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| |    Cocaine Effects: The Challenges Researchers Face by Robert Needlman, M.D., F.A.A.P. reviewed by Robert Needlman, M.D., F.A.A.P. Research into the effects of cocaine on babies and children has been going on for nearly 20 years. A huge number of researchers all over the United States have been involved. Everyone agrees that babies should not be exposed to cocaine either before birth or afterward. But in other respects, the scientists are less certain, because the research is very hard to do well. Understanding more about the research involved may help you to see beyond the frightening headlines about crack babies, to realize that cocaine is just a piece of a much bigger problem. How cocaine research is done Early reports about cocaine-exposed infants appeared in the mid-1980s. These accounts were terribly frightening: The babies had an extremely high risk of crib death, or SIDS, and as children, nearly all had severe behavioral problems. Later, more carefully done studies found that the risks were much less than originally reported, although still significant. A lot of the research has involved giving doses of cocaine to pregnant laboratory animals (mostly mice, rats, and sheep) and observing the effects on their offspring. This is done because humans are much more difficult to study, since it's hard to know exactly when a baby was exposed to cocaine, how much was involved, and what other substances (alcohol, cigarettes, other drugs) were taken along with it. (And, of course, many other factors influence how children grow and develop, such as the quality of care and education they receive and whether they are exposed to abuse, neglect, or violence.) Studies show that changing the amount given to the lab animals, or the timing of the dose, produces different results. Along with that information, detailed studies of the brains of exposed animals allow scientists to make educated guesses about what may be happening inside the brains of exposed infants. But animal research cannot substitute for actual studies of children. In order to pinpoint the effects of cocaine in children, researchers have to collect a great deal of information. For example, they need to know about the baby's interactions with the important people in her life (parents, siblings, child-care workers). What is the quality of the child's environment? Is there exposure to lead paint? Has the child witnessed domestic violence? Have there been disruptive moves and traumatic separations from mother, father, or other important adults? All of this information, and much more, must be collected over many years in order to find out how cocaine exposure before birth might affect a child's performance in, say, the third grade. What's more, studies of cocaine effects are only meaningful if they compare cocaine-exposed children to children growing up in similar situations who were not exposed to cocaine. So a study of 100 cocaine-exposed children might also have to involve another 100 comparison children. Take-home messages Given the hundreds of details and decisions that go into a long-term study of children, it's not surprising that different researchers have produced studies that show somewhat different results. In one study in which I participated, a main finding is that the fact of cocaine exposure itself is less important in the long run than the quality of the care the child receives. The most important factor in determining a child's behavior and development was the psychological health of the parent--be it the biological mother, grandmother, or a foster mother. Recently, Deborah Frank and colleagues conducted an analysis combining the results from every available well-designed cocaine outcome studies. The main result was the same: The cause most responsible for the problems of so-called crack babies is not the cocaine itself, but the poverty and maternal despair that give rise to it. This is not to say that using cocaine during pregnancy is harmless. Exposure to cocaine before birth almost certainly results in short-term changes in the brain and probably also in long-term effects. In the short-term, exposed babies tend to be more difficult and less rewarding to care for. In the long-term, problems with attention, learning, and impulse control seem likely. On the other hand, some of the very worst issues that face these babies once they enter school are not a direct result of cocaine exposure. Instead, they are a consequence of the physical and psychological environments in which the children grow up. Blaming these problems on crack does no good. It diverts society's attention away from things that can and should be done to make children's lives better--preventing domestic violence, for example, and assuring quality child care--and instead heaps blame on addicted women, who themselves are in need of therapy and support. For more useful information check out our Tobacco, Family Relationships, and School Problems programs. Click here to join the discussion on Drugs, Alcohol, and Tobacco.
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