THE TRUTH ABOUT CRACK/COCAINE AND CHILDREN
Mary Bellis (Waller) Williams, Ph.D.
The crack epidemic is no longer in the news, but adult use has NOT decreased since the 1990s, and cocaine use among adults has remained constant. This means that there are tens of thousands of children born every year in the US who have been exposed to crack or cocaine during pregnancy.
Research by Stanwood et al. (2001) shows that when the fetal brain is exposed to cocaine in the first and second trimesters, the development of the prefrontal cortex is harmed in several ways. The prefrontal cortex is the area of the brain just behind the forehead, and it is called the "executive function" of the brain, since it governs decision-making, self-control, judgment, and problem-solving (Duncan, 2000). Damage to this part of the brain leads to the behaviors that are typical of "crack babies" as they grow up and enter school (and, unfortunately, as they are entering prisons). These behaviors include: lack of self-control, failure to understand cause and effect, sudden mood swings, violent behavior, inappropriate social behavior, inability to recognize patterns, inability to learn by watching, no conscience, and no remorse. There are also typical learning and memory problems (Sprenger, 1999).
These problems are NOT caused by lack of discipline, poor parenting, by poor teachers, or by permissiveness. They are caused by brain damage.
Because there is no recognized label for drug-affected children, like Fetal Alcohol Effect (FAE) and Fetal Alcohol Syndrome (FAS), schools typically label them ADD, ADHD, BD, LD, or ED. Most are "mainstreamed" into regular classrooms, where they are unable to benefit from instruction or the good examples of other children. Even when they are placed into special education classrooms, the techniques used in those classrooms are generally inappropriate and ineffective, because the deficits of the crack and cocaine children are so unusual and their deficits are also masked by their behavior problems.
With the rise in methamphetamine manufacture and use, we can expect these behaviors to increase in classrooms. Children exposed during pregnancy to methamphetamines ("crank", "ice", "crystal meth") have behaviors identical to those of children exposed to crack and cocaine. Since these are all strong stimulants, it is likely that methamphetamines are also harming the formation and development of the prefrontal cortex just as cocaine does.
Basically, the affected children are unable to learn by watching or by example. This means that demonstrations, like science demos, don’t teach them. This means they don’t learn to play games with other children. This means they are not capable of representational play (Rodning, et. al, 1991). Affected children also don’t recognize social cues, like facial expressions or body language. They don’t appear to have a context within which to evaluate them. Carter (1998) states that myelinization (maturation of the covering of the nerves) of the prefrontal lobes starts at about 18 months, and that self-consciousness begins at that time. She suggests that an internal sense of "I" starts in the prefrontal cortex in normal children. We know that this is the site of damage caused by exposure to cocaine.
Lack of conscience and remorse is a major problem among children and youth exposed to cocaine and/or crack in utero. The building blocks of conscience and remorse are empathy and an understanding of cause and effect and also are lodged in the damaged prefrontal cortex.
Effective teaching and parenting with crack and cocaine affected children require using very counter-intuitive methods. The effective methods require direct instruction, even of social interactions and games, what facial expressions mean, and how to themselves make the appropriate expressions (Waller, 1993).
Since these children are overwhelmed by normal stimuli, their ideal learning setting must be a very low-stimulus one, where they can be presented with only one task at a time, and where the physical setting does not flood them with input. Contrast this with the rich, busy, interesting environments we know work best with most children! A normal child will eagerly explore a number of activities in a full classroom environment, not overstimulating herself, able to make choices about what to explore and how long, and about how to interact with the materials or other children. Unfortunately, children with prefrontal cortex damage are unable to make these choices. They are overwhelmed by the presence of so much, and are unable to benefit from the experience, often losing control of their behavior, throwing the materials around, or misusing materials.
The Salvin Special Education School in Los Angeles was the first place to institute intervention classrooms for crack/cocaine affected children in 1988. They served preschoolers, and found that in a low-stimulus setting, with all activities routinized, the children did well. Unfortunately, budget constraints in Los Angeles forced the closing of the school in the early 1990s.
