Risk with Protective
Interventions(Impacting the Nurture)

• Family is strongest predictor of success
• Early intervention critical
• Address childs issues globally
• Within the context of history of child (birth
  family to date)
• Long term coordinated services
• Services for entire family raising child

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Prenatal Alcohol Exposure FAS/FAE/FASD

• Consuming while pregnant
• The leading cause of preventable mental
  retardation in the U.S.
• Estimated that 50 of the children available for
  adoption have verifiable prenatal alcohol
  exposure
• The only commonly abused substance known to cause
  birth defects
• A neurobehavioral teratogen an agent that can
  cause defects in the structure and function of
  the developing central nervous system in humans.

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Prenatal Alcohol Exposure

• Results in
• Head circumference below third percentile
• Developmental delays
• Poor impulse control
• Inconsistent knowledge base
• Difficulty grasping abstract concepts

• Speech/language disorders
• Perception, sensory integration, and tactile
  defensiveness issues
• Hyperactivity
• Learning disabilities
• Distractibility

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Prenatal Alcohol Exposure

• Why is it so widespread?
• Women who use drugs or smoke cigarettes are more
  likely to drink alcohol
• Women who abuse drugs may not be aware of a
  pregnancy for several months
• Women in the U.S. are still told by obstetricians
  that a small amount of alcohol will not harm
  their unborn child

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Prenatal Alcohol Exposure

• Long-term Outcomes for Children
• According to one study
• 23 were confined to a mental hospital
• 15 were confined to a drug treatment program
  and
• 35 were confined to a correctional system.
• We dont know how many became involved in the
  child welfare system Streissguth, 1996
• However
• Children studied most often remained in substance
  abusing families
• Children taken into care may have more positive
  outcomes

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Intervention Strategies for the Drug Exposed Child

• We have learned
• Health issues and growth deficiencies eventually
  resolve
• Behavioral issues remain a significant concern

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Intervention Strategies for the Drug Exposed Child

• Is it just a kid being a kid?
• Look for
• Relationships being harmed (with peers,
  teachers, family)
• Is learning compromised
• Is performance impacted
• Is it prenatal exposure or ADHD?

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Intervention Strategies for the Drug Exposed Child

• Types of behavior issues
• Withdrawn behaviors
• Overactive behaviors
• Combination behaviors

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Intervention Strategies for the Drug Exposed Child

• Common Strategies
• safe, stable, attentive home environment
• supportive, trained adults
• predictable, consistent atmosphere
• modify physical environment for child
• teach child to modify environment
• identify specific academic challenges

• develop individualized approach to academic needs
• teach child to craft their own approach
• self advocacy
• global strategies for life
• careful drug therapies
• diet
• sleep

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Characteristics of Birth Mother of the Drug
Exposed Child

• Likely drug and alcohol exposed
• Lacking in organizational/processing skills
• Probably has co-occurring disorders
• Possibly presents very convincingly
• May never be able to parent safely
• May be doing her best

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Intervention Strategies for Birth Mother of the
Drug Exposed Child

• Recognize what she is living with
• Help her write everything down
• Provide her with calendar and pen
• Help her make phone calls for appointments
• Remind her of appointments
• Remember how important she will always be to her
  children

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Where do we go from here?

• Develop new strategies for dealing with families
  and children with challenges contrary to the
  framework of traditional solutions
• Adults and children with co-occurring
  disorders, with prenatal drug exposure, who may
  never be successfully independent
• Community supports for families
• Share information and knowledge
• Encourage prevention activities beginning in
  elementary schools and continuing throughout
  child bearing years

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References

• Childrens Research Triangle, Dr. Ira Chasnoff,
  www.childstudy.org
• Fetal Alcohol Syndrome Diagnostic and Prevention
  Network, University of Washington, Seattle,
  http//depts.washington.edu/fasdpn/
• National Center on Substance Abuse and Child
  Welfare, www.ncsacw.samhsa.gov
• National Organization on Fetal Alcohol Syndrome,
  www.nofas.org
• Texas Partnership for Family Recovery,
  www.dshs.state.tx.us/sa/txpartnership/print.shtm
  contact Judy Brow, Judy.Brow_at_dshs.state.tx.us
• Zero to Three, www.zerotothree.org

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• Carole Hurley, J.D.
• Hurley Consulting
• 512-345-4095
• churley_at_austin.rr.com