Substance
Exposed Infants and ChildrenERIC EC Digest #E505
Nov. 1991
Author: Diana Pinkerton
How Many Children
Are Substance Exposed in Utero?
According to a study conducted
by the National Association for Perinatal Addiction Research and Education,
an estimated 375,000 newborns per year face serious health hazards due to their
mother's prenatal drug use. It is estimated that 11 to 15% of the babies born
in the United States today were exposed in utero to alcohol and/or other illicit
drugs (Poulsen, 1991). The problems associated with prenatal substance abuse
are increasing and has serious implications for the future educational needs
of the children and families affected. Services, programs, and strategies that
have been developed in the field of special education will have a role to play
in meeting their needs. What Techniques Can Be
Used to Promote Interaction in Substance Exposed Infants? Parent/caregiver education
is essential for an effective, comprehensive early intervention program. Specific
techniques to increase periods of alertness and promote infant-caregiver interaction
include positioning to improve posture and movement patterns, swaddling and
rocking, tactile stimulation of facial and oral areas, and slow gentle movements.
Sidelying, prone positioning, and carrying in a flexed position are preferred
for positioning and handling. Slow rhythmical input may be effective in calming
an infant. When infants are calm, they can be held in a face to face position
to encourage visual tracking, vocalization, and playful interaction with their
caregiver. Initially, this interaction may be brief because the infant may become
over-stimulated. Caregivers need to take cues from the infant during interaction
and respond appropriately by reducing stimuli or introducing calming techniques.
(Schneider et al., 1989). What Are the Educational
Implications for Substance Exposed Children? In order to work effectively
with young children prenatally exposed to drugs and/or alcohol in the preschool
setting, educators must recognize the vulnerabilities arising from both biological
and environmental risk factors. They must also recognize the children's strengths
and the ways in which they are like typical children. Appropriate intervention
strategies must be selected based on the systematic application of what is known
about successful early intervention. The Los Angeles Unified School District
has developed a document that summarizes successful classroom strategies (Cole,
Ferrara et al., 1990). They divide the strategies into two areas: protective
classroom factors and facilitative classroom processes. Protective factors to
be built into a classroom - Curricula should be developmentally
appropriate and promote experiential learning, interaction, exploration, and
play in a context that is interesting and relevant.
- Play: Adults must actively
facilitate children's play activities by helping them extend the complexity
and duration of such activities.
- Rules: The setting should
be one in which the number of rules specifically told to the children is limited.
- Observation and assessment:
Assessment should be made during play, at transition time, and while a child
is engaged in self-help activities.
- Flexible room environment:
The setting should allow materials and equipment to be removed to reduce stimuli
or added to enrich the activity.
- Transition time plans:
Transition should be seen as an activity in and of itself with a beginning,
middle, and end.
- Adult/child ratio: There
should be enough adults to promote attachment, predictability, nurturing,
and ongoing assistance in learning appropriate coping styles.
- These guidelines are
appropriate for all preschool classrooms. Most young children prenatally exposed
to drugs and/or alcohol can be served in regular preschool settings.
Facilitative processes
to be built into a classroom
- Attachment: A major goal
for each child is to develop an attachment to one of the adults in the classroom.
- Respect: Adults must
respect children's work and play space.
- Feelings: Feelings are
real and legitimate; children behave and misbehave for a reason, even if adults
cannot figure it out.
- Mutual discussion: Talking
about behavior and feelings, with empathy not judgment, can validate the child's
experiences and set up an accepting atmosphere.
- Role Model: Teachers
need to model behavior that is appropriate for children to imitate.
- Peer sensitivity: Until
children experience having their own needs met repeatedly and consistently,
they will not become aware of the needs and feelings of others.
- Decision making: Teachers
need to recognize the importance of allowing children to make decisions for
themselves and provide many opportunities for such decision making.
- Home-school partnership:
Establishing a close working relationship with the home as an essential part
of the curriculum, strengthens the positive interaction between child and
family and increases parental confidence and competency.
- Transdisciplinary model:
The activities of all the professionals concerned with the child and family
should be coordinated.
The strategies identified
as facilitative processes shape educational personnel's interaction with children
and families on a daily basis. They are designed to counteract or help children
cope with stressful life events they may be experiencing. In addition, the strategies
are designed to provide children support in coping with any neurodevelopmental
behaviors that impede their learning and classroom performance. These strategies
can be combined with teaching techniques of using play as a learning activity
and providing individualized and small-group guidance to assist children in
mastering new skills (Vincent et al., 1991). What Planning Is Required
for Future Needs? School boards need to prepare
for the arrival of drug-exposed children in the schools by considering future
funding needs, involving administrators and other school personnel, and supporting
appropriate classroom programs (Rist, 1990). Transdisciplinary/transagency
approaches to program development are necessary to provide for the varied needs
of children and families affected by substance exposure. A variety of services
may be needed by these families including specialized medical care, family therapy,
home health care, early intervention services, mental health services, and vocational
services. References Cole, C., Ferrara, V., Johnson,
D., Jones, M., Schoenbaum, M., Tyler, R., Wallace, V., & Poulsen, M. (1991).
Today's challenge: Teaching Strategies for working with young children pre-natally
exposed to drugs/alcohol. Los Angeles, CA: Los Angeles Unified School District.
Rist, M. C. (1990). The
shadow children. American School Board Journal. 177(1), 18-24. (EJ402318) Schneider, J., Griffith,
D., & Chasnoff, I. (1989). Infants exposed to cocaine in utero: Implications
for developmental assessment and intervention. Infants and Young Children. 2(1),
25-36. (EJ396632) Poulsen, M. (1991). Schools
meet the challenge: Educational needs of children at risk due to substance exposure.
Sacramento: Resources in Special Education. Vincent, L., Poulsen, M., Cole,
C., Woodruff, G., & Griffith, D. (1991). Born substance exposed, educationally
vulnerable. Reston, VA: The Council for Exceptional Children. Resources Cocaine Hotline
1.800.COCAINE Cocaine Baby Help Line
Northwestern Hospital
Chicago, IL 60611
800.638.2229 National Association for
Perinatal Addiction Research and Education
11 E. Hubbard Street, Suite 200
Chicago, IL 60611
312.329.2512 March of Dimes Birth Defects
Foundation
1275 Mamaroneck Avenue
New York, NY 10605
914.428.7100 National Center for Clinical
Infant Programs
733 15th Street, NW, Suite 912
Washington, DC 20005
202.347.0308 National Clearinghouse
for Alcohol and Drug Information (NCADI)
PO Box 2345
Rockville, MD 20852
301.468.2600
ERIC Digests are in the
public domain and may be freely reproduced and disseminated, but please acknowledge
your source. This publication was prepared with funding from the U.S. Department
of Education, Office of Educational Research and Improvement, under contract
no. RI93002005. The opinions expressed in this report do not necessarily reflect
the positions or policies of OERI or the Department of Education. The
ERIC Clearinghouse on Disabilities and Gifted Education (ERIC EC)
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