Inclusion of crack and cocaine affected children is a terrible and unfair burden upon the children themselves. Instead of being helped, they are placed into an environment that guarantees their failure, and disrupts the other children, who are prevented from learning by the interruptions and mood swings of the affected childre. This further frustrates the teacher, who spends most of his time making sure the classroom remains safe and conducive to learning.
These behaviors are NOT outgrown, instead they manifest themselves in different ways depending upon the age of the children. Infants’ tantrums may annoy, but will not disrupt a classroom. Toddlers’ hitting may hurt, but the same uncontrolled and sudden violence by a teen with a weapon, may kill.
Preliminary research in Wisconsin indicates that as the crack and cocaine affected children grow, they are ending up in disproportionate numbers in residential treatment programs, mental health centers, reform schools and prisons. Of course, these youngsters have not received appropriate schooling. They have not been taught cause and effect, appropriate social interaction, or self-control. Effective teaching of affected children is basically a training model until the children internalize the lessons, begin walking themselves through decision-making, and incorporate the appropriate actions and thought patterns into their daily lives.
The head of a reform school for teenage boys has checked over the social service records for family history, and says that 90 percent of the boys sentenced there over the past 3 years were born to crack and/or cocaine users. Since nationally only about 5% of fetuses are exposed to crack or cocaine, and half of those are females, the figure of 90% is shocking – as much for the failure of society to act and help them, as for the violence of their acts (Waller, 2003).
Research reported in The American School Board Journal (Waller, 2003) shows by age the types of behaviors typical of crack and cocaine-affected children, as babies, preschoolers, and school-age children (ages 5 – 17):
Traits of Prenatally Drug-Affected Children, by age
A total of 49 teachers, caregivers, and social workers, with constant contact with 281 children and youth who were born crack and cocaine users, reported on those behaviors.
As the children’s ages increased, the frequency of most anti-social and/or dangerous behaviors increased. These behaviors include violence, inappropriate social behavior, hyperactivity, learning problems, lying and stealing, showing no conscience or remorse, isolation from others, tough and gaze aversion, impulsivity, repeating painful behaviors, and not understanding cause and effect. These measures showed actual increases toward the older group.
We have changing expectations for children as they grow older. For example, it’s inappropriate to speak of a toddler to lies and steals – fantasy and taking things they want are just part of their development. But here we see mood swings and temper tantrums for ALL the children, a sure disruption of a classroom or home.
Learning and memory problems begin to move up the list for 3- and 4-year-olds. Many children of this age are in Head Start, early learning programs, and day care, with trained teachers who can recognize problems with cognition.
Note the change in traits as the children reach school age. Many are unable to meet higher social and academic expectations. They have not progressed in moral reasoning. They are still unable to grasp cause-and-effect and logical consequences (which has an effect on any school discipline system). Many of the behaviors that are not alarming in toddlers are considered serious anti-social behaviors in older children and youth.
Mary Bellis (Waller) Williams, Ph.D.
The crack epidemic is no longer in the news, but adult use has NOT decreased since the 1990s, and cocaine use among adults has remained constant. This means that there are tens of thousands of children born every year in the US who have been exposed to crack or cocaine during pregnancy.
Research by Stanwood et al. (2001) shows that when the fetal brain is exposed to cocaine in the first and second trimesters, the development of the prefrontal cortex is harmed in several ways. The prefrontal cortex is the area of the brain just behind the forehead, and it is called the "executive function" of the brain, since it governs decision-making, self-control, judgment, and problem-solving (Duncan, 2000). Damage to this part of the brain leads to the behaviors that are typical of "crack babies" as they grow up and enter school (and, unfortunately, as they are entering prisons). These behaviors include: lack of self-control, failure to understand cause and effect, sudden mood swings, violent behavior, inappropriate social behavior, inability to recognize patterns, inability to learn by watching, no conscience, and no remorse. There are also typical learning and memory problems (Sprenger, 1999).
