 vasoconstrictive feliception. So what it does is it tends to constrict blood vessels and thereby reduce blood flow. It also does it inside the fetus so that blood flows affected the various organs of the fetus including the brain, heart, kidneys, and that so that it has a tremendous effect on the fetus. It also tends to induce labor so that those babies tend to be born prematurely. In fact it's not unusual that a mom who uses cocaine may try and induce labor in herself by taking a large dose of cocaine. We get them though because they're premature. They come in with the respiratory problems. Their lungs aren't mature so they can't breathe. We get them because they're a thermal regulation. They have temperature problems. They don't have enough fat on their bodies. They're real slim. They're skinny babies. There's no fat on their bodies so they can't regulate the temperature. We get them because their gut is immature. They're intestine stomach. They're immature. They cannot feed so we have to give them IV fluids or parental fluids or they're too small to do the suck and swallow so we may have to feed them by tube. We get them because their nervous system is immature. They may be real real jittery. So there's a variety of reasons why they come in. A lot of times with your premature babies you can't tell if they're drug exposed. We know because maybe of the history but if we did not know if I were to walk in and see a premature baby I would not be able to tell you that this baby was drug exposed or not. What we're talking about is the kids that are basically have come through the whole thing with an intact brain generally good health but have some of the behavioral and other problems and there is a lot of bright hope that with really good thoughtful programs early on that those kids can be turned around and do just fine. So I think if we try to look above our own stereotypes and above our own prejudices and just you know encourage them the best you can then I think they've got great potential. Nobody says they can't be road scholars just because they had a slow start in life. While the drugs have been filtered out of her body the effect of the newborn's first environment may linger for a lifetime. As she leaves the healing forces of the hospital this young life faces the challenges of a second environment the home. Traditionally the home has been a place of security and love with all eyes on the newest member of the family. Unfortunately this is often not the case with the substance exposed baby. Substance abuse undermines the normal patterns of interaction and alters conventional priorities. This exposes the child to an unstable chaotic environment which will dramatically influence the child's development. However a setting characterized by structure consistency and warmth can go a long way toward reducing the difficulties associated with prenatal exposure to drugs. I think that it's a constellation of factors that we should look at with these children and the first of course is just how basically strong the child is genetically. Some children are going to be strong individuals they're going to be health wise strong and that's the way they're made. Then the prenatal period and what happened did mother get services. Was her environment fairly stable? Was the child involved in anything else except that you know the drugs and then after the child is born a tremendous and really important environment enters. This child has really three places that it can go. It can go to a foster care or group home setting that at this point in the United States I think is very overworked. It can go home with a mother who is may or may not be using drugs but certainly was using drugs or it can go into an institutional or maybe even a family you know grandmother and this grandmother is already or family is already dealing with the fact that one of their children use drugs during pregnancy. We hope that we'll be able to do the same kind of interventions with the caretaker whoever they are if it's a grandmother that we would have done with the biological mother. The problems they identify with foster parents are similar. Foster parent may have had many foster children and now all of a sudden has a foster child who has a little bit different need and responds differently than any other child in need that they have taken into their home before and so the foster parents too need special information special education on what works and what doesn't work with these children. They require a lot more attention a lot more love and care and understanding then than what my kids did when when they were little. It's just they're insecure they have episodes of screaming and there is their most aggressive more irritable the least little thing can set them off into a screaming episode. Many substance exposed children go home with their natural parent. The arrival of a baby is difficult for any new mother especially if she has a history of drug addiction. The challenges of caring for her baby are compounded by the additional needs of a substance exposed newborn. What it's like for me it's scary. I was really scared at first. I'm scared that I would use again and wouldn't be able to be there for. I'm scared that I can't do it and I can't be a mom and I'm not ready for it. I think that all mothers love their babies whether they're addicted to drugs or not. They can form a close attachment. I think the problem is that the environment that these children are raised in can can definitely make it very difficult for the child to have the types of role models that would be beneficial to the child. I haven't ever seen a mother who didn't love her child. It's just her drug addiction that causes her to put her energies elsewhere other than into appropriate parenting for her child. I prostituted but I