THE EPIDEMIC OF CRACK COCAINE had just hit the inner cities in the mid-1980s when pediatricians and hospital nursery workers began reporting truly harrowing observations: babies born to women who had used cocaine while pregnant were not like other infants. They were underweight. They trembled. As newborns they were as rigid as plastic dolls. They cried inconsolably, seeming to recoil from hugs or touches and startled at the slightest sound. As they approached school age, it seemed that many could not sit still or focus, even on activities they enjoyed. For schools and for society, warned the press and the legions of anti-drug crusaders, cocaine babies would be a lost generation.
Well, scientists have found this generation. The snow babies, it seems, are neither the emotional and cognitive cripples that many predicted--nor the perfectly normal kids that biological revisionists have lately been claiming. Last week, at a landmark conference in Washington convened by the New York Academy of Sciences, more than three dozen neurologists, pediatricians and other researchers presented studies suggesting that the effects of cocaine on a fetus are far from simple, let alone predictable. They depend not only on such obvious things as how much of the drug the mother took and when but also on what sort of environment the baby grows up in. Although studies on large numbers of school-age children are only beginning, research on toddlers suggests that ""most cocaine-exposed children do very well,'' says Dr. Barry Kosofsky of Harvard Medical School, co-chair of the conference. ""Cocaine is not a sledgehammer to the fetal brain.''
But neither is it a prenatal vitamin. Experiments show that rats, rabbits and monkeys exposed to cocaine in utero are profoundly messed up. Their brains develop abnormally. Neurons are too long or too short. ""Receptors'' to which brain chemicals attach are too many or too few or too sensitive. The animals' behavior reflects these aberrations: they typically act impulsively, have trouble learning and can't block out extraneous sights and sounds when learning a task. The challenge, obviously, is to figure out why the human and animal data tell such a ""on the one hand, on the other hand'' story it takes a human octopus to keep it all straight.
One reason cocaine-exposed children do not seem to be faring worse may reflect how human studies are done. To get a clean result, scientists must compare children who are as similar as possible on every measure except the one being studied--cocaine exposure. It is a fact of life, and thus of science, that the women and children who wind up in these studies are not the wealthy Wall Street traders sniffing a line at the end of a hard day. Instead they are poor, and often single, and the home they bring their baby to can be chaotic. These children have so many strikes against them that adding cocaine to the mix may not hurt them much more. Or as Prof. Barry Lester of Brown University puts it, ""If you grow up in such a lousy environment, things are so bad already that cocaine exposure doesn't make much difference.'' That may be the case in a study at Philadelphia's Albert Einstein Medical Center. At the age of 4, cocaine-exposed kids score 79 on IQ tests; their peers in the impoverished neighborhood score 82. The U.S. average is 90 to 109.
Studies of coke-exposed children may also be looking for the wrong thing. ""It is possible that what is being tested are not areas where these children are most vulnerable,'' says Lester. In tests at Einstein, for instance, cocaine-exposed children figure out the locks and secret compartments in a box holding little toys. And at the University of Illinois, Dr. Ira Chasnoff finds in his study of 170 children that the coke-exposed ones had roughly the same IQ scores at the age of 6 as those whose mothers were clean. But children take IQ tests, and do puzzles for scientists, in quiet rooms with few distractions. All of the animal data suggest that the brain systems most damaged by cocaine are those that control attention and, especially, screen out irrelevant sights and sounds. ""The children do fine in a quiet room by themselves,'' says neuroscientist Pat Levitt of the University of Pittsburgh. ""But there is no question they have alterations in their brain structure and function which, while not keeping them from learning a task in isolation, could well hurt them in real life.''
Real life is the classroom as multimedia madhouse, with posters covering every wall and kiddie art dangling from lights. It is not clear how cocaine-exposed children will fare in such environments. Of the 119 studies on how cocaine affects a child's development, reports Lester, only six have followed the children beyond the age of 3. One is already setting off alarm bells. A pilot study at Wayne State University in Detroit finds that teachers rated 27 cocaine-exposed 6-year-olds as having significantly more trouble paying attention than 75 non-exposed children (the teachers did not know who was who).
There is little debate that distractibility hinders learning. That's why thousands of parents put their hyperactive children on Ritalin. And that's why cocaine-exposed children who seem to be OK now may fare worse as they make their way through school. Dr. Gideon Koren of Toronto's Hospital for Sick Children is following 47 cocaine-exposed children who were adopted as infants. Their new families ""can't tell the difference'' between these children and others, says Koren. But he can. When the children were 3 years old, their language skills were developing a little more slowly than that of nonexposed children; there were no IQ differences. But at the ages of 5 and 6, an IQ gap of 10 points has opened up. The older the children get, says Koren, ""the more likely there will be [cognitive] differences'' compared with other kids. ""These must be biological differences.''
It's too soon to draw final conclusions. Clearly the legions of crack babies have not turned out as badly as was feared, but the damage assessment is continuing. Most likely, the effects of cocaine are real but small. How starkly those effects show up depends, argues Kosofsky, on myriad factors, including the environment in which the child is raised. In Toronto, Koren's cocaine-exposed kids have, at the ages of 5 and 6, lower IQ scores than their otherwise healthy siblings. But their average score of 106 is still more than 20 points higher than typical scores of children raised in disadvantaged homes.
There will be plenty of time for further study. Even though the crisis has left the front pages, every year at least 40,000 babies are born to women who took cocaine while pregnant, according to a 1995 estimate by the National Institute on Drug Abuse. For years these children have been demonized and written off. But as the results of studies of young children show, few are beyond the help that a loving and stress-free home can provide. As last week's conference broke up, scientists who spend their nights tracking neurotransmitters and their days running underfunded clinics for cocaine-exposed kids raised a very different question: is labeling these babies ""hopeless and lost'' just a handy excuse to avoid helping them and their mothers?