“We’ve been observing your kindergartner,” the teacher said, “and he needs special education.” I was sad but not surprised. Alex would be my third adopted child to need special education.
I adopted all three from the foster care system. They were not siblings before joining my family, and none of the three suffer from a hereditary condition. The bond they share is that their biological mothers used drugs while pregnant. And meth and opioid use during pregnancy can cause irreparable brain damage.
Pregnant women struggling with addiction need early and effective paths to sobriety. This would both decrease the effects of drug exposure in the infants and decrease the likelihood of foster care by giving moms a longer runway for recovery.
Alex’s report reads like so many others’ born in these circumstances: “Learns very slowly compared to peers; difficulty recalling information; below grade level in writing and math.”
Every three minutes, a woman seeks care in an emergency department related to prescription opioid misuse. With the opioid epidemic at an all-time high, a child like Alex is born roughly every 15 minutes. These children will bear the costs of their mothers’ mistakes throughout their lives.
Children like Alex suffer varying degrees of neonatal abstinence syndrome, or NAS, the group of problems that can happen when a baby is exposed to drugs like meth, heroin and opiates while in their mother’s womb. These children have a lower birth weight, length and head circumference, and they are more likely to be born with birth defects.
Impaired development of a child’s nervous system is evident as early as 6 months old across multiple measures of intelligence. These kids also display declining academic achievement relative to their peers in reading, math and writing. Asking my kindergartner to write his name might as well be asking him to write the great American novel.
On society’s frontlines, teachers triage these children and watch helplessly as special education rates climb. The American Journal of Managed Care reviewed a cohort of children in Pennsylvania and estimated the cost of a limited provision of 3 to 5 years of special education services for children due to NAS-related disabilities ranged from $24.8 million to $41.3 million. The costs don’t stop there.
Children with NAS are 2 to 3 times more likely to fail to attain grade-level achievement compared with controls, which means grade retention and all its associated costs. In our home, attaining grade-level achievement is celebrated like acceptance into Harvard. To be on grade level is to triumph against the odds.
State and federal policy should squarely address the national crisis of neonatal abstinence syndrome. In particular, funding streams for the prevention of foster care should be broadened to include and prioritize assisting pregnant women with treatment and sobriety. This would decrease the likelihood of foster care by giving the parent a longer runway for sobriety and decrease the effects of drug exposure in the infant. The need for special education, retention and a host of other physical and mental impairments inflicted on new lives will be drastically reduced.
Federal law has opened more resources for substance use treatment, but the doors remain closed to too many pregnant women. Women with first-time pregnancies, or women with children not deemed at risk of entering foster care, do not qualify for help. Under the Family First Prevention Services Act, treatment is only available after a child has been placed in state custody or to prevent a child from entering foster care.
Until federal law is fixed, the states can seek waivers to establish a statewide “no wrong door” system of care for pregnant women, eliminating red tape and prioritizing treatment. A few states have also sought and received permission to extend postpartum coverage to 12 months, instead of the current 60 days, giving mothers the consistent care they need to improve chances for sobriety.
Only a handful of states have created or funded drug treatment programs for pregnant women, and those plans and policies remain patchy. One worth watching is the Colorado Special Connections program. Special Connections provides a comprehensive range of treatment services to pregnant women for up to twelve months postpartum, including residential treatment, individual counseling and referral to aftercare and ongoing support.
More money for substance abuse treatment does not necessarily mean better outcomes or higher efficacy, so honest measurements must accompany programs with a commitment to constant improvement and adaptation.
At the same time, we must seek a smarter balance in child protection laws. Twenty-four states consider substance use during pregnancy to be child maltreatment under civil welfare statutes. The impetus for these laws is understandable given the impact of drug use on the infant in utero.
But the unintended consequence is that women are afraid to seek help and risk being turned in. To give more infants a chance at a healthier start, women who seek and sustain treatment should be held harmless from these punitive laws.
For Alex and his siblings, the time for prevention has come and gone. But acting together and quickly, we can protect the next generation of infants from the addictions of their parents through quality treatment programs.