"Adults may interpret normal infant or child behavior as abnormal if adults have preconceived negative beliefs about the consequences of prenatal drug exposure," says lead author Ruth Rose-Jacobs, Sc.D., of Boston University School of Medicine.
Recent research suggests that most maladaptive behavior and developmental delay in children from urban and impoverished areas is not uniquely due to prenatal cocaine exposure, and, conversely, that such exposure does not necessarily lead to developmental delay or behavioral problems.
Using a battery of standardized cognitive and behavioral assessments, assessors tested 163 children who were relatively healthy at birth. When the children were compared on a computer by their actual cocaine exposure, there were no statistically significant differences on the developmental and behavioral tests. Other biologic and social factors that could influence the development of impoverished children were not evaluated in these analyses, the researchers note.
Assessors in this study were purposely not told of the children's actual cocaine exposure and developmental history. The study, published in the October issue of the Journal of Developmental and Behavioral Pediatrics, refers to these assessors as "masked" to exposure status.
The masked assessors labeled 111 of the 163 children as having been exposed to cocaine prenatally, although only 87 had actually been exposed. The assessors did not report reasons why they classified certain children as cocaine exposed. The children who had significantly lower scores on all of the administered assessments were assumed to be cocaine-exposed by the assessors regardless of actual exposure status.
"In other words, the assessors were not only unable to correctly identify which children had been exposed in-utero to cocaine, they were also more likely to presume exposure if a child displayed cognitive and behavioral problems during testing," says the study's lead author Rose-Jacobs. "These results suggest that clinicians and educators should distrust the perception that at the preschool age, there are subtle cues that allow them to 'just know' who is cocaine exposed."
"Stigma itself is a social and developmental risk to children who were cocaine-exposed prenatally, regardless of the pharmacological effects of the drug or the reasons for assuming cocaine exposure," the researchers warn.
Previous research has shown that the same videotapes of healthy infants were rated very differently when given the label of "born without any known problems" versus "born without any known problems other than the infant's mother had used cocaine during pregnancy." When videotaped infants were labeled cocaine-exposed, they were rated as less smart, affectionate, well behaved, outgoing, cheerful, alert and coordinated than when they were not so labeled.
Labeling children as cocaine-exposed may lead to the imposition of negative expectations, which in turn undermines the children's cognitive and behavioral development, they said.
"Rather than merely creating a stigmatizing label, early identification of cocaine exposure should provide these children with the same treatment and nurturing needed by all children who are at developmental risk," says Rose-Jacobs.
The study was funded by grants from the Foundation for Physical Therapy Inc., the National Institute of Drug Abuse and the National Center for Research Resources.
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