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CHILDREN EXPOSED TO ALCOHOL, MARIJUANA, TOBACCO, AND OTHER DRUGS IN-UTERO

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Mother’s use of alcohol and other drugs during pregnancy or while nursing has been proven to cause life-long behavioral problems in children and affecting areas vital for their success in school and life. These may include memory, attentiveness, cognitive performance, information-processing, and attention to tasks.

 

Drinking alcohol during pregnancy can result in fetal alcohol spectrum disorder (FASD), thought to be the leading cause of developmental delays in children and more prevalent than autism.  Children with FASD may have characteristic facial features and be small or can appear typical. However, the brain damage which has been done, has no cure. Typical behaviors of the brain damage are poor decision making, impulsivity, impaired memory, inability to think ahead or to understand consequences of their behavior. 

 

Studies tracking drinking patterns of fathers and health outcomes of their children suggest alcohol use in the preconception period (6 months prior to conception) can be related to increased risk of miscarriage, heart malformation, microcephaly, fetal growth, children’s mild cognitive impairments, and future mental health challenges, including anxiety. Although the underlying mechanisms are not understood, research has shown that alcohol use by males prior to conception changes the DNA in developing sperm and sperm activity. (Science Daily, October 2019. https://www.sciencedaily.com/releases/2019/10/191003074846.htm)

 

Prenatal cannabis exposure is associated with greater risk for psychopathology during middle childhood. The US Surgeon General issued an advisory against any use of marijuana during pregnancy. (Results from ABCD Study, in Journal American Medical Assoc, Psychiatry. Published online September 23, 2020. doi:10.1001/jamapsychiatry.2020.2902.)

 

Short-term neonatal outcomes, such as lower birth weight and neonatal abstinence syndrome, are the well-recognized outcomes of opioid use during pregnancy. Emerging literature also reveal an association with longer-term adverse neurocognitive, behavioral, and developmental outcomes, which may become more noticeable as children reach preschool and school age. Genetic, environmental, and biological variables result in a highly complex picture. (PEDIATRICS Volume 144, number 2, August 2019  https://pediatrics.aappublications.org/content/pediatrics/144/2/e20190514.full.pdf) Researchers at the University of Maryland School of Medicine have shown that opioid exposure can cause long-lasting impairment in the brain's ability to process sensory information, which may give rise to autism, attention deficit hyperactivity disorder, and substance use disorders during adolescence. (Journal of Neuroscience, January 2014 https://www.jneurosci.org/content/early/2021/01/14/JNEUROSCI.2470-20.2020)

 

An interview with Dr. Nadine Burke Harris, Surgeon General for California, in Mother Jones, states, “The Opioid EpidemicIs Literally Changing Kids’ Brains”, including increased risk that the children are more likely to use drugs later in life. In this article besides the impact in-utereo. Dr. Burke Harris discusses the Adverse Childhood Experience study and the impact of alcohol and drug use by parents on children’s early childhood development.   https://www.motherjones.com/politics/2017/07/the-opioid-epidemic-is-literally-changing-kids-brains/

What Can You Do?

 

Not all babies exposed show these negative physical, mental, or emotional effects from perinatal exposure to alcohol, drugs (including marijuana) or tobacco. No one knows which children or infants may be affected. We do know that the following factors lessen the chance of damage to the fetus’s brain:

  • Stop use as soon as possible - do not stop opioids suddenly

  • Get prenatal care and regular check-ups (for you and your child)

  • Follow good nutrition

  • Stop smoking or being around people who smoke.

 

The following are protective factors for children who have been exposed:

  • Getting an early diagnosis

  • Living in a stable and nurturing home

  • Never having experienced violence 

  • Getting 8-10 hours of sleep consistently

  • Having a predictable environment especially for meals and bedtime.

Successful interventions 

  1. Adapt the environment:

  • Have a predictable structure, routines and rituals with clearly posted, stable daily routine

  • Build transitions into routine

  • Keep it simple: limit exposure to people, visual/auditory stimulation including TV, violent movies

  • Reduce stimuli in rooms ‑ remove materials and equipment 

  • Have clearly defined spaces for different activities. 

2.   Teach using multiple sensory modalities: sight, sound, touch, taste, smell, emotion and action

  • Be concrete rather than abstract 

  • Keep directions simple: one at a time

  • Give time to process information. Keep silent after giving a direction, question, or comment.

  • Teach and model appropriate ways to express feelings, social skills and appropriate behavior to accomplish tasks.

3.   Modify expectations regarding timelines and transitions:

  • Use behavioral/physical cues to help direct or re‑direct

  • Modify goals without compromising or limiting child’s potential

  • Review expectations of "normal" timelines 

  • Identify patterns of behavior that are not working, such as use of consequences

  • Identify range of behaviors which may reflect attempt to communicate, such as increased movement, subtle verbal or nonverbal cues, aggression, withdrawal, or inappropriate comments. 

4.   Remember there is no "typical" profile:

  • Help them identify their own strengths, skills and interests.

5.   Children are more alike than different:

  • Provide constant, appropriate praise 

  • As with all children, affirm that they are wonderful.

6. Facilitate home/school/community partnership.

Resources

  • Parent Support Groups on-line

  • Assessment

  • FASD NorCal is a group of parents and professionals aiming to foster diagnosis, services, and support for everyone affected by fetal alcohol damage in Northern California.  

  • Recommended references:

    • Beyond Behaviors by Mona Delahooke.  Nate Sheets has a podcast book club for this book.  Having read the book is not necessary to listening to the podcast. The link is www.oegonbehavior.com.  Click on It’s a Brain Thing and scroll down to episode 17 for Beyond Behaviors book club. 

    • Guided Growth by Ira Chasnoff, M.D.  and Ronald Powell, Ph.D., 

              Part I https://www.youtube.com/watch?v=LCz7C05kTRw.   

              Part 2 https://www.youtube.com/watch?v=02By-2riXzA

©2020  Tisch.