never would come out and say you know I'll do this for this. I just say come to my house. I meet me here and they knew you know they did it to people night and day and I get high not for very long and then when it was gone I'd go back to the desperately seeking some other way to get more and it wasn't in my circle like that all the time and the more I prostituted the more dope I had to do to be able to live with myself for doing that because that is a nightmare. My kid missed my love and their attention and the caring and stuff and I know they love me but I wouldn't give it back to them because they drug won't let me I love that drug and then love my children. Parents who are chemically dependent often center their lives around drugs even if they want to quit they often can't and face tremendous guilt about their addiction. When I was in my using stage my main focus was getting high that was it I wouldn't have time to be a mom sometimes today when I think because I have cravings and things now to get high I just look at her and and I try to picture where would she be what would I if she was in her bed crying and I'm in here smoking crack what you know how could I do that because I can't it's totally impossible for me to do I can't have both I can't have I can't have crack and I can't have her I'm gonna lose her if I do smoke again. Now with a baby that is likely to have health problems be difficult and demanding and often less responsive and emotionally rewarding parents find it difficult to bond with and meet their child's needs. These are babies who don't make eye contact very well they're easily overstimulated and when they're overstimulated they have two responses either they respond into framed frantic crying almost rage or they shut down they go to sleep it's like tuning out the world. These are babies who don't like to be handled they don't cuddle well they aren't these aren't the babies that curl up next to your chin and and feel really good. Their babies that are hard to handle. The two smallest babies it was like the time when they wake up at night I'll be so knocked out I won't hear them and my stepmother she had to come in and wake me up you know and I used to get mad you know I used to get real mad. I probably cussed you know but what I can say for what I know now it's not good to do drugs pray or after you have that baby it's not healthy for neither one of you. Strangely enough sometimes a home that doesn't look cosmetically so good if there is a lot of interaction between the child and the caregiver if there is a lot of receptivity to your clue the baby's clues and the mother's clues it might really be a good growth promoting home. Conversely you could have a home that's in a very wealthy neighborhood that is very sterile where the people are not reading each other's clues whether they're not paying attention to each other that may not be a growth promoting home. Whether children come from wealthy middle class or low-income neighborhoods are raised in white Hispanic or African American homes or are cared for by foster parents family members or the natural parents. All children are products of their environments. There are factors within all of these environments that can have a positive or a negative influence on children as they grow older. Drug use, parenting skills, and neighborhood safety all affect a child's level of security and ability to bond. Consequently children who feel insecure and have difficulty forming attachments are developmentally at risk physically, intellectually, socially, and emotionally. As children walk into a classroom for the first time many carry the baggage of a chaotic beginning. It is easier to accept a child's behavior if you say well that child's had three placements it's never really had a good secure attachment with a parent. Well no wonder he can't sit still in his classroom. I think we at once we understand the history of a child the social emotional history of a child we are a bit more forgiving of their behavior and we can work better with the behavior. To prepare for these students schools should examine their current structure climate and resources. Take a look around see if there are other teachers that are experiencing similar concerns if so again pulling together as a team looking at what the schools problems are in in terms of reaching at risk students what particular plans have already been in place what's working what isn't and going from there in terms of developing new programs or more effective programs. Making a serious commitment to intervention will include everyone on staff starting with the principal. Here at Rowley we have a child study team or an intervention team and it consists of our school social worker school psychologist our referral coordinator for exceptional student education programs teachers speech therapists our guidance counselor administrators are on it and we also pull in additional help when we feel a need to. Each week we meet and we discuss children not only substance exposed children but all children because we have found that the characteristics of substance exposed children are very similar to exceptional students and we're trying to make sure that we clearly distinguish the two. The exceptional technology is very powerful when it's using regular education classrooms the problem is that regular educators it's not in their literature. By drawing on the resources and talents of a multidisciplinary team educators can make their schools more responsive to the needs of substance exposed children. I think some of the things that we have found is environmentally to make the room a very very safe and organized place for the child I think that a teacher that's very very organized that involves themselves with very structured routines and rituals will find that this