Imagine that you are fast asleep. Suddenly you are awoken by a strange and frightening sensation. It seems to be inside your body and you might equate it to suddenly having 12 cups of espresso in your system, only worse—it’s more jittery, more jagged. You can’t escape the sensation, it doesn’t seem to go away, and you can’t possibly go back to sleep. But what’s really scary about it is that you don’t know or understand what it is, or if it might get worse. Your heart is racing and you seem to be having trouble getting enough oxygen. You don’t know if you are going to survive this onslaught that seems to be coming from inside you and racing through your body and you don’t know how long it will last. There is no escape. After your first or maybe second experience like this, you become too anxious to be able to relax and sleep, never knowing when this experience will be repeated and whether you will survive the next time.
Imagine then that this same experience happens unpredictably for a number of months: perhaps only occasionally, perhaps daily or even more often. This may be what it is like to be a fetus exposed to maternal substance abuse: particularly a substance like methamphetamine. The fetus is also exposed to its mother’s stress hormones–adrenaline, cortisol, norepinephrine—depending on her circumstances: there may be domestic violence, she may be homeless, prostituting, and not eating well. She is unlikely to get regular prenatal care and her baby may come early, and spend time in the N.I.C.U., where its already hypersensitized nervous system is further assaulted by the standard care that infants receive in most neonatal intensive care units: no warnings before a diaper change, a bath, or a needle being poked into a vein: if they are lucky, a nurse will speak softly to them, if not, sounds, lights, sensations and medical procedures can be exhausting and overwhelming. In addition, many of these children are detained from their mothers at birth and find themselves in the care of others: perhaps family members, or strangers. Some of the babies not detained at birth show up in the child welfare system months or years later: victims of neglect and possibly abuse.
By age three many of these children are being “suspended” or “expelled” from their preschool or day care for their aggressive behaviors, their resistance to following directions, their disruptiveness and their inability to relax and sit quietly through an activity or story. Many also have problems with falling or staying asleep, which may add to their irritability. By five, many of them will have been diagnosed with Disruptive Behavior Disorder, AD/HD, Oppositional Defiant Disorder and other similar childhood diagnoses. Some will begin on medication early, sometimes for a lack of alternative treatments (such as occupational therapy for sensory processing and/or regulatory disorders that often co-occur with AD/HD), or to keep their teachers happy and keep them in school, perhaps making it possible for them to avoid being placed in Special Education classes or classes for “emotionally disturbed children.”
I have a theory. I wonder if the sensations of angry feelings inside a preschooler are experienced as similar to the sensation of drugs in their bloodstream prenatally. I wonder if these children therefore believe that they cannot control angry feelings (the very big angry feelings common in 3-5-year-olds) because they couldn’t control the sensations of the drugs entering their fetal bodies carried by blood from their mother through the umbilical cord (although apparently many try—they instinctively contract the muscles around the umbilicus in a vain attempt to squeeze off the offending substance, but of course, can’t do this with complete effectiveness because they’d also be reducing their oxygen levels. These children tend to have constipation as infants and gait problems when they begin to walk from this chronic pattern of muscle contraction. I wonder if each time they experience feeling angry and frustrated they also feel the terror of possibly being annihilated by those sensations, just as they formerly feared the very real possibility of dying as a result of a huge overdose of a drug for the size of the fetal body. I wonder if their hyperactivity and inability to settle and focus results from the hardwired need to be hypervigilant, to watch out at all times for the next possible threat to their survival. I wonder if their aggressive behaviors are the result of the fight/flight system having become the dominant operating system at such a young age. Not necessarily that they are just plain aggressive, but that they perceive every stick to be a snake, every movement around them to be a potential source of danger.
I wonder what these souls seek in such a life experience. What makes them survive circumstances that might result in miscarriage for another fetus in a similar situation? They used to say that our fears for “crack babies” were overstated and that many turned out just fine. A psychiatrist I know said that prenatal drug exposure is such a random process it affects the brain like scattershot, so the damage is like Swiss cheese: little pockets of damage concealed among normal brain tissue. You may see the effects right away or not until later on. And no two children so affected are affected in quite the same way, though there are commonalities in many (see above). Is it treatable? Yes, I think so, in most cases. But whether the appropriate treatments are available and affordable varies by location and family circumstances. And then there are the families. Some are in denial that there is any problem. Others simply don’t notice anything out of the ordinary until later on. Some have limited resources. Some are misled by practitioners who are unaware of the possibilities for helping such children into thinking there is little or nothing they can do. Many children ultimately get medication, which treats symptoms, but not the source.
I would so love to find out what’s being done for these little ones around the country, and around the world. I’ll bet there are pioneers all over the place, some of whom are doing marvelous, brilliant things. I only wish they were right here where I live and work!
Here is a link to a report of a recent study on prenatal methamphetamine exposure: http://tinyurl.com/lgf5do
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