Parental Drug Abuse: Effects on the school-age child

1. Parental Drug Abuse: Effects on the school-age child Jordan Greenbaum, MD Stephanie V. Blank Center for Safe and Healthy Children Children’s Healthcare of Atlanta

2. 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

3. 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

4. Spontaneous abortion Prematurity Abruptio placentae Fetal death Decreased birth weight, length, head circumference No ‘abstinence’ syndrome at birth In-Utero Cocaine Exposure and the Fetus

5. 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

6. 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

7. After the Birth… • Infant Development, Environment and Lifestyle Study (IDEAL) • Longitudinal study of moms/babies beginning in 2002-2003 • 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

8. 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.

9. Fetal Alcohol Syndrome • Most severe form of FASD • Abnormalities in 3 domains • Abnormal facial features • Poor growth • CNS deficits • Features less distinct after puberty

10. Prenatal alcohol photo: Clarren, 1986 Slide courtesy of Research Society on Alcoholism, Alcohol and Alcohol Actions Lecture Series http://rsoa.org/lectures/about.html

11. 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)

12. 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.

13. Caregiver Substance Abuse & Child Maltreatment

14. 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

15. During a binge, “nourishment, sleep, safety, survival, money, morality, loved ones and responsibility become immaterial.” Gawin, 1988

16. 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

17. Substance Use & Child Abuse • Children at risk for • Physical abuse • Sexual abuse

18. Substance Use & Neglect • Children at risk for • Malnutrition and dehydration • Injury

19. Environmental Hazards • Ingestion • Infection • Fire-related injury

20. 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)

21. 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

22. This is all well and good, but what about hard data?

23. Limitations of Studies on Maltx • Timing of maltx unknown • Other confounding factors • Definition of maltx • Detection bias • Incorrect classification of substance users

24. 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

25. Drug Intoxication of Child • Ingestion (accidental or intentional) • Passive inhalation • Intravenous use (older children)

26. 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)

27. What About the Long Term Outcome? • Prenatal effects • Effects of adverse childhood experiences • Chronic stress and brain development

28. Cumulative Effect of ACEs Depression Mental Health Anger Drug use/addiction Increasing number of ACE’s Behavioral Antisocial behavior Early alcohol use Liver dz Physical Lung disease Heart disease Schilling, 2007, Dong, 2003 Dube, 2003, Dong, 2004 Felitti and Anda, 2009

29. 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

30. 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

31. My contact info:Jordan Greenbaum, MD Jordan.greenbaum@choa.org 404-785-3829