population works best in that classroom. I also think that high respect for children space to lower the number of people that are walking in and out of your classroom you know to avoid it until that child can feel secure. To keep your classroom if you're going to make major moves in your classroom make sure the children are involved so they don't come into a strange environment. If you're going to be out make sure you're there involved in that decision that you're not going to be there so that they know what the next thing that's going to happen to them is they're very comfortable with the next decision. I think that's the most important in this population because they are so disorganized we're not sure if that disorganization comes from central nervous system damage. The withdrawal period when they were very very young and babies were learning to organize themselves in infancy and they were going to withdraw or the environment that happened later being so chaotic but we do know that when the child feels very stable and secure in the classroom that we have a much more comfortable child. Also I think the areas in our classrooms need to be very very clear as to the function. We do have art areas and dramatic play areas and block areas but we do need to make these very very clear and I think that helps reduce verbal commands so that you'll have less inappropriate behavior. You'll have less directions for the children. It's very clear to them what goes on in this area of the room. Classroom rules expectations and consequences should be posted and their meanings understood by the students. I have a lot of very high expectations. I have a very quiet classroom. I think that an environment where people are you know where expectations aren't set can add more chaos. So in my particular classroom you will see a fairly high degree of expectations. Consistent scheduling of the day's events adds much needed stability for substance exposed children. Routines and rituals have to be so ingrained in these children. They have to understand that we will be there that this follows that follows that and follows that in the beginning of the year. I don't expect children to tell time but I do know that if I repeat over and over again that after breakfast we have circle after circle we have play time after play time we have music. They expect that sequence to move. If play time is shortened to great deal they don't seem to be very upset as long as I move to music next. We took the day and we broke it up into chunks. There was a schedule on the wall and we called those chunks components. So there's a number of components in the day and we made a sheet with icons of all the components of the day. The kids call them tickets and so that's kind of what we call them now is tickets. Each ticket has a blank space next to the icon. At the beginning of the day we give the kids their tickets and we discuss what's going to happen during the day. If there's going to be an alteration in the routine then that's written in on the ticket. So the kid knows what's going to happen to them during the day and that has had a dramatic impact in helping them to delay reinforcement to understand where they are in the routine. And it looks now like it's a lifeline that when there's an alteration in the routine they become visibly upset. At the beginning of the day when the teacher says our routine is going to be the same today the kids will cheer. They'll break out in applause because they know that that day everything's going to go the way they expect it to go. I think transitions are generally hard for young children. We found that we need to use physical and or verbal cues with the children. If it's cleanup time-time to go to music we might give them a 10 minute warning then a 5 minute warning then a 3 minute warning and little by little the child hopefully will be able to organize himself also will be able to predict what comes next in the day. There's a timer so everybody should be putting your work up now. Thank you. This is a challenge for teachers because teachers are trained primarily to be educators. However with the children of today many of us are having to be social workers, mothers, fathers, nurses and we're trying to take on a variety of roles. And I think what the teacher needs to do a few things first of all work with the family get a good history of the child find out from former teachers what that child's experience has been at school and then if the teacher feels that further intervention is needed use the resources available within the school. Some children might need additional help with speech and language. Some children might need some resource help. Some in some cases the teacher might want to work closely with the social worker or the school psychologist and try to develop as good a team as possible within the school setting. I think knowledge goes a long way in terms of helping teachers get ready to say to settle their classrooms to be stable environments to meet the needs of all children. Once they have that knowledge I would add in-service training. I'd also encourage teachers to become more proactive in working with families and making sure that they understand the children and also get into a problem-solving mode with the parent so that they can work together on helping children. Play is a normal instrumental part of development. Through play children learn to understand themselves, their relationship to others and their place in the world. A chaotic background often steals important opportunities for children to benefit from organized play. These missed opportunities may make it difficult for children to understand the rules of a game or why they have to take turns. They may also have trouble organizing individual play activities appearing confused and unable to focus on