These problems are NOT caused by lack of discipline, poor parenting, by poor teachers, or by permissiveness. They are caused by brain damage.
Because there is no recognized label for drug-affected children, like Fetal Alcohol Effect (FAE) and Fetal Alcohol Syndrome (FAS), schools typically label them ADD, ADHD, BD, LD, or ED. Most are "mainstreamed" into regular classrooms, where they are unable to benefit from instruction or the good examples of other children. Even when they are placed into special education classrooms, the techniques used in those classrooms are generally inappropriate and ineffective, because the deficits of the crack and cocaine children are so unusual and their deficits are also masked by their behavior problems.
With the rise in methamphetamine manufacture and use, we can expect these behaviors to increase in classrooms. Children exposed during pregnancy to methamphetamines ("crank", "ice", "crystal meth") have behaviors identical to those of children exposed to crack and cocaine. Since these are all strong stimulants, it is likely that methamphetamines are also harming the formation and development of the prefrontal cortex just as cocaine does.
Basically, the affected children are unable to learn by watching or by example. This means that demonstrations, like science demos, don’t teach them. This means they don’t learn to play games with other children. This means they are not capable of representational play (Rodning, et. al, 1991). Affected children also don’t recognize social cues, like facial expressions or body language. They don’t appear to have a context within which to evaluate them. Carter (1998) states that myelinization (maturation of the covering of the nerves) of the prefrontal lobes starts at about 18 months, and that self-consciousness begins at that time. She suggests that an internal sense of "I" starts in the prefrontal cortex in normal children. We know that this is the site of damage caused by exposure to cocaine.
Lack of conscience and remorse is a major problem among children and youth exposed to cocaine and/or crack in utero. The building blocks of conscience and remorse are empathy and an understanding of cause and effect and also are lodged in the damaged prefrontal cortex.
Effective teaching and parenting with crack and cocaine affected children require using very counter-intuitive methods. The effective methods require direct instruction, even of social interactions and games, what facial expressions mean, and how to themselves make the appropriate expressions (Waller, 1993).
Since these children are overwhelmed by normal stimuli, their ideal learning setting must be a very low-stimulus one, where they can be presented with only one task at a time, and where the physical setting does not flood them with input. Contrast this with the rich, busy, interesting environments we know work best with most children! A normal child will eagerly explore a number of activities in a full classroom environment, not overstimulating herself, able to make choices about what to explore and how long, and about how to interact with the materials or other children. Unfortunately, children with prefrontal cortex damage are unable to make these choices. They are overwhelmed by the presence of so much, and are unable to benefit from the experience, often losing control of their behavior, throwing the materials around, or misusing materials.
The Salvin Special Education School in Los Angeles was the first place to institute intervention classrooms for crack/cocaine affected children in 1988. They served preschoolers, and found that in a low-stimulus setting, with all activities routinized, the children did well. Unfortunately, budget constraints in Los Angeles forced the closing of the school in the early 1990s.
Inclusion of crack and cocaine affected children is a terrible and unfair burden upon the children themselves. Instead of being helped, they are placed into an environment that guarantees their failure, and disrupts the other children, who are prevented from learning by the interruptions and mood swings of the affected childre. This further frustrates the teacher, who spends most of his time making sure the classroom remains safe and conducive to learning.
These behaviors are NOT outgrown, instead they manifest themselves in different ways depending upon the age of the children. Infants’ tantrums may annoy, but will not disrupt a classroom. Toddlers’ hitting may hurt, but the same uncontrolled and sudden violence by a teen with a weapon, may kill.
Preliminary research in Wisconsin indicates that as the crack and cocaine affected children grow, they are ending up in disproportionate numbers in residential treatment programs, mental health centers, reform schools and prisons. Of course, these youngsters have not received appropriate schooling. They have not been taught cause and effect, appropriate social interaction, or self-control. Effective teaching of affected children is basically a training model until the children internalize the lessons, begin walking themselves through decision-making, and incorporate the appropriate actions and thought patterns into their daily lives.
