Helping Crack-Affected Children Succeed - ASCD
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December 1, 1992

Helping Crack-Affected Children Succeed

Children impaired by this cheap form of cocaine are as intelligent as other children; their affect and social skills are damaged. Adaptations in teaching methods and the classroom environment can help them achieve academic success.

A classroom for young children affected by crack does not look like other early childhood settings with their mobiles, bright bulletin boards, and a constant stimulation of the senses. The classroom for crack-affected students is austere. There are no bulletin boards and no examples of children's art until, perhaps, late in the year, when the children can handle such stimulation. Only a few toys and books are in view, and other materials are hidden on shelves behind a simple fabric curtain. The lights are low, and there is little to distract the child. Learning and teaching areas are set up so that each child can be alone while learning. Play equipment usually used outdoors, like basketballs and climbing bars, is available inside the classroom so children can learn how to handle it appropriately and hone their gross motor skills with simple exercise. Tumbling mats are also available for the same purpose.

The classroom I'm describing isn't necessarily lacking in funds, nor is it a place where the teacher has failed to provide the kind of rich environment students need. On the contrary, this teacher has made the important modifications needed to meet the special needs of children exposed to crack and cocaine. As former Wisconsin governor Lee Sherman Dreyfus observed, “There are only two kinds of school districts: those that have crack-affected children, and those that will have.”

Who Are Crack-Affected Children?

Chasnoff and associates (1990) report that about 14 percent of pregnant women use drugs or alcohol that can cause permanent physical damage to a child during pregnancy. Approximately 400,000 children are born annually to mothers who used crack or cocaine during pregnancy. These drugs are chemically similar and have the same effects on fetuses.

A recent study by Yazigi and associates (1991) shows that cocaine molecules bond to human sperm in lab tests. The ramifications of this are not clear, but it is possible that some children are affected by paternal use of these drugs immediately prior to conception. Extensive medical research documents actual changes in the fetal central nervous system in response to crack and cocaine (Chasnoff et al. 1985, 1986, 1989, 1991; Lewis et al. 1989; MacGregor 1987; Rodning 1989; Ryan 1987). This has enormous implications for early care providers and schools.

How They're Different

Children affected by crack and cocaine look like other children: they show the full range of size, vigor, and intelligence. However, many of them also show a number of problems that do not simply resolve themselves. Unless those crack-affected children receive specially designed interventions, they will continue to experience the problems during each developmental stage.

Infancy. Crack-affected infants are susceptible to Sudden Infant Death Syndrome (SIDS), apnea, and other sleeping disorders. Many have tremors and convulsions. They are easily overwhelmed by stimuli, responding with a hyper-startle or, in the extreme, by losing consciousness. These infants have difficulty paying attention, and they cannot track visually (Ryan 1987; Schneider 1990; Weston et al. 1989; Van Baar et al. 1989a, 1989b).

More important, crack-affected infants are often averse to being touched and to being looked at, as these strong stimuli threaten to overload them. Consequently, they do not cuddle and often fail to bond with a caregiver. This failure to bond is an important indicator that the child may have great difficulty forming relationships in the future.

In a series of interviews with teachers who had worked with crack-and cocaine-affected children, I found that the problems identified in infants by medical researchers continue in different form through elementary school and into the teens (Waller, unpublished). As a teacher educator working with hundreds of these children and their instructors, I also found that teachers have discovered effective methods for working with such children.

Preschool. As toddlers, crack-affected children are often hyperactive, late in developing language, and late in walking. They are self-absorbed, impulsive, unaware of others, and unable to focus attention for any length of time. By age 3, they are often isolated because other children do not trust their unpredictable mood swings and sometimes violent outbursts.

These toddlers do not understand cause and effect relationships, either in classroom discipline that prescribes a timeout for certain behaviors or in play where jumping off a table causes pain. They do not feel remorse for hurting others, and they do not seem to develop conscience.

Crack-affected toddlers can do what they are told and shown, but they cannot plan their own time or activities. In general, they seem to have trouble organizing their experiences and making sense out of them. Their play is random, disorganized, and pointless. They often do not understand games, and they are unable to focus attention long enough to learn them.

School age. The oldest crack-affected children today are only 8 years old, but older children whose mothers took cocaine during pregnancy offer us a window on how crack-affected children will act when they reach high school. Teachers report that cocaine-affected school-age children are still impulsive and sometimes violent. Also, they are distractible, hyperactive, and disruptive, and school discipline does not seem effective. These children show learning and memory problems, and they are slow to develop friendships. They often remain isolated, even into high school, and their social skills are hampered by their inability to set limits or recognize appropriate limits for speech and behavior. As they grow older, they embarrass peers because of their inappropriate social behaviors and blurted comments. Cocaine-affected children are unable to catch nonverbal cues. Their efforts to make friends are hampered by this, because they do not understand what another's smile or frown means in terms of their own behaviors. This makes classroom motivation and discipline especially difficult because a teacher's expressions have no meaning.