what they're doing. By supporting and encouraging play teachers can open an important new world for many substance-exposed children. A world which will help them learn new skills and develop stronger friendships with their classmates. High-risk children have always been in the classroom. Over the years educators have identified the behaviors of these students and developed effective intervention strategies. By drawing on these experiences, learning new information and using the resources in the school and district, educators can be successful in teaching all high-risk children, especially those that have been exposed to alcohol and other drugs. Like all high-risk students, substance-exposed children will exhibit a diverse range of behaviors. As young children move through space and manipulate objects in their environment, they learn about themselves and their world. Many factors influence the development of motor and spatial behavior in children. Inadequate care in the prenatal and early stages of life may cause children to have fine and gross motor delays. Young children exposed to drugs prenatally or environmentally are particularly at risk since they are often under-stimulated and not supported in the development of motor and spatial skills. Some of these delays are fairly obvious. Children may trip when walking. They may have trouble judging distances, which can result in moving too close or too far away from an object so that they seem a little clumsy. They may have trouble grasping objects like a crayon or a toy. They may have difficulty manipulating materials like the piece of a puzzle or a carton of milk. These are the children in gross motor that you would call clumsy or adaptive P.E. called clumsy. If you're holding their hand, they walk into you. They don't walk with a child that does that. They just walk into you, trips over their own feet, walks into walls. They're not grossly. They don't have that ORT classification. There's not cerebral palsy there, but they just don't have a very good idea of where they are in space. Many children seem uncoordinated at one time or another. Even adults sometimes feel as if they have two left feet. The difference is that compared to their classmates, children exposed to alcohol and other drugs are likely to be delayed in developing their motor and spatial skills. Teachers and caregivers can help these students to catch up by reminding them of physical obstacles in their environment and by helping children judge how near or far away they are from objects or boundaries. By physically guiding children through the specific steps of an activity, teachers can help their students develop better body control. Songs, games, manipulative exercises, tactile activities and special equipment are all tools which teachers can use to enhance the motor and spatial development of substance exposed children. Very good. Four plus two equals six. Good. Go on, you're doing a good job. Language is a highly complex function which develops as a result of the interaction of cognitive, motor and social skills. Children who were not led to, did not have access to books or were not supported in learning new words are likely to have a slow start in language development. When you feed a baby, they suck for a while and then they stop and then they suck again and it's a pattern, it's a rhythm that takes place. And if you watch a mother and a caretaker and a baby doing this together, you'll see that when the baby pauses inevitably the caretaker does something. They jiggle the bottle or they pat the baby or they stroke the baby's cheek or they do something. It's a, it's a dance that develops. It's sort of like the baby says something and the mama says something and the baby says something and the mama says something. And we say they're waltzing. We say they're dancing with each other. And when they have been doing, when they do developmental tests on these children as they grow up, they're finding that although some of these children test out normal or low normal in all of the developmental scales that we, that we commonly use, that they frequently are very low or if they bottom out on anything it's in language development or sometimes in the fine motor movements. And one of the theories is, is they, they don't do well in language because they don't have this, they never learn this suck pause response. As teachers assess the language needs of their students, key areas of concern are delays in expressive and receptive language, prolonged infantile articulation or baby talk. Difficulty in understanding directions and an inability to verbalize needs, wants and fears. Substance exposed children also have difficulty choosing the words to match what they want to say. Use your words. Tell me what do you want to do? What do you want to do? I don't want to bite me. Their resulting frustration may lead to shouting, stomping or other inappropriate and aggressive communication behaviors. Such barriers to effective communication may cause children to remain passive observers rather than active participants and classroom activities. Teachers can help children develop good language and communication skills by making direct eye contact with the student and gently guiding the child's gaze to her own. Are you eating eggs and grits too? Yeah? Okay, let's look at, well, let's look at this. Let's look to see what we've done. That's right. Six, right. Once accomplished, the teacher can use words the student understands to give step-by-step instructions and gradually increase the complexity of directions. Usually you're gonna fix cubes, show me what you did to get six. By repeatedly reminding students to say what they want instead of pointing or shaking their heads yes or no, teachers can help students to interact more effectively with others. Also, teachers