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Little is known about the long-term biological effects of prenatal exposure to drugs; longitudinal prospective studies are needed to build a solid base of knowledge. However, children who exhibit language delays, distractibility, and/or problems with fine motor coordination during the preschool period are at increased risk for learning problems during their school and teenage years. For children who were prenatally exposed to alcohol, there is growing information about the cognitive development of school-aged children with FAS. By the time such children reach elementary school age, many demonstrate cognitive skills that fall within the mentally retarded range. Other less severely affected children display attention deficit disorder and specific learning problems related to difficulties with visual and auditory processing.

In the absence of research data describing the long-term effects of prenatal substance exposure, there are still a number of ways in which professionals can provide services for children and adolescents from substance-abusing families. Sometimes, older children may come to professionals' attention because of the birth of a younger substance-exposed sibling in the family. Other children may demonstrate problem behaviors in school (e.g., depression, learning difficulties, repeated absences) that can alert professionals to a possible problem with alcohol and/or other drug abuse within the family. Additionally, children may come to the attention of professionals through the child welfare system. The children also may begin experimenting with or abusing drugs and/or alcohol themselves. Further, law enforcement professionals also may be in a position to identify family substance abuse problems when adolescents engage in acting-out behaviors.

Whatever behavioral symptoms a child may demonstrate (and whatever their cause), as he/she passes from preschool into elementary school and beyond, available testing measures become increasingly more sensitive in identifying learning strengths as well as problems. A team of teachers, psychologists, speech and language therapists, hearing and vision specialists, nurses, and other professionals can be called in to assess difficulties with learning that may be related to short attention span, speech and language problems, impulsivity, difficulties with short-term memory, auditory and visual processing, etc. Based on such an evaluation, school personnel can more readily develop effective educational programs to help the child or adolescent compensate for identified problems.

However, more often than not, this educational intervention alone is not sufficient to support ongoing success in learning for children who live in substance-involved households. Unlike many children who have learning difficulties but who have grown up in stable family environments, the majority of drug-affected children have experienced environmental instability that may have included multiple placements, child abuse and neglect, inconsistent parenting (possibly including extended parental absences), domestic violence, and other stressors related to alcohol and/or other drug abuse. Thus, social workers, other mental health professionals, and members of the clergy may also need to provide services to help identify, treat, and prevent mental health disorders in such children.

For children who experience problems in school and who also are growing up in dysfunctional homes, the cumulative effects of both academic failure and environmental instability may greatly impair their functioning in a variety of other areas. Poor peer social relationships and low self-esteem place such children and adolescents at high-risk for depression, suicide, substance abuse, teenage pregnancy, and school dropout. In terms of primary prevention efforts, professionals can:

• Advocate for needed specialized educational services within the school system, tutoring for academic underachievement, and assessment and intervention for neuropsychological problems.
• Encourage participation in school or community-based, teen-oriented support groups, such as AlAteen or AlAnon if alcohol abuse is a concern.
• Encourage a stable relationship with an adult role model through participation in programs such as Big Brothers or Big Sisters.
• Explore recreational and work experiences whereby the older child or adolescent will have opportunities to experience success.
• Refer parents to support groups that provide education and guidance for dealing with difficult childhood and adolescent behaviors.
• Provide individual and family therapy.

Summary

The point at which a substance-affected child becomes visible to professionals usually depends on the child's age, and it is important to remember that the child welfare system may not always be the primary identifier. A prenatally substance-exposed newborn is most likely to be identified within the health care system on the basis of maternal or infant signs and symptoms, as is a toddler, who may have problems with infections, FTT, etc. A preschooler, on the other hand, may be more visible within programs such as Head Start or early intervention programs for special-needs children, in which the child or his/her parents may demonstrate behaviors that are suggestive of a substance abuse problem within the family. Teachers and other educational professionals may identify school-aged children from alcohol- and/or other drug-abusing families on the basis of child or parental behavior or the content of the children's conversations with staff and peers. Adolescents from substance-abusing families also may demonstrate problem behaviors at school, or within the community, thus coming to the attention of law enforcement professionals.

At any one of these points of visibility, professionals can garner their resources and provide intervention. An interdisciplinary approach that encompasses the children's problems as well as those of other family members is most likely to be effective in helping families with problems related to alcohol and/or other drug abuse. Further, it is important to remember that child development is an ongoing process. Just as early intervention has been shown to have a positive impact, comprehensive, coordinated efforts can be helpful at whatever stage they are begun.

Tags: Addictions

About the Author

www.childwelfare.gov
Formerly the National Clearinghouse on Child Abuse and Neglect Information and the National Adoption Information Clearinghouse, Child Welfare Information Gateway provides access to information and resources to help protect children and strengthen families. A service of the Children's Bureau, Administration for Children and Families, U.S. Department of Health and Human Services.