Their learning is affected by a continuing problem with cause and effect. Middle school teachers report that the cumulative and sequential nature of mathematics has posed a substantial problem to cocaine-affected teens, while language-based subjects are more accessible for them. They are still unable to structure or plan their own activities, and they are easily influenced by others because they are lonely and lack friends.

How Can Schools Respond?

Teachers report that crack-affected children who experience early intervention tailored to their problems can be mainstreamed successfully into regular classes. They estimate that if children are identified by age 2, a two-year intervention will teach a child enough to be mainstreamed. If the schools do not see a student until age 5, as often happens, a longer intervention may be necessary. Few believe that the crack-affected child will need to be in special education classes all through school, unless no appropriate intervention is ever provided.

Schools must acknowledge that cocaine and crack are easily available in any area of the country and that affluence does not protect against recreational drug use. Schools must also acknowledge that many exposed children will never officially be identified. There is tremendous denial on the part of drug-using parents, and only a fraction of them will admit to behaviors which harmed their children.

On the basis of identification of a cluster of behaviors often associated with crack use, children need to be placed into an intervention environment where special teaching techniques will be used. Placement must be understood as only temporary, for a period of 1 to 3 years. The child will return to regular classes as soon as basic academic and social skills have been mastered.

Inside the Intervention Classroom

Teachers in intervention classrooms need to emphasize long-term expectations for their students. It can be frustrating to teach and reteach the same thing daily for weeks and find that students still don't understand it, but this is what often happens with crack-affected children. Their intellect works, and can be reached, but a longer timeline may be necessary.

Teachers need to forget all they know about their repertoire of exciting teaching styles. Crack-affected children can be overwhelmed by ordinary experiences, and they need stability, routine, and sameness in the intervention classroom to feel secure enough to learn.

Since their affect appears to be flawed, teachers must work with the intellect, which is undamaged. Words are the way to the intellect, so early therapy with speech is vital to reach the crack-affected child at all. Facial expressions have no meaning (or inappropriate meaning) to crack-affected children, so they must be taught in words in home and school. Encouragement and praise must be done verbally, not simply with a smile or a friendly look.

It's important to use one teaching modality. Because of their inability to order their experiences, crack-affected children cannot recognize one lesson taught five different ways. Crack-affected children will believe they're learning five different things! Teachers must teach, tell, reteach, retell, model, demonstrate, and have the child demonstrate the lesson.

Teachers of crack-affected children report idiosyncratic learning and memory problems. Students are taking in all the information, but the “filing system” required to recall information is flawed. Teacher after teacher tell stories like this: A 5-year-old child learns to tie her shoelaces one morning and demonstrates she knows how to do it. That afternoon, she again demonstrates her skill. But day after day, the child cannot remember how to tie her shoes, and must be retaught.

The parents finally buy her shoes that are fastened with Velcro. Two weeks later, the teacher sees the child tying another child's shoes. This same disrupted rhythm is exhibited in academic areas. All the 6- and 7-year-olds I have seen so far have been able to read, but their comprehension lags far behind decoding. Teachers may respond to such memory problems by allowing more wait time for students to respond, but they also must be prepared to reteach and reteach.

Teaching Social Skills

Social skills also must be taught in words and modeling. Since the children are unable to pick up on nonverbal cues on their own, words are again the vehicle. Hints and facial expressions are meaningless to a crack-affected child; direct instruction in sharing, greeting, and thanking is necessary. Role playing is appropriate for school-age children, because it allows actual practice in face-to-face interactions with other children, providing a structured social occasion with specific tasks to achieve.

Play must also be taught in words and modeling. Play has no intrinsic value to crack-affected children; they are disorganized and make no sense out of their experience. Their physical activities are random and without point. Play and games must be taught by direct instruction, then by guided play, then by play under supervision. The instruction must be specific so children do not see play and games as a time they need to arrange for themselves.

Routine and familiarity are vital in maintaining attention and facilitating learning. Transitions are particularly hard for crack-affected children, and the teacher must prepare students for transitions from active to quiet activities, from class to lunch or dismissal, from school to field trips, and from one subject to another. Preparation is done by talking about and reviewing all the things that will happen with the change, perhaps by questioning the children about the transition or sometimes by role playing (as in preparing for a field trip).

Effective Restraint

Teachers of crack-affected children must also know how to safely restrain children when they become hyperactive or threaten to hurt others. This restraint serves as a safety mechanism for the child, who cannot regain self-control when hyperactive. Teachers report that children who have been restrained become conditioned to eventually calm themselves when merely hugged for a moment by the teacher. The child struggles momentarily, then sighs and relaxes, achieving balance again.

Teachers cannot assign blame for disruptive behaviors. The most successful teachers with crack- and cocaine-affected children are those who recognize that the child has no self-control and the behavior needs to be changed. Time-outs are often effective, but physical restraint may be necessary. For children with good language skills, it can be effective to take away privileges and give a full explanation of why and under what circumstances privileges are lost. This needs to be explained over and over.

