When Sondra was born, she had so much cocaine, morphine and heroin in her system that her body was wracked by spasms. Moments later, she suffered a stroke and lost all movement in her legs and left arm.
Seven years have passed, and Sondra is now a bubbly and attractive second-grader at 24th Street School in South-Central. Aside from the hour a day in which she receives help with math and reading, she is in regular classes and has no physical disabilities.
Occasionally, however, Sondra behaves strangely--bolstering her relatives' belief that she is still damaged by drugs.
"One time, when a social worker was over, (Sondra) walked in the room with a big knife, started waving it in big circles and told the social worker to get out of the house," said her grandmother, Julia Stackhouse, who was awarded custody of Sondra and her two older sisters, who were also prenatally exposed to drugs. "I was shocked because this was just bizarre behavior. This is not what a normal child would do."
As an increasing number of children exposed prenatally to drugs enter school, teachers throughout the nation are struggling to meet their complex needs. The problem is especially prevalent in Los Angeles County, where almost 3,000 children a year are exposed to drugs and alcohol while in the womb, according to the county Department of Children's Services. Nationwide, 750,000 substance-exposed babies are born each year, according to the National Assn. of Perinatal Addiction Research and Education.
Although the practice among many pregnant women of using drugs and alcohol is not new, the problem became startlingly evident a few years ago when the first large wave of children exposed to crack cocaine as infants entered kindergarten. Many of these children are now in the second and third grades, exhibiting signs of learning and behavioral problems that put them at a high risk of failure.
"We look at prenatal drug exposure as a risk factor, just like other things, including lack of health care, poverty and violence in the home," said Carol Cole, a teacher who works in the Los Angeles Unified School District's special education infant preschool department. "Some children don't come to our attention because they're doing fine, but others have more severe problems."
Although the Los Angeles school district does not keep track of how many prenatally drug-exposed students it enrolls, one indication that the number is growing is that the special education population is increasing at a far faster rate than the general student population. In April, 1986, the district enrolled 49,927 special education students. In April, 1993, that figure grew 23% to 65,062, while the district's total enrollment grew only 10% during the same period.
"There's a proliferation of young women taking drugs and having babies, and we're seeing an outgrowth of this," said Wayne Foglesong, a specialist in the district's information and technology division. "But the increase is also a result of many other factors," including the influx of immigrants who bring children with special education needs.
Prenatal drug exposure does not in itself qualify a student for special education, but many affected students are placed in special education because they are physically or mentally handicapped, emotionally disturbed or suffer learning disabilities. Although there is no such thing as a typical drug-exposed child, many display common symptoms, including hyperactivity, speech and language deficiencies, memory lapses, mood swings and attention problems.
Since 1986, researchers at the Chicago-based National Assn. for Perinatal Addiction Research and Education have been following the developmental progress of more than 286 drug-exposed children.
So far, the association has found that drugs do have an impact on a child's overall development, but that the child's home environment plays just as much of a role in determining how he or she will function, said Ira J. Chasnoff, president of the association. "Most kids with appropriate intervention can do fine," Chasnoff said. "But teachers need to be properly trained to learn how to work with these children."
Parents or guardians must also make adjustments.
After Sondra was born, Stackhouse and her husband agreed to take the infant and her two older siblings from their drug-addicted mother. Sondra's 8-year-old sister, Natasha, is severely learning-disabled and 20-year-old Roberta has had a long history of emotional problems. (The names of all children in this story have been changed to protect their privacy.)
Stackhouse, a marketing coordinator for Good Shepherd Home Health Agency in Glendale, said her 40-year-old daughter sees the girls, but only on occasion because she still uses drugs.
"She says she loves her children very much, but can't take care of them right now," Stackhouse said. "Whenever she is ready to see the children, she calls. But we don't push it."
Stackhouse's daughter, who lives in South-Central and has been in and out of drug treatment programs, has attended beautician school for the past three years, but is struggling to complete her course work.
"It was hard on me for all this to come into my life," said Stackhouse, who lost three of her four children to sickle cell anemia. "But I look at it as my second chance to help children take advantage of the help that's out there. I know they can overcome this with the proper care, guidance and love."
Indeed, Stackhouse believes that physical therapy, special education and counseling saved Sondra's life.
Because of Sondra's critical condition at birth, she was eligible to receive two years of medical care and therapy through the South Central Regional Center, a social services agency that helps pay for care for the developmentally disabled. She then attended the Salvin Special Education Center, a preschool-through-adult facility in South-Central, before moving on to 24th Street School.
"She couldn't move her arm and didn't walk until she was 2 years old," Stackhouse said. "But with therapy, she became mobile again. And with speech therapy, she learned how to talk. Without this help, I don't know where she would be now."
Natasha, who did not receive the sort of specialized therapy that Sondra got through the the South Central Regional Center, is now having a much more difficult time at school than her younger sister.
"Something is off in the brain," Stackhouse said of her three granddaughters. "They can live in a normal setting, but it has to be orderly and disciplined. If they get in the wrong hands, it will be chaos."
A third-grader at 36th Street School, Natasha will forget simple lessons learned the day before and tends to be more introverted and irritable than her younger sister.
"These are two girls with the same environment and two different outcomes," said Vicky Ferrara, who taught both girls at the Salvin Center. "Both girls are lovely and delightful, but (Sondra) is just at a much better point. Drugs tend to affect each child very differently."
