Parental Drug Abuse Effects on the schoolage child
Parental Drug Abuse: Effects on the school-age child Jordan Greenbaum, MD Stephanie V. Blank Center for Safe and Healthy Children’s Healthcare of Atlanta
Objectives Recall the adverse effects of prenatal exposure to alcohol, cocaine and methamphetamines Understand the ongoing risks to health and well being for children living with substance-using caregivers
Facts 6% pregnant women used illicit substances in past month Illicit drug use during pregnancy 15 -17 yo’s: 18% 18 -25 yo’s: 9% 26 -44 yo’s: 3% 7. 6% pregnant women used alcohol during month prior to study Over 6 million children in U. S. live with a substance abusing parent Chang, 2014; USDHHS 2002; Gold, 2013
In-Utero Cocaine Exposure and the Fetus Spontaneous abortion Prematurity Abruptio placentae Fetal death Decreased birth weight, length, head circumference No ‘abstinence’ syndrome at birth
What about after birth? Controversial Preschoolers: IQ scores similar to unexposed kids Visual-spatial skills, general knowledge and arithmetic skills lower Lower likelihood that IQ > 100 Quality of home environment very important Singer LT, 2004
Prenatal Exposure to Meth Very limited data No ‘syndrome’ No ‘abstinence’ syndrome May be increased risk of Preterm labor Placental abruption Low birth weight, small for gest. age Abnormal neonatal behavior www. irishhealth. com
After the Birth… Infant Development, Environment and Lifestyle Study (IDEAL) Longitudinal study of moms/babies beginning in 20022003 Outcomes studies 2006 -2014 (babies 3 -12 yo) No differences in mental development 1 -3 years More cognitive problems at age 7. 5 years Home environmental issues
Maternal Alcohol Abuse Average of 2 drinks per day can lead to defects in fetus At least 50% risk of abnormalities in offspring of chronic alcoholics Maternal alcohol abuse may be one of the most frequent recognizable causes of mental deficiency in U. S.
Fetal Alcohol Syndrome Most severe form of FASD Abnormalities in 3 domains Abnormal facial features Poor growth CNS deficits Features less distinct after puberty
Prenatal alcohol photo: Clarren, 1986 Slide courtesy of Research Society on Alcoholism, Alcohol and Alcohol Actions Lecture Series http: //rsoa. org/lectures/about. html
FAS: CNS Problems Functional Developmental delays Motor functioning delays Executive functioning deficits Attention or hyperactivity problems Social skill deficits Other (sensory, language or memory problems)
FAS in adolescence/adulthood Microcephalic Short stature Cognitive impairment Attention, memory difficulties Hyperactivity, impulsivity Poor socialization skills Conduct disorders, depression, anxiety Often unable to live independently, work.
Caregiver Substance Abuse & Child Maltreatment
Caregiver ‘High’ and Maltreatment Imagine mom with… Euphoria and grandiosity Impaired judgment Hypervigilance and agitation Imagine dad with… Reduced social inhibitions Increased sexual interest Paranoid ideation and bizarre behaviors
During a binge, “nourishment, sleep, safety, survival, money, morality, loved ones and responsibility become immaterial. ” Gawin, 1988
The ‘Post-High’ Crash Mom’s irritable and depressed Dad’s awake all night and craving drugs Either or both are paranoid Withdrawal effects can persist for weeks
Substance Use & Child Abuse Children at risk for Physical abuse Sexual abuse
Substance Use & Neglect Children at risk for Malnutrition and dehydration Injury
Environmental Hazards Ingestion Infection Fire-related injury
Drug Use and Neglect Educational neglect No one wakes child for school Older sibs must stay home to care for younger ones Medical neglect Chronic medical problems leading to preventable complications Delayed medical care for acute illness (DM, asthma)
Also consider… Criminal behavior Adult as role model May use child to transport or sell drugs May have child steal to support drug habit Groom child to be meth cook Encourage child to use drugs
This is all well and good, but what about hard data?
Limitations of Studies on Maltx Timing of maltx unknown Other confounding factors Definition of maltx Detection bias Incorrect classification of substance users
A Closer Look…. Alcoholism and child abuse Inconsistent study results for physical abuse Increased risk for child sexual abuse Cocaine and child abuse Conflicting results from studies Maternal cocaine use may be a marker for presence of risk factors
Drug Intoxication of Child Ingestion (accidental or intentional) Passive inhalation Intravenous use (older children)
Cocaine Ingestion Chasnoff (1987) 2 wk old breast fed w/ acute onset irritability, V/D, dilated pupils Dinnies (1990) 3 toddlers: seizures (2) and irritability (1) Bateman (1989) 4 infants/toddlers w/ passive crack inhalation Drowsiness (1); unsteady gait (1); seizures (2)
What About the Long Term Outcome? Prenatal effects Effects of adverse childhood experiences Chronic stress and brain development
Cumulative Effect of ACEs Depression Mental Health Anger Increasing number of ACE’s Drug use/addiction Behavioral Antisocial behavior Early alcohol use Physical Liver dz Lung disease Heart disease Schilling, 2007, Dong, 2003 Dube, 2003, Dong, 2004 Felitti and Anda, 2009
Consequences related to parent Parent with chronic consequences of drug/alcohol addiction Early death Violent injury Incarceration Unstable home environment These increase early adversity for children
In Conclusion… Caregiver substance abuse harms children Prenatal exposure Association with abuse and neglect Drug and chemical intoxication Injury from meth labs Chronic stress and unstable living conditions
My contact info: Jordan Greenbaum, MD Jordan. greenbaum@choa. org 404 -785 -3829
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