Now we are on the precipice of learning through basic brain research about the long lasting and actual physical changes in children’s brains from natal exposure to drugs such as heroin and cocaine. Brain research is showing daunting, frightening and even chilling findings that children’s are functionally and developmental physically changed.
The controversial magazine, Mother Jones, has this month published an article, “The Opioid Epidemic Is Literally Changing Kids’ Brains: One effect: These children are more likely to use drugs later in life,” by Julia Lurie, on July 5, 2017. It is well worth reading in its own right.
The article points to the coming era of research on childhood post addiction issues. One of those areas we already know a great deal about. There is, for instance, a growing body of social research literature concerning “Adverse Childhood Experiences,” or ACEs. This is a recent label-shorthand term used to refer to and encompass the childhoods of children, say with parents or parent, with continuing addictions and all the behaviors and child care deficits that accompany this debilitating social=medical-legal lifestyle and its effect on the young child.
One issue is that of defective attachment. Rene Spitzer the famous developmental pediatrician in Paris and others after him such as the Anna Freud group in London, the child psychoanalytic groups in New York and Boston in the decades after WWII, all demonstrated the importance of attachment between mother and caretaker in the earliest days and months of life through even the teen years. Spitzer showed the appalling effects of lack of attachment in babies in Paris orphanorges. Babies were not held by the nuns in the largely Catholic sponsored orphanages but a few times a day, when they had to be fed on strict schedules or when they had to be changed. Other than those times they were not talked to, held, sung to or anythiing. Within even the first year of life, they would develop ruminative syndrome behaviors of eructating, or vomiting up, their feedings into their mouths and chewing and mouthing them over and over simply to furnish themselves more oral stimulation to make up for the lack of physical touch and holding. They did this so much that their appetite mechanisms and social needs/drive/wishes for feeding diminished markedly. They became “anorexic,:, lost weight progressively and often died of self-starvation. Spitzer studied this by observation and head scratching developmental thinking in the immediate post-WWII years when there were so many orphaned infants and children, and also sadly due to the hardships of life in the post-war years when food and even milk was so scarce, the plentitude of abandoned infants and children by parents who could not care for them. I recall only part of a cruel angry common comment quoted in the post-WWII press that said something to the effect that it was a daily occurrence for infants to be abandoned on the steps of Catholic churches in Europe in those years.
In any case, Spitzer somehow hit upon the notion that the babies were not receiving enough holding and tactile stimulation. He noticed that infants who had begun to develop the anorectic behaviors also demonstrated a turning away from the facings and verbal ministration of the good nuns who fed and held them at their allotted times. This was, in my opinion, one of those moments of true genius in which someone like Spitzer had an epiphany before there was enough evidence in sight to easily suggest and point the way to the new idea. He began to hold certain infants both before and after they had developed the syndrome of rumination and anorexia. And he would hold them for longer and daily periods of time. He recruited more and more volunteers to do the same. And lo and behold the infants who received more holding did better, started responding interactively with their wet nurses, smile and coo and such, and eat and gain weight as well, or “thrive,” as the pediatric practitioners call this process.
The study of attachment began then.
We have seen another version of lack of attachment in an old group of perhaps millions of children more recently perhaps beginning in the 1990’s. Many many thousands of orphaned children from the broken Soviet Union came to be abandoned for reasons that are not clear to me during the years after the Soviet system crumbled. Probably it was the result of basic systems of agriculture, education, healthcare, employment for parents and national poverty making it hard for parents to adequately care for their children and they were abandoned by the hundreds of thousands. Many came to be warehoused, and I use even that horrible term apologetically, as what happened to those children was nothing short of barbaric [sorry Putin, but it’s true].
Orphanages were placed in all kinds of abandoned buildings such as old research labs, abandoned schools, university buildings, armed forces barracks, factories. Conditions were horrible. Stories began to emerge of numbers such as six thousand or more children being housed in concentration camp like conditions with perhaps staff to children ratios of 1 to a few hundred were commonly reported in the Western press. Many adoption agencies, often church sponsored and experienced organizations, geared up to try to help. The adoption of children from Siberia, the Ukraine, Russia itself, Romania and other former Soviet satellite states increased to large numbers in a short period of time. As time went on, the adoption procedures, requirements, and fees skyrocketed and lengthened. The costs averaged $20,000 to #40,000 from families I had contact with who adopted such children. The stories brought by adoption workers and parents who visited these child warehouses for required get-acquainted visits were at the least unnerving and at the worst unbelievable.
Within two years or so, child mental health professionals of all disciplines started seeing these children en masse. The children presented a myriad of behavioral, educational, social and psychological/psychiatric problems. Many were beyond diagnosis in a sense since they displayed so many possible diagnosable conditions that many of us did not know where to start first or what to emphasize, for instance even in the simple routine task of affixing a primary diagnosis on insurance claims forms. Many of them redefined the diagnosis of “reactive attachment disorder,” in form and numbers most of us had never seen before. In many of them who were adopted as older children, such as middle school, pre-teens, did not do well even with years of therapy, multiple stints of sophisticated residential long-term treatment. Those youth often left home illicitly, running away unpredictably and literally disappearing. Some resurfaced periodically or briefly and came back to their families but since they had not bonded to them, there was not strong emotional tie and they would become restless in family life and leave after brief “touching base” kinds of stays as I called them. A number of them became involved heavily in crime before they left such as drug dealing, petty or major theft. I remember one child who by age 12 was already regularly stealing and selling his stolen cars. Others would end up dead, killed in crime-related activities in other states and the families would get the sad news after those kids/adults were identified. Some were lost and no word was ever received of their fates.
Attachment deficits in the children of addicts are well described in the article referenced above. The parents cannot bond reliably as they are drinking and/or drugging compulsively, meaning in binges or nonstop and are not able to give anything in the way of a healthy, caring, “I’ll Be There For You,” as the song goes. No protection, no assurance that the child’s needs from food to clothing, to heat and electricity in the home, to school supplies, to protection from sexual predators. Consequently, most simply put these children grown wisely, unfortunately, trusting no one. They seem to have the same vulnerabilities as their addict parents, the ability to experience ordinary pleasure is largely absent. This plays a huge part in why people who are or become addicts cannot get enough of their pleasure-giving drugs. The reward centers of the addicts’ brains are changed, diminished in function and size. Ordinary pleasures such as doing well, excelling, getting praise, attaining a self-enhancing achievement, do nothing for them. These children also have a prior ‘strike against them,’ in that they have we know from research, the genetic, brain-based vulnerability to drug use and addiction. I have always thought this explained why many would use drugs briefly, and become ‘instant addicts,’ since their genetic history in their parents and extended families showed addicts everywhere in the family tree. Other folks could try some drugs [with perhaps the ominous exception of meth] briefly and not become addicts and relate in an interview, “eh, it didn’t do anything for me…”
I have held the quiet opinion-fear for over 20 years, arising out of this understanding of severe attachment disorders, that we have generated a number of national and regional cohorts of similarly disturbed children in different places. The areas of the world where we have massive economic disruptions, years of famiines, refugee problems in numbers never seen in the world before, portend to me possible populations of these very impaired children who are orphaned, left to survive on their own in conditions that are in no way supportive of adeuate child development. There are