Various new programs for drug-exposed children have sprung up at Los Angeles schools, but shrinking funds, increasing class sizes and a variety of other problems are threatening educators' attempts to service this high-risk population.
In 1986, the Los Angeles school district established a pilot program for prenatally drug-exposed 3- to 6-year-olds at the Salvin Center. The program became a model for educators throughout the country, but it was eliminated by budget cuts last fall.
And although a federal grant has allowed the Los Angeles school district to train teachers at seven children's centers to work with prenatally substance-exposed children, the district lost its federal funding for a program that trained primary-grade teachers to work with the same type of children. The program also involved high school students working with at-risk elementary students--many of whom were prenatally exposed to drugs or alcohol.
"I think regular education teachers are experiencing an increasingly frustrating problem of class sizes going up to 35 students, kids coming in with more high-risk factors and the district providing less support services," said Marci Schoenbaum, a Salvin teacher who participated in the program for drug-exposed children. "Teachers are throwing up their hands because they don't know what to do."
Although the Salvin program is officially over, Schoenbaum and teacher Mary Jones still have a few substance-exposed children in their preschool classes. The teachers say their main goal is to provide these students with a predictable, secure and stable environment so that they make successful transitions to a regular classroom or to a special education program.
During "circle time" in Jones' class, the children sing songs and clap their hands.
Eugene, whose mother took drugs while she was pregnant, reaches out to kiss Jones on the cheek. The 3-year-old has no physical deformities, but no words have ever come out of his mouth.
Other substance-exposed children in Jones' and Schoenbaum's classes have various problems. Paul cannot sit for more than a few minutes before he starts running around the room, and Anjetta has malformed eyes and a flat nose--both characteristics of fetal alcohol syndrome.
As part of their ongoing research on prenatally drug-exposed children, Schoenbaum, Ferrara and Jones have been tracking their former students and have found that 65% of them have developed learning disabilities and were placed in special education classes.
"At one point, everyone said, 'There's no hope for crack babies,' " Schoenbaum said. "Then, they said, 'Everything will be fine.' But I think it's somewhere in between."
Along with efforts initiated by the Los Angeles school district, the Los Angeles County Office of Education began a three-year project last fall to help Head Start teachers learn how to work with prenatally drug-exposed children and their families.
"Head Start families are now serving a different population than 25 years ago," said Beverly Morgan Sandoz, coordinator of the project. "Problems are more severe, so teachers need a different type of training."
County education officials also provide in-service training to school staff members who want to learn strategies to work with substance-exposed youngsters, but training is limited to slightly more than 100 people a year. Those who finish the program then serve as trainers to teachers at their schools.
Of the prenatally drug-exposed children born last year in Los Angeles County, 76% tested positive for cocaine, said Michael Durfee, who runs a county child abuse prevention program and compiles statistics on drug-exposed babies. The next most prevalent drug, not including alcohol, was marijuana, which was found in 14% of the affected newborns.
Although drug use cuts across all ethnic and socioeconomic lines, African-Americans have the most drug-exposed babies. Last year, African-Americans constituted 11.5% of all births in Los Angeles County, but 63% of the drug-exposed babies. Latinos made up 59% of all births and 22% of the drug-exposed infants, while whites made up 19% of the births and 14% of the affected babies. Asians constituted 8% of the births and less than 1% of the affected newborns.
At SHIELDS for Families Project, an organization trying to reduce the number of drug-exposed babies in South-Central, 73% of the clients are African-American. The agency, which is affiliated with the Martin Luther King Jr.-Drew Medical Center, offers counseling, treatment and educational programs to families affected by drug or child abuse.
Mary (not her real name), who used cocaine and drank alcohol while she was pregnant with her 2-year-old daughter, said the SHIELDS program helped her kick her drug habit and keep custody of her daughter. "At the time I was pregnant, I was so sick," she said. "I didn't know who the father was, and I didn't care if the baby came out with one arm because I wasn't going to keep her. But when I saw her in my arms, she was so beautiful. I knew I had to keep her.
"I'm not going to say she didn't have all those defects and jitters, because she did. But all I can say is 'I'm sorry,' and that I'm going to be there for my children."
Although Mary is determined to help her daughter overcome problems she may develop, many educators wonder what is going to happen to other substance-exposed children who do not receive proper care.
"How are these kids going to contribute to society?" Ferrara asks. "They may not be college-bound, but what are they going to do?"
Gerald Ivory, a Los Angeles County juvenile probation officer, worries that more prenatally substance-exposed youths will enter the criminal justice system unless society reaches out to them.
"When a kid is brought to my attention, I first ask about the mother's condition (when) she was pregnant, and whether she took drugs or alcohol," Ivory said. "All these things play a role in why they behave the way they do."
One stereotype that Ivory tries hard to fight is that substance-exposed children are damaged for life.
"Children with proper care and a proper environment can come out of this," he said. "But that's utopia. That's not always going to be the case.
On the Cover
Julia Stackhouse hugs her granddaughters, ages 7 and 8. Both girls, along with their 20-year-old sister, were prenatally exposed to drugs.
An estimated 3,000 prenatally substance-exposed children are born in Los Angeles County each year and, like Stackhouse's granddaughters, many need special care in school.
"I think with all the help, they will have a good chance to survive in the normal setting," Stackhouse said. "We've got a long road ahead, but we've got a good start."