The 4-year-old girl in teacher Vicky Ferrera's preschool class had made remarkable progress, the high point of her year being when she learned to tie her shoes. Mastering that task, which her pals asked her to help them with, made the little girl proud.
Then, in one week, her class took a field trip, went to an assembly and entertained a visitor. To most 4-year-olds, the disruptions would have been easy to handle, even fun.
Not a Trivial Incident
But the deviation from routine so doused the 4-year-old's self-confidence that she suddenly forgot how to tie her shoes. She re-established the skill only after Ferrera taught her how to do it again.
Though the incident may seem trivial, it is not in Ferrera's South-Central classroom, where such small matters are part of a bigger concern for the Los Angeles Unified School District, public educators and health experts nationwide. They all are beginning to deal with the emergence of a generation of children, like Ferrera's student, who are known simply as "drug babies."
These youngsters have been the focus of intense media scrutiny, which has etched into the public consciousness images of infants wailing in hospital cribs as they suffer the effects of their mothers' abuse of alcohol, cocaine, phencyclidine (PCP) and other substances.
But what has been less publicized is that as the drug babies have grown--many now are reaching school age--their presence is prompting questions and concerns about their future in society.
Though studies still are under way, drug babies already have surprised experts by displaying a wider than expected range of academic abilities. This, in turn, has underscored to some researchers the importance that childrens' environment may have on their development.
Experts also are unsure just how many drug babies there are, though they caution that contrary to some public perceptions, the youngsters are not just the offspring of minority group members and the poor.
In Los Angeles, the school district has taken the unusual--and, in some quarters, controversial--step of housing some drug babies, now ages 4 and 5, in three special classrooms in two inner city schools.
There, teachers like Ferrera are trying to identify instructional techniques to help get the drug babies back into regular classrooms as soon as possible.
The Los Angeles experiment began in March with one room at the Sophia T. Salvin School, an elementary school for handicapped children near downtown. This year, the program has been expanded to two classrooms at Salvin with a total of 10 students now and capacity for 16; there also is one room at another, regular elementary school in South-Central Los Angeles. To avoid stigmatizing the children and their parents, the district has declined to identify the second school.
Officials developed the special program at least partly in response to a perception by inner-city teachers and school psychologists that there are so many drug babies in the district that some elementary schools have at least one such child in almost every classroom. They are thought to be enrolled citywide, from Watts to the San Fernando Valley.
Not all experts agree with the district's policy of isolating the youngsters in an experimental program. "I don't really know of any data that would support that," said Dr. Stephen Kandall, a drug baby expert at New York's Beth Israel Hospital.
He said studies thus far suggest that most drug babies will grow up and learn normally or nearly normally: "Most of the studies seem reasonably optimistic, taking into account the negative (physiological) effects. I think these children will end up closer to the mainstream, if the environment at the home level is reasonably intact."
Ferrera said it is too early in the school year to predict whether youngsters in the district program, who will be old enough, will be ready for first grade next fall.
Los Angeles is not alone in facing a daunting challenge of educating drug children. New York, Miami, Detroit and Philadelphia also can expect large numbers of drug babies to enroll in their schools, said Dr. Coryl Jones, a research psychologist at the National Institute on Drug Abuse.
Results of Studies
Based on their studies, experts now believe this about the developing drug babies:
* They seem to display a wider range of academic ability than first was anticipated. Dr. Ira Chasnoff, a prominent drug baby researcher at Northwestern University in Chicago, said he believes that their mothers' drug use will have widely varying effects on childrens' intellectual and educational development; many will qualify for gifted classes, many will be in normal programs and some will be permanently impaired.
But he noted: "Most of these kids are going to end up in a regular school. They're going to end up in regular classrooms and with regular teachers. We're hoping that (with early intervention), nothing special will be needed for them."
* They are not supplying answers to a crucial, long-term question about their physical and mental health, as well as their educational achievement: Which is more damaging to the child--the physiologic damage from drug exposure or the harm of being raised in the social environment of drug abuse?
There is good evidence that environment plays the more significant role, say some experts, including Chasnoff and Dr. Rachelle Tyler, a UCLA pediatrician, Los Angeles school district physician and researcher.
Chasnoff said the arrival of drug babies in school systems has developed into enough of a trend nationally that school districts should start examining ways to deal with such children if they are not already doing so. He said a seminar that will focus on drug baby issues for educators has been scheduled mid-November in Los Angeles.
