Prenatal poverty may cause more harm than drugs

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A recently released long-term study conducted at a premier pediatric research center indicates that prenatal poverty–not cocaine–may beresponsible for low-income children’s learning disabilities.

Researchers at the Albert Einstein Medical Center in Philadelphia first tested the organizational abilities and attention spans of two groups of children- those whose mothers used cocaine during their pregnancies and those whose mothers did not.

All the families with children in the study had incomes low enough to qualify for federal health insurance.

Surprisingly, the researchers found very little difference between the two groups of children. They did, however, find a significant difference between the abilities of the study’s children and a third group—economically better-off children whose test scores are considered standard.

The study, published in the December 1999 issue of Developmental and Behavioral Pediatrics, and written by neonatologist Hallam Hurt with others said the children in their study group were tested at age three and one-half and again a year later.

Both groups were asked to play with a large red box covered with ten locksand doors leading to compartments filled with toys-known as a Goodman LockBox. They then were evaluated for attention, planning and organizationalskills.

The children were tested in their ability to unlock and lock the doors, and open and close the doors, as well as remove toys from and return them to the various compartments. The 19 behavior codes were broken down into three main outcomes: aimless actions, competence and mental organization.

Aimless actions were unfocused and impulsive behaviors, such as repetitive opening and closing of doors, banging toys, or leaving the lock box entirely. Competence was defined as purposeful problem-solving and age-appropriate play, including the number of doors opened successfully. Mental organization measured the pattern and sequence of movements children used to explore the Lock Box; orderly actions indicated self-regulation. “Our group of cocaine-exposed children performed as well as control children on Lock Box outcome measures,” the researchers reported, “with both groups’ scores increasing over time.” They added, “Our research suggests that in utero cocaine exposure is not a marker for attentional and organizational problems in economically disadvantaged children.”

The red Lock Box is unstructured and stimulating–a toy researchers expect kids to quickly lose interest in. This fact, combined with the children’s drug-positive status (90 percent of the cocaine-using mothers had tested positive for the drug at delivery) would usually predict a bad outcome. The results, however, showed that the cocaine-exposed children were not more inattentive, disorganized or impulsive than the controls.

However, the researchers added that the children in their study did not do as well on any of the tasks as the group that set the test standards–known as the Goodman group after the scientist who invented the test.

The researchers noted that “pervasive disadvantage” of poverty may overshadow any prenatal cocaine exposure that does contribute to long-term developmental problems.

“For these children, reducing the array of risk factors through increasing access to public resources and creating a stable learning environment may foster the development of more organized approaches to problem-solving. Such interventions can improve learning and adaptive skills which, in turn, will increase the children’s chances for success in more complex environments such as school,” the paper concluded.

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