Avoiding Overload

Small groups are effective for presenting one idea or set of materials at a time and ensuring that children have achieved mastery. Teachers need to check on task completion frequently, because lack of perseverance is often a problem.

Teachers should focus students' attention on the paper, book, or toy in the lesson. For example, the teacher may place the child's hand on the page and move it down to focus attention. A good teacher knows that touching a child, speaking to her, and looking into her eyes at the same time can be overwhelming. There is a better chance of success if the teacher touches the child's hand while speaking in a low voice and avoiding eye contact.

Art and music must be carefully introduced in a highly structured manner. Without structure, these subjects are too stimulating because they reach several senses simultaneously. Teachers suggest working with one color crayon at a time, or teaching simple songs without accompaniment. Several teachers have reported success with humming or singing without words, so students aren't overloaded.

The Future

Interviews with teachers, parents, and foster parents of older cocaine-affected children, some of them teenagers, indicate that the behaviors seen in younger children can persist until adulthood. Without intervention, the impulsivity and inability to internalize rules of appropriate behavior will result in early sexual activity and drug and alcohol use. This probably means drug-impaired children born to drug-impaired children who are unable to care for them.

Without intervention, we are looking at millions of healthy, vigorous, intelligent sociopaths in the schools and in society. A long-term research study on the moral development of crack-affected children is now under way in Wisconsin (Waller, in press), and it will provide information on whether interventions can help in the development of conscience and internalization of social rules.

With intervention, children can learn and complete school. With intervention, children can learn appropriate social behaviors and interactions.

Schools have a choice.

References

Chasnoff, I.J., K. A. Burns, W. J. Burns, and S. H. Schnoll. (1986). “Prenatal Drug Exposure: Effects on Neonatal and Infant Growth and Development.” Neurobehavioral Toxicology and Teratology 8: 357–362.

Chasnoff, I. J. (1991). “”Cocaine Use in Pregnancy: Mother and Child.” Keynote address to the Illinois Special Education Leadership Institute Third Annual Initiative Conference.

Chasnoff, I.J., D. R. Griffith, S. MacGregor, K. Dirkes, and K. A. Burns. (1989). “Temporal Patterns of Cocaine Use in Pregnancy: Perinatal Outcome.” Journal of the American Medical Association 261, 12: 1741–1744.

Chasnoff, I.J., H. J. Landress, and M. E. Barrett. (1990). “The Prevalence of Illicit-Drug or Alcohol Use During Pregnancy and Discrepancies in Mandatory Reporting in Pinellas County, Florida.” The New England Journal of Medicine 322, 17: 1202–1206.

Chasnoff, I.J., W. J. Burns, S. H. Schnoll, and K. A. Burns. (1985). “Cocaine Use in Pregnancy.” The New England Journal of Medicine 313, 11: 666–669.

Lewis, K.D., B. Bennett, and N. H. Schmeder. (1989). “The Care of Infants Menaced by Cocaine Abuse.” American Journal of Maternal Child Nursing 14: 324–329.

MacGregor, S.N., L. G. Keith, I. J. Chasnoff, M. A. Rosner, G. M. Chisum, P. Shaw, and J. P. Minogue. (1987). “Cocaine Use During Pregnancy: Adverse Perinatal Outcome.” American Journal of Obstetrics and Gynecology 157: 686–690.

Rodning, C., L. Beckwith, and J. Howard. (1989). “Prenatal Exposure to Drugs: Behavioral Distortions Reflecting CNS Impairment?” NeuroToxicology 10: 629–634.

Ryan, L., S. Ehrlich, and L. Finnegan. (1987). “Cocaine Abuse in Pregnancy: Effects on the Fetus and Newborn.” Neurotoxicology and Teratology 9: 296–299.

Schneider, J.W. (1990). “Infants Exposed to Cocaine In Utero: Role of the Pediatric Physical Therapist.” Topics in Pediatrics. Lesson 6.

Van Baar, A.L., P. Fleury, and C. A. Ultee. (1989a). “Behavior in First Year After Drug Dependent Pregnancy.” Archives of Disease in Childhood 64: 241–245.

Van Baar, A. L., P. Fleury, S. Soepatmi, C. A. Ultee, and P. J. M. Wesselman. (1989b). “Neonatal Behaviours after Drug Dependent Pregnancy.” Archives of Disease in Childhood 64: 235–240.

Waller, M. B. (In press). Crack-Affected Children: A Teacher's Guide. Newbury Park, Calif.: Corwin Press.

Waller, M. B. (Unpublished). Survey of Teachers of Crack-Affected Children.

Weston, D.R., B. Ivins, B. Zuckerman, C. Jones, and R. Lopez. (June 1989). “Drug Exposed Babies: Research and Clinical Issues.” Bulletin of National Center for Clinical Infant Programs IX.

Yazigi, R. A., R. R. Odem, and K. L. Polakoski. (1991). “Demonstration of Specific Binding of Cocaine to Human Spermatozoa.” Journal of the American Medical Association 266, 14: 1956–1959.

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