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This qualitative study examined a preschool classroom serving a child considered to be at-risk (i.e., with indications of prenatal drug exposure). For a period of one semester, the investigator collected field notes through observations and taped sessions with little direct interaction with the children. Taped discussions and interviews with the teacher and assistant were a part of the data collection, as were photographs of the physical environment. Data were analyzed and recommendations were made based on established research findings that support specific physical changes in the environment, as well as changes in teacher-child interactions. The purpose of the recommended adaptations was to create a more conducive learning environment for children exhibiting characteristics of drug exposure or who are easily over-stimulated. (Contains 17 references.) (Author/EV)

This report describes the activities and outcomes of Project RISK, a 3+2 years service delivery demonstration and replication project that was based on the assumption that infants of HIV positive women are at significant developmental risk from prenatal exposure to HIV infection and, possibly, teratogenic drugs, as well as from the complex caregiving environments of families with HIV. Project Risk attempted to facilitate the transition of developmental and family coordination services from tertiary AIDS centers to community early intervention services. There were three components to the RISK model: (1) direct service to assess developmental status, risk, and needs for children and families and to provide support and intervention in the community for children referred to tertiary care hospitals for "exposed not infected" status; (2) to develop a model for providing linkage to community service agencies appropriate for child and family needs; and (3) to provide education in pediatric HIV risk and infection and associated developmental and family needs to community service agencies. Materials include a study on the community service utilization of families of young children who are exposed to HIV and a directory of service for individuals and families living with HIV/AIDS in Wake County, North Carolina. (CR)

This final report discusses the outcomes of the federally funded Infant Care Project (ICP) that provided comprehensive and continuous services to 99 women who had used cocaine during pregnancy and their infants. The ICP model combined high risk obstetric care, infant and child development services, and substance abuse services on site in the health care setting. The objectives and activities of the ICP addressed: (1) prenatal identification and intervention in substance abuse, fetal development, mother-child relationship, and family support; (2) newborn assessment and intervention in substance abuse, infant development, mother-child relationship, and family support; (3) follow-up assessment and intervention in the same areas; (4) intervention/training with community agencies that provide care for substance abusing families and their infants; (5) the coordination of an interagency group for families with substance abuse disorders; and (6) a 2-year replication of the ICP in a community health department. Evaluation data indicate that participation in the project was associated with improved compliance with prenatal care, reduced drug use during pregnancy, improved obstetric outcomes, and an increased likelihood of the mother retaining custody at 12 months postpartum. Child developmental outcomes at 12 months were similar for those recruited prenatally and the controls who had no drug use. (CR)

A study involving 83 child care providers conducted two surveys to investigate providers' self-perceived knowledge, skills, and attitudes toward working with children (and their families) who are exposed to substances, and their attitudes towards children with Down syndrome and children who are chronically ill. Results from the surveys indicated: (1) attitudes toward children who had been exposed to substances were poorer than toward children with Down syndrome, but were not significantly different from attitudes toward children with chronic illness; (2) participants who had received prior training in working with children who are chronically ill had better attitudes toward these children than those who had not received training; (3) participants who had received prior training in working with children who had been exposed to substances had poorer attitudes toward these children than those who had not received training; (4) providers' self-perceived level of knowledge or skill regarding working with children exposed to substances had no relationship with attitude scores; and (5) the only significant correlations were between the attitude subscales and between self-perceived level of skill and level of knowledge regarding working with children exposed to substances. (CR)

This collection of papers presented at a 1996 conference on children's mental health focuses on early intervention approaches. Papers have the following titles and authors: (1) "Child Maltreatment and Prenatal Exposure to Alcohol and Other Drugs: Some Preliminary Findings" (Patrick A. Curtis and Mary Wood Schneider); (2) "Evaluation of the Total Family Strategy Program" (Liang Wu and Oliver T. Massey); (3) "The Public Mental Health and Head Start Partnership in the Ventura County System of Care" (Donald W. Kingdon and others). (Individual papers contain references.) (DB)

This thesis discusses normal principles of infant development during the first 2 to 3 months of life and applies these principles to the provision of services to drug-exposed infants. Emphasis is on the infant as an active and interactive participant in his/her own development, the primacy of the body during this early developmental period, and the interrelatedness of physical experience and emotional development. Chapter 1 examines underlying assumptions of the infant's basic nature. Cultural assumptions are discussed as is the infant's capacity for subjective experience. Chapter 2 outlines key principles and processes of normal development and provides information on neurobehavioral organization and the organizational model. Chapter 3 evaluates the emotional development and subjective experience of the infant. The infant's achievement of basic trust, ego integration, and the "coming into being" of the infant's true self is discussed. Chapter 4 provides information on the medical and neurobehavioral effects of intrauterine drug exposure. Also discussed is how various environmental variables impact development of hospitalized infants. Chapter 5 describes a hospital-based early intervention program which stressed that effective clinical interventions with very young drug-exposed infants should be based on normal development. (Contains over 100 references.) (Author/CR)

Experts now estimate that one half to three quarters of a million infants are born each year who have been exposed in utero to one or more illicit drugs. When legal drugs--alcohol and tobacco--are added, the figure rises to considerably more than one million substance-exposed infants. This monograph is one in a series created by the Educational Development Center to address the needs of administrators and teachers for accurate, up-to-date information on the effects of prenatal exposure to alcohol and other drugs. The report also examines what is known about other risk factors that may amplify these effects or produce similar consequences. The first chapter of the report addresses what the research suggests about the short- and long-term effects of prenatal exposure to alcohol and other drugs. The second chapter discusses environmental factors which, by themselves or in combination with the effects of prenatal exposure to alcohol or other drugs, can affects a child's development. The third chapter explores the implications of prenatal exposure for preschool and primary education and describes specialized programs that serve children identified as having been prenatally exposed to alcohol or other drugs, as well as the behavioral and developmental characteristics these children display. Finally, the report sums up the central findings and suggests ways that this information can guide the development of strategies, techniques, and materials to help teachers and administrators provide children at risk with appropriate and effective educational experiences. Two appendices list sources of information used in the monograph and experts interviewed. Contains 428 references. (HTH)