The head of a reform school for teenage boys has checked over the social service records for family history, and says that 90 percent of the boys sentenced there over the past 3 years were born to crack and/or cocaine users. Since nationally only about 5% of fetuses are exposed to crack or cocaine, and half of those are females, the figure of 90% is shocking – as much for the failure of society to act and help them, as for the violence of their acts (Waller, 2003).
Research reported in The American School Board Journal (Waller, 2003) shows by age the types of behaviors typical of crack and cocaine-affected children, as babies, preschoolers, and school-age children (ages 5 – 17):
Traits of Prenatally Drug-Affected Children, by age
A total of 49 teachers, caregivers, and social workers, with constant contact with 281 children and youth who were born crack and cocaine users, reported on those behaviors.
As the children’s ages increased, the frequency of most anti-social and/or dangerous behaviors increased. These behaviors include violence, inappropriate social behavior, hyperactivity, learning problems, lying and stealing, showing no conscience or remorse, isolation from others, tough and gaze aversion, impulsivity, repeating painful behaviors, and not understanding cause and effect. These measures showed actual increases toward the older group.
We have changing expectations for children as they grow older. For example, it’s inappropriate to speak of a toddler to lies and steals – fantasy and taking things they want are just part of their development. But here we see mood swings and temper tantrums for ALL the children, a sure disruption of a classroom or home.
Learning and memory problems begin to move up the list for 3- and 4-year-olds. Many children of this age are in Head Start, early learning programs, and day care, with trained teachers who can recognize problems with cognition.
Note the change in traits as the children reach school age. Many are unable to meet higher social and academic expectations. They have not progressed in moral reasoning. They are still unable to grasp cause-and-effect and logical consequences (which has an effect on any school discipline system). Many of the behaviors that are not alarming in toddlers are considered serious anti-social behaviors in older children and youth.
All ages |
3-4 years |
5-17 years |
Behavior |
86% |
100% |
92% |
Temper tantrums |
82% |
86% |
100% |
Hyperactive |
82% |
71% |
100% |
Learning problems |
78% |
86% |
100% |
Impulsive |
73% |
100% |
92% |
Sudden Mood Swings |
73% |
71% |
100% |
Inappropriate social behavior |
69% |
42% |
77% |
Averse to eye contact |
65% |
86% |
77% |
Doesn’t understand consequences |
65% |
57% |
85% |
Doesn’t understand cause and effect |
63% |
57% |
62% |
Averse to touch |
59% |
57% |
62% |
Seldom smiles |
59% |
28% |
62% |
Clumsy |
59% |
71% |
69% |
Memory problems |
57% |
57% |
31% |
Late talking |
55% |
57% |
62% |
Isolated from others |
53% |
57% |
31% |
Needs little sleep |
51% |
42% |
85% |
Lying |
51% |
57% |
69% |
No remorse |
43% |
42% |
62% |
No conscience |
43% |
28% |
54% |
Repeats painful behavior |
43% |
14% |
23% |
Late walking |
39% |
42% |
15% |
Late toilet training |
39% |
42% |
62% |
Violent |
37% |
71% |
46% |
Doesn’t understand nonverbal cues (smile and frowns) |
37% |
14% |
54% |
Stealing |
35% |
42% |
31% |
Unfriendly |
It is important to note that many prenatally drug-affected children are not raised by their drug-using parents. Many are adopted at birth. Many are fostered from birth in competent, loving, and experienced foster homes. Love does not solve these problems.
There were also statistically significant differences between the 3- and 4-year-olds and the school age group, toward the older group. These differences were in hyperactivity, learning problems, lying, impulsivity, stealing, not understanding cause and effect, inappropriate social behaviors, clumsiness, repeating painful behaviors, and gaze aversion.
What Does This Mean?
If we can generalize from this study, the continued use of crack, cocaine, and methamphetamine, means that—without interventions—the children affected by prenatal exposure are behaving in ways that are anti-social, dangerous, and isolating. Their lack of judgment and social abilities also means that they are unlikely to have friends and will be more likely to engage in criminal behavior.