who model good language and communication skills provide the student with actual visual cues. This makes it much easier for a student to understand what the teacher expects. Right there on the table, do you need to move some stuff up the table? You can do that. Recognizing that appropriate and inappropriate behavior often results from unmet needs. It is important to plan and implement strategies which encourage children to appropriately express needs, wants and fears. Last and perhaps most important, the teacher should always take time to listen to the student. This way, she can praise the child's efforts to use good language skills because much of language development rests on students feeling confident. It is often best to ignore the small mistakes students make while speaking. He wants to add. He wants to teach you how to add. We've already started adding. Let's see if we can add now. Okay. Who'd like to come and do this first Parliament? Add it for me. Okay. Frederick, would you like to come up here? Learning occurs in a developmental framework. It is an ongoing process in which the child constantly organizes and reorganizes experiences within a continuum of stages. While children have an unending potential for learning, the ability to perceive and explore the environment may be delayed in a child who has been prenatally exposed to drugs. When you're trying to instruct them, they don't remember things the way you would expect kids to remember. For instance, one of the activities kindergarten kids have is there's four pictures and you paste them down on a piece of paper in order. So one picture will have a kid with a glass and a carton of milk and the next picture he's pouring it and then he's drinking it and then there's an empty glass and he's satisfied. These kids will put them together anyway. In fact, in talking to these kids, they had a lot of characteristics of people who get labeled autistic. They don't remember things in linear time order. They remember them in order of importance. So they will tell you the most important. So when you say what happened first, first to them means what was the most important thing out of the elements. So they will remember the most important thing and then in descending orders of importance. So like if they saw somebody get hit and start bleeding and say that was blood and we were going then we went to the door and as you listen to it, you say it doesn't make any sense. There's no linear conception to it. And that's exactly right. Well, in terms of education, education is a linear activity. You put in a little bit of foundation and you build on it. Well, if the kid doesn't understand that letter recognition is going to end up with word recognition because they don't have any concept linear time, then there's no payoff to learn your alphabet. There's no payoff to do anything. Children who are easily distracted by sounds, movements or people may be showing signs of cognitive delays. The ability to concentrate and visually scan words and pictures may also be impaired. Many high risk children have trouble with problem solving, become frustrated and in turn give up on challenges quicker than their classmates. Substance exposed children sometimes seem to achieve a task one day and then forget the skill the next. This sporadic mastery of skills contributes to their frustration with learning. They sometimes feel unsafe when their routine has been changed and may withdraw from an activity. To help students with cognitive development, the teacher should limit classroom interruptions and outside distractions as much as possible. It is also important to protect the child from too much or too little stimulation. A consistent daily routine and structure will provide substance exposed children with security and comfort while helping to regulate the amount of stimulation they will experience in the classroom. If there are changes, children handle them best when teachers alert and prepare students for visitors and schedule alterations, especially events such as fire drills. High risk children may have trouble understanding sequence in the order of events. The teacher can help develop the concept of linear time by teaching the child to take one step at a time, talking through each task step and asking the child to process these steps. Then what did we do? Okay, come on, you're going to have the teacher show me what you did. The teacher can also use other children to model the completion of tasks while the targeted children observe. And as always, the teacher should praise the child throughout the process as well as at the outcome. Very good. So we can say that three plus one equals four. Right, Eric? Is that correct? Three plus one equals four? You scared? Yeah. You know, I got much scared. What is it you're scared of? Is it different for you? Do you trust me? You think I'll take care of you? The early years of life are critical for social and emotional development. During this time, a secure and dependable environment fosters self-confidence and trusting relationships with the child's adult caregivers. But an inconsistent environment that is insensitive to a child's needs, such as a home where drugs are the primary focus, stimulates fear and suspicion. These feelings can manifest themselves behaviorally in the classroom. Biting other kids, injuries that required medical attention from our nurse. We had a kindergarten kid suspended for aggression towards another kid. I'd never seen kindergarten kids suspended for that. We had kids who'd pick up chairs and throw them at the other kids, try and stab them with scissors. When probably the other thing that we noticed the most was a total lack of social understanding or social control when it was playtime. We used to call it free time but now it's structured play activities and