This pilot study used a multidisciplinary, ethnographic approach to evaluate effects of prenatal drug exposure on four cocaine/polydrug-exposed infants and their rural mothers/caregivers and to begin development of a model training program. The study involved document review of hospital and social services records, participant observation, structured interviews, and administration of a test of locus of control and a family needs survey. Specific information evaluated included newborn medical information, demographic information, perceptions of the primary caregiver, and locus of control of caregivers. Findings included: infant complications were experienced by all four children; all four caregivers lived as single mothers; all mothers indicated that a preschool program would be helpful but only one indicated a need for more training herself; caregivers expressed a combination of internal and external loci of control; all caregivers expressed a need to know more about their child's condition; and all believed their children to be normal and healthy. The development of a home-school partnership for educating these children is stressed. Figures and tables detail responses of caregivers. (Contains 15 references.) (DB)

This paper synthesizes findings of major research studies on development of learning impairment and its prevention in children from birth to age 5. The paper's scope does not include children who died or suffered major retardation. The paper attempts to demystify the language of research and medicine to clarify the prevalence of health, environmental, and poverty-based risk factors; their impact on a child's ability; and ways to prevent the risk factor or ameliorate the learning impairment once it occurs. Major preventable factors associated with learning impairment are low birthweight, prenatal alcohol exposure, maternal smoking, prenatal exposure to drugs, lead poisoning, child abuse and neglect, and malnutrition: each of these factors is discussed in turn. Prevention strategies include, among others, access for all women to early and informative prenatal care, health care before pregnancy and between pregnancies, developmentally stimulating infant day care with parent involvement, school health education, and societal commitment to diminish poverty. A separately printed 3-page summary is appended. (JDD)

The North American Council on Adoptable Children (NACAC) released this report in response to recent calls for a return to institutionalized care for children. The response is based on NACAC's long-held position that: (1) every child deserves a family; (2) institutionalization is not an acceptable substitute for a family; and (3) many important, more cost-effective, and humane options to institutionalization have not been tried. The report notes that infants and young children, many with medical complications and physical and mental limitations due to prenatal drug exposure, comprise the fastest growing group of children entering substitute care. It is estimated that 375,000 of the infants born in 1988 had been exposed to drugs before birth. Many successful maternal health and prenatal care programs bring about favorable outcomes for mother and child. These programs offer a variety of options, such as client-oriented scheduling, integration of key services, and inclusion of the family in client services. However, a large and growing number of women do not have access to adequate public health services, prenatal care, or drug treatment. As for the call for a return to orphanages, it is maintained that long-term institutionalization in childhood leads to recurrent problems in later life. It is noted that a return to orphanages would be in clear violation of Public Law 96-272, the federal Adoption Assistance and Child Welfare Act of 1980. Contains 48 references. (LB)

The effects of drug and alcohol use by pregnant women which concern state policymakers are discussed in this booklet. Topics discussed include: (1) the effects of fetal alcohol syndrome on infants and children, as well as the effects on children of drug use by mothers during pregnancy; (2) initiatives aimed at helping these children; (3) women addicts and alcoholics, including statistics which show that substance abuse during pregnancy appears to cut across racial and socioeconomic lines; (4) initiatives aimed at helping the mother; (5) the relationship of substance abuse and child abuse; (6) state action concerning pregnant women who are suspected of using a controlled substance; (7) foster care or care outside the home of children of drug addicts; (8) state foster care initiatives; (9) the concerns of educators about drug-exposed children in the school systems; (10) miscellaneous state actions and task forces; (11) legal issues; (12) federal actions; and (13) implications to the states of perinatal exposure to drugs and alcohol. Appendix 1 lists relevant sections of statutes of seven states that specifically address alcohol and drug use as they relate to infants. Thirty footnotes and 10 sources consulted are listed. (ABL)

Cocaine use during pregnancy is a high-risk indicator for adverse developmental outcomes. Three levels of intervention (center, home, and primary care) were compared in a full service, birth to age 3, early intervention program serving children exposed to cocaine prenatally. Data were collected on 130 children from urban, predominantly poor, primarily minority families. At 36 months, statistically significant, moderate to large intervention effects were found for cognition, receptive and expressive language, and gross motor development. Small effects were observed for behavior problems, and no statistically significant effects were found for fine motor or prosocial skills. Center-based care was most effective for improving language. These findings provide support that the center- and home-based early intervention programs examined in this study had positive effects on children at risk due to prenatal cocaine exposure.

In a study of 66 in-utero drug exposed (IUDE) infants, evaluated infant cognitive status, caregiver-infant interaction, and caregiver cognitive functioning (IQ) to determine which caregiver variables were associated with infant cognitive status. Analysis indicated that caregiver IQ was the only statistically significant coefficient in the model predicting poor infant cognitive status; however, caregiver-infant interaction showed a moderate effect. (Contains 28 references and 4 tables.) (GCP)

Examines whether crack-exposed children are necessarily doomed for failure and why specialized educational policies and programs are necessary. Reviews relevant research and explores implications of early-intervention and school-based programs. Punitive policies against crack users have displaced need for policy work in education. (Conatains 48 references.) (MLH)