Without conscience and remorse, many affected children are growing up to be sociopaths, a danger to themselves and others. An overwhelming number of commitments of youth to prisons, residential treatment centers, and mental hospitals are of children whose brains have been harmed by pre-natal exposure to these drugs.
What Can Schools Do?
Schools must recognize that there is an organic cause for the violent and disruptive behaviors of many children in the classroom, and that there are effective interventions that can normalize the behavior of the affected children.
The best intervention classroom is a special low-stimulus classroom, with a small group of children, taught by a specially trained teacher. This kind of classroom is actually more cost-effective than the usual high-stimulus classroom environment we have been taught is best for all children. In fact, the rich environments are sabotaging efforts of prenatally drug-affected children to attend and to learn.
Using the Behavior Frequency Scale (BFS) (Waller & Waller, 1994) will identify for the schools the children who will benefit from this intervention classroom. Because the intervention classroom is designed to correct the reasoning and behavior deficits, it is unlikely that any child would need to spend more than a year or two in the special classroom. This is far more cost-effective than putting affected children into special education and being labeled emotionally disturbed or behaviorally disordered and keeping them there for their entire school career.
We have a choice: we can continue to do nothing effective, putting the blame on teachers for the outrageous and/or dangerous behaviors of affected children, or we can decide to provide an appropriate intervention which will normalize the behaviors of the children and get them back into regular classrooms, equipped to benefit from them and not disrupt them, and give them a chance at a normal life.
It costs about $50,000 a year to keep a child or youth in a juvenile justice facility, and far more to keep a child in a mental health center. The average cost for a year in a special education classroom is approximately $12,000. Intervention classrooms for drug-affected children ideally have 5 – 8 students, typical for special education classrooms. There is less cost per classroom because it is a low-stimulus classroom and doesn’t have as many materials, equipment, decorations, etc. in it. Most of the children will be in the intervention setting 1 to 2 years, not for their entire school lives, further lowering the cost.
Of course, untreated youths will continue to offend and are already entering adult prisons for real crimes for which they have no remorse.
Teachers can learn the specific intervention techniques that work with affected children, and school districts must provide that training and help. Do the schools have the courage to act?
References
Carter, Rita (1998). Mapping the Mind. University of California Press, Berkeley, CA. pp. 22-23.
Duncan, John (2000). A neural basis for general intelligence. Science.
Rodning, C., L. Beckwith, and J. Howard (1991). Spontaneous play and the development of young children. Identifying the Needs of Drug-Affected Children: Public Policy Issues. OSAP Prevention Monograph – 11. Rockville, MD: U.S. Dept. of Health and Human Services, Public Health Service, Alcohol, Drug Abuse, and Mental Health Administration: 87-92.
Sprenger, Marilee (1999) Learning and Memory: The Brain in Action. Association for Supervision and Curriculum Development: Alexandria, VA. Pp. 47-56.
Stanwood, Gregg, Washington, Ricardo, and Levitt, Pat. Identification of a Sensitive period of Prenatal Cocaine Exposure that Alters the Development of the Anterior Cingulate Cortex, Cerebral Cortex, May 2001; 11:430-440, 1047-3211.
Waller, Mary Bellis (1993). Crack Affected Children: A Teacher’s Guide. Newbury Park, CA: Corwin Press.
Waller, Mary Bellis (1994). Crack Babies Grow up. The American School Board Journal. July.
Waller, Mary Bellis (2003). Preliminary research: What’s happening to crack babies as they grow up? A study of prisons, residential treatment centers, and mental hospitals.
Waller, Michael I., and Waller, Mary B. (1993). The Behavior Frequency Scale. M&M Publications. Milwaukee.
There were also statistically significant differences between the 3- and 4-year-olds and the school age group, toward the older group. These differences were in hyperactivity, learning problems, lying, impulsivity, stealing, not understanding cause and effect, inappropriate social behaviors, clumsiness, repeating painful behaviors, and gaze aversion.
