Prenatal cocaine exposure not linked to bad behavior in kids

Toddlers exposed to cocaine before birth exhibit no more behavioral problems than other children their age, despite early predictions that "crack babies" would grow up to be delinquents, University of Florida researchers say.

Studying 3-year-olds exposed to crack and powder cocaine in the womb and a similar group of children who were not, UF researchers found that disruptive behaviors in children actually seem to be linked more closely to maternal depression than prenatal cocaine exposure.

"In all of the various outcomes we have looked at, people have expected very bad things," said Tamara D. Warner, Ph.D., a postdoctoral associate in the UF College of Medicine and lead author of the study. "These dire predictions were made about this group of kids. This study shows there really aren't the huge problems that we might expect."

The researchers found that mothers, on average, reported a high number of symptoms of depression, regardless of whether they used cocaine during pregnancy, according to findings published this month in the Journal of Developmental and Behavioral Pediatrics. Biological mothers also tended to report more behavioral problems than nonmaternal caregivers and foster parents, who were caring for about half the cocaine-exposed children by the time they reached 3.

"One might have expected that caregivers who took on children with prenatal cocaine exposure would've expected (more problems) and reported a higher number of problems," Warner said. "But that wasn't the case."

The researchers studied 256 children, about half of whom were exposed to cocaine before birth. Most of their mothers were poor and black and lived in rural North Central Florida.

Poverty could explain why many of these mothers showed signs of depression, and in turn, depression could explain why mothers of cocaine-exposed and non-exposed children tended to report more behavioral problems, such as hyperactivity and impulsive behaviors, Warner said.

About 5 percent to 10 percent of children exhibit disruptive behavioral problems. But the mothers UF researchers studied reported that as many as 46 percent of their children demonstrated certain disruptive problems, Warner said.

Mothers could be showing signs of depression because of their children's misbehaving ways, but researchers can't pinpoint whether maternal depression causes misbehavior or if disruptive behavior leads to depression.

"If you're poor and you need mental health services, you're in bad shape," Warner said. "Both sets of moms were reporting a large number of depressive symptoms and have been from the beginning. And that is probably more likely to result in emotional behavior problems for the children than prenatal cocaine exposure."

Deborah Frank, Ph.D., a professor of pediatrics at Boston University's Boston Medical Center, also noted that UF is the only institution studying rural mothers, important because urban mothers face different obstacles, such as violence, which could potentially affect childhood behavior and rates of maternal depression.

"The very high rates of clinically important depression in all the (maternal) caregivers are striking," said Frank, who also studies prenatal cocaine exposure. "We're finding that the most devastating effects are from the postnatal environment, not the prenatal environment.

"None of this research should be taken as, 'It's OK to use crack when you're pregnant," Frank added. "It's not something women do for fun. It's something women do out of despair."

Tackling that despair is still a problem that needs to improve, said Marylou Behnke, M.D., a UF neonatology professor and co-author of the study. Access to treatment programs and mental health services is still poor for mothers, she said.

Behnke and Fonda Davis Eyler, Ph.D., began studying children exposed to cocaine prenatally in 1991. Their research, funded by the National Institutes of Health's National Institute on Drug Abuse, has debunked beliefs that cocaine-exposed children would be malformed and not have the same cognitive abilities as other children. Last year the researchers reported that cocaine-exposed children exhibit only subtle problem-solving differences in school. The children they studied, including the 3-year-olds in the current study, are in their early teens now.

"There were really dire things that are being predicted," Behnke said. "It's encouraging that we're not seeing those kind of behavioral problems."