Tuesday, July 23, 2013

Crack babies and convenient explanations of poverty

The Philadelphia Inquirer has a story on a 25-year-long longitudinal study of 224 children (110 actually participated for the full 25 years) that set out to show the dangers of uterine crack cocaine exposure to children.  Instead, they wound up showing the dangers of poverty:
At age 4, for instance, the average IQ of the cocaine-exposed children was 79.0 and the average IQ for the nonexposed children was 81.9. Both numbers are well below the average of 90 to 109 for U.S. children in the same age group. When it came to school readiness at age 6, about 25 percent of children in each group scored in the abnormal range on tests for math and letter and word recognition.

"We went looking for the effects of cocaine," Hurt said. But after a time "we began to ask, 'Was there something else going on?' "

While the cocaine-exposed children and a group of nonexposed controls performed about the same on tests, both groups lagged on developmental and intellectual measures compared to the norm. Hurt and her team began to think the "something else" was poverty.
Basically, the study determined that poverty is really bad for children.  It's not hard to think of better headlines for this story (Poverty Bad for Children: Science).
As the children grew, the researchers did many evaluations to tease out environmental factors that could be affecting their development. On the upside, they found that children being raised in a nurturing home - measured by such factors as caregiver warmth and affection and language stimulation - were doing better than kids in a less nurturing home. On the downside, they found that 81 percent of the children had seen someone arrested; 74 percent had heard gunshots; 35 percent had seen someone get shot; and 19 percent had seen a dead body outside - and the kids were only 7 years old at the time. Those children who reported a high exposure to violence were likelier to show signs of depression and anxiety and to have lower self-esteem.

More recently, the team did MRI scans on the participants' brains. Some research has suggested that gestational cocaine exposure can affect brain development, especially the dopamine system, which in turn can harm cognitive function. An area of concern is "executive functioning," a set of skills involved in planning, problem-solving, and working memory.

The investigators found one brain area linked to attention skills that differed between exposed and nonexposed children, but they could not find any clinically significant effect on behavioral tests of attention skills.

Drug use did not differ between the exposed and nonexposed participants as young adults. About 42 percent used marijuana and three tested positive for cocaine one time each.
As the Inquirer piece points out, this is not a new finding.  We have known for years that crack baby hysteria is based on lies and hypocrisy.  But it's easy to forget just how far it went; based on the crack baby craze, numerous states enacted laws defining prenatal drug use as child abuse or neglect; some states even enacted laws allowing child protective services to imprison drug abusing mothers.  While these laws technically apply to all types of substances, the focus was clearly on crack: newspapers generally don't keep archives dating to the late 1980's, but here is one about an Illinois law entitled Ryan says "crack baby" law a success.  And, while these laws technically apply to all mothers suffering from addiction, there is a clear racial bias in their enforcement.

All of this is particularly inane when considered that the dangers of alcohol exposure during pregnancy (Fetal Alcohol Syndrome, now known more appropriately as Fetal Alcohol Spectrum Disorder) have long been known:
Problems that may be caused by fetal alcohol syndrome include physical deformities, mental retardation, learning disorders, vision difficulties and behavioral problems.

The problems caused by fetal alcohol syndrome vary from child to child, but defects caused by fetal alcohol syndrome are irreversible.

There is no amount of alcohol that's known to be safe to consume during pregnancy. If you drink during pregnancy, you place your baby at risk of fetal alcohol syndrome.
The fact that FASD is common, yet (until recently) largely ignored reflects the fact that the crack baby hysteria was about creating a convenient explanation of poverty, and not out of concern for infant, child, maternal, or public health.  This is further supported by the fact that the focus lay on crack cocaine, rather than powder cocaine, a well-known, flagrant racial bias; the only difference between powder and crack cocaine, of course, is that white drug users prefer powder cocaine:
The sentencing disparity between the two forms of cocaine dates back to 1988 when Congress established a special sentencing exception for cocaine base or "crack." That year, Congress increased the penalties for the sale of crack cocaine so that a dealer with five grams of crack received the same punishment as a dealer who had 500 grams of powder cocaine, a disparity of 100-to-1. Congress also increased the penalty for simple possession of crack to five years. Before that time, the law did not distinguish between the punishment for powder and crack cocaine...the vast majority of powder cocaine users were white.
As the Inquirer points out, this entire movement was based on "anecdotal" evidence--one premature baby here, one developmental disability there, etc.  It's telling to note how limited anecdotes stuck to society's throw aways, but not to society's more affluent (or white) drug users.

All this argues strongly about entire purpose of crack baby hysteria and crack baby laws.  None of these drug scolds actually care about public, child, or maternal health.  They simply want to absolve themselves of their responsibility to fight poverty:

We can't do anything about poverty when it's caused by an out of control crack cocaine epidemic.  The real issue is these mothers that can't control their urges to do crack, and there's nothing we can do to help those poor kids or their mothers.  Because of the crack, America's urban youth are beyond any help we can offer them.  We would help if we could, but there's simply nothing we can do.

How convenient, of course, that the explanation for poverty involves an unstoppable personal vice and children who are beyond help.  Both absolve any responsibility to solve the problem because there is nothing that can possibly be done.  Providing day care services, maternal care, children's health care, more funding to schools, after school activities, libraries, summer enrichment activities--none of these things would work.  How convenient that spending no money is exactly as effective as spending money.  Were crack baby concerns honest, they would have focused instead--decades earlier--on the well-documented risks of Fetal Alcohol Spectrum Disorder, or at least not have made the imaginary (and racially motivated) distinction between crack and powder cocaine.  Clearly, the intent was to absolve responsibility with a convenient explanation of poverty: We'd love to help, but there's simply nothing that can be done.

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