Tyler and other experts said recent emphasis on drug baby issues has tended to foster erroneous beliefs, including the generalization that such children are born exclusively to mothers who are poor or minority group members. Issues raised by the recent wave of drug babies also are not entirely new, Tyler noted, adding that mothers long have abused alcohol and raised children. Also, "since the 1960s, people have been using a pretty wide variety of drugs," she said.
"Drug babies are everywhere ," she said. "They're going to be in private schools and in middle class areas. Cocaine, for instance, is a drug that everybody aspired to and has been widely used."
Both Tyler and Chasnoff are involved in long-term studies of dozens of drug babies. UCLA is following 40 youngsters born to poor women using PCP; they are being compared from birth to age 2 with 25 youngsters born at the same hospital to drug-free women.
The more ambitious Northwestern study is tracking 200 youngsters, now age 3, who were identified before birth as potential drug babies. Chasnoff said researchers in Chicago hope to follow the children as they enter schools.
"We're following some kids who were exposed to drugs but were adopted and are now being raised in middle-class, stable, drug-free homes," he said, noting it will be "interesting" to see if the children have similar behavioral disorders as those raised in their original homes.
Tyler, Chasnoff and other experts and researchers warn against making sweeping generalizations or drawing hard conclusions about drug babies.
How Many Exist
For one thing, despite the intense media attention, there still is no reliable estimate of how many of the children exist.
And though some drug baby phenomena, like fetal alcohol syndrome, lend themselves to diagnosis after birth, the effects on a school-age child of many other types of drug exposure cannot be confirmed with certainty without accurate information on substances a mother may have taken and when she took them when during her pregnancy.
Chasnoff recently released a survey-based study concluding that an average of 11% of births in just 44 hospitals were to women who were using drugs. Based on that data, he estimates 375,000 drug babies may be born each year and believes the true nationwide figure may be higher.
But in a telephone interview last week, he noted it would be irresponsible to suggest any figures for the number of children with a drug background.
Chasnoff and other experts emphasize that drug babies are far from a cohesive group. Their strengths and shortcomings can be expected to vary widely depending on what drugs, the amounts and when their mothers took the substances during pregnancy; alcohol, methadone, heroin, marijuana, PCP and cocaine have widely varying effects on the fetus.
Dr. Carolyn Reid-Green, a Los Angeles drug baby researcher, observed: "To me the variables are--what types of substance did the mother take? How much did she take? When did she take it? We just can't have a catchall called drug-exposed babies and have that category encompass all of the various possible scenarios."
Dr. Leila Beckwith, a UCLA pediatrics professor involved in the on-going study of 65 youngsters, agreed. Because the children in her study group had mothers who abused PCP (they appeared to be intoxicated at delivery), experts expect the youngsters will experience some problems, probably similar to those other researchers say affect the most severely affected children as they approach school age.
"In general, in terms of development scores, our children are within the normal range but low," Beckwith said, adding the children do not seem to be able to follow normal sequences in events.
"At 18 months, instead of putting the spoon in the cup, stirring and then drinking, they simply pick up the cup and drop it," she said. "Their vocalization and language is very limited and sort of atypical.
"When they reach school age, we do think their language will be limited, and we expect that will make for difficulty in learning to read and write. We do think there will be difficulties in achievement motivation."
Though her expectations are pessimistic, she and other experts agreed it is difficult--impossible, perhaps--to differentiate drug babies from children with other, more traditional learning disorders.
Many children in the special Los Angeles drug baby classes would not have been targeted for help if district officials had not known of their mothers' drug use, said Valerie Wallace, a psychologist working with the program.
She said children in the program exhibit shortcomings in their fine motor coordination. They may have trouble with clumsiness or may revert to staring at times. They have a harder time organizing tasks, concentrating and problem solving. They cannot tolerate interruption of classroom routine.
Kids of Mothers Who Used Drugs: Images, Reality
Public perception of drug babies has been limited to memorable images of wailing infants suffering effects of mothers' substance abuse in hospital wards, above.
But the less-publicized reality is that the generation of children whose mothers used drugs is approaching school age. Experts are unsure how many drug babies there may be. It also is hard to discern what drug-related learning disabilities children may suffer without knowing what substances their mothers took (such as the PCP-user at right). Studies have shown drug babies display a wider than expected range of academic abilities. This has underscored the importance environment plays in children's development.