they brought out different things to play with. If it was my truck and you dared to touch my truck, you would eat my truck. I mean they would become physically protective of whatever item they were playing with. Many children who have been prenatally exposed to drugs have had a chaotic beginning, have been in multiple placements, have had multiple caregivers. So we really need to look at that in understanding the child and we very often see the result of that in behaviors. We see children who have difficulty relating to adults. We see children who are very clingy, who need constant holding and especially at the preschool level and I think that one thing that we find is that when we try to meet those needs that then the child will be better able to cope and to move beyond that stage. Some children may engage in indiscriminate attachment to unfamiliar adults. While this may seem like a friendly gesture, it is often the result of a lack of bonding in their early lives. We refer to it as indiscriminate attachment, which we see more often than children that are withdrawn. The indiscriminate attachment is at age three or four, developmentally children should be at a point where they look to a familiar figure to get approval to go to a non-familiar figure. So if they're with mother, they look up to mother. She says, yes, this is someone I know. This is someone you can go to and the child then may move toward that person. More than likely they'll still stay pretty close to mom. Same in a classroom. If you go into a classroom with a three-year-old, they huddle all behind the teacher when a stranger comes into the room and look to the teacher in a way to say, I'm waiting for your approval so I can move toward this. The teacher then will say, oh, this is the principal and she's come to visit us. Let's all say hello. Our children, as a rule, if a stranger walks into the room, if we are careful about it, they'll just run up. They may call that person mommy. They may say to them, are you here to see me? Hold my hand. If the person sits down and say our music, they'll crawl right up into their lap and at first it's viewed as how friendly they are. And I think people enjoy children that are that friendly, but when you see it consistent where you realize that that child has no one that they turn to for security. So we work very hard in the classroom going back to the original problem of no attachment, of attaching to a teacher or attaching to the assistant, bonding with someone so that they will feel that that person has given them safety to check with that person. And I think without that, this is a population with the indiscriminate attachment that we're going to have real problems later on because they're always going to be looking for someone for that security. And I think in adolescence that gives us some real problems. Expressing emotions is difficult for anyone, especially if they've had a chaotic start in life. Substance exposed children may have poor inner control, losing their tempers more easily and more often than their classmates. These outbursts often contribute to conflicts with other children and undermine their ability to build friendships. Their peer relationships also suffer because they have trouble empathizing with other children. High-risk children may also have trouble in their relationships with adults. While most children use adults for comfort and approval, substance exposed children may not look to their teacher's full recognition or even respond to verbal praise. This may result in ignoring or challenging routine simple instructions and not understanding the meaning of a stern look or other nonverbal cues. The teacher may find it helpful to move close and look directly at the child while explaining exactly what her look, body language or gesture means. The teacher should also take advantage of opportunities to develop a nurturing relationship using facial expressions and touch. It is also helpful for the teacher to center activities around the child and make sure the child has his or her own space. To help students understand and control their emotions, the teacher can use manipulatives such as books, stories, dolls, pictures and games. Also by helping students identify and describe their own emotions, students may begin to build empathy for others. The teacher should also enforce consistent limits of behavior and respond to infractions with predictability and regularity while talking the child through the consequences of his or her actions. Exaggerated behavior patterns are often the way children cope with stressful and overwhelming situations. By establishing a responsive nurturing classroom, teachers can build self-esteem and create a safe environment, one that is conducive to learning and teaches the skills necessary for positive healthy development. There is no typical profile of a high-risk child who has been prenatally or environmentally exposed to drugs. Each must be seen and respected as an individual with particular strengths and vulnerabilities. The sources of a child's behavior must be understood for teachers to develop specific interventions geared to the individual child. Rather than labeling children as crack or cocaine babies, educators should view these children as individuals, each with their own unique characteristics. These traits develop from the medical impact of their mother's drug use, their different home and community environments, and the positive and negative experiences of their young lives. The specific behaviors and interventions discussed in this video should be viewed as separate pieces of a puzzle. These behaviors and interventions have been highlighted and separated for learning's sake only. Now it is up to each educator to fit these pieces back together and create the whole picture of a very special child.