What Does This Mean?
If we can generalize from this study, the continued use of crack, cocaine, and methamphetamine, means that—without interventions—the children affected by prenatal exposure are behaving in ways that are anti-social, dangerous, and isolating. Their lack of judgment and social abilities also means that they are unlikely to have friends and will be more likely to engage in criminal behavior.
Without conscience and remorse, many affected children are growing up to be sociopaths, a danger to themselves and others. An overwhelming number of commitments of youth to prisons, residential treatment centers, and mental hospitals are of children whose brains have been harmed by pre-natal exposure to these drugs.
What Can Schools Do?
Schools must recognize that there is an organic cause for the violent and disruptive behaviors of many children in the classroom, and that there are effective interventions that can normalize the behavior of the affected children.
The best intervention classroom is a special low-stimulus classroom, with a small group of children, taught by a specially trained teacher. This kind of classroom is actually more cost-effective than the usual high-stimulus classroom environment we have been taught is best for all children. In fact, the rich environments are sabotaging efforts of prenatally drug-affected children to attend and to learn.
Using the Behavior Frequency Scale (BFS) (Waller & Waller, 1994) will identify for the schools the children who will benefit from this intervention classroom. Because the intervention classroom is designed to correct the reasoning and behavior deficits, it is unlikely that any child would need to spend more than a year or two in the special classroom. This is far more cost-effective than putting affected children into special education and being labeled emotionally disturbed or behaviorally disordered and keeping them there for their entire school career.
We have a choice: we can continue to do nothing effective, putting the blame on teachers for the outrageous and/or dangerous behaviors of affected children, or we can decide to provide an appropriate intervention which will normalize the behaviors of the children and get them back into regular classrooms, equipped to benefit from them and not disrupt them, and give them a chance at a normal life.
It costs about $50,000 a year to keep a child or youth in a juvenile justice facility, and far more to keep a child in a mental health center. The average cost for a year in a special education classroom is approximately $12,000. Intervention classrooms for drug-affected children ideally have 5 – 8 students, typical for special education classrooms. There is less cost per classroom because it is a low-stimulus classroom and doesn’t have as many materials, equipment, decorations, etc. in it. Most of the children will be in the intervention setting 1 to 2 years, not for their entire school lives, further lowering the cost.
Of course, untreated youths will continue to offend and are already entering adult prisons for real crimes for which they have no remorse.
Teachers can learn the specific intervention techniques that work with affected children, and school districts must provide that training and help. Do the schools have the courage to act?
References
Carter, Rita (1998). Mapping the Mind. University of California Press, Berkeley, CA. pp. 22-23.
Duncan, John (2000). A neural basis for general intelligence. Science.
Rodning, C., L. Beckwith, and J. Howard (1991). Spontaneous play and the development of young children. Identifying the Needs of Drug-Affected Children: Public Policy Issues. OSAP Prevention Monograph – 11. Rockville, MD: U.S. Dept. of Health and Human Services, Public Health Service, Alcohol, Drug Abuse, and Mental Health Administration: 87-92.
Sprenger, Marilee (1999) Learning and Memory: The Brain in Action. Association for Supervision and Curriculum Development: Alexandria, VA. Pp. 47-56.
Stanwood, Gregg, Washington, Ricardo, and Levitt, Pat. Identification of a Sensitive period of Prenatal Cocaine Exposure that Alters the Development of the Anterior Cingulate Cortex, Cerebral Cortex, May 2001; 11:430-440, 1047-3211.
Waller, Mary Bellis (1993). Crack Affected Children: A Teacher’s Guide. Newbury Park, CA: Corwin Press.
Waller, Mary Bellis (1994). Crack Babies Grow up. The American School Board Journal. July.
Waller, Mary Bellis (2003). Preliminary research: What’s happening to crack babies as they grow up? A study of prisons, residential treatment centers, and mental hospitals.
Waller, Michael I., and Waller, Mary B. (1993). The Behavior Frequency Scale. M&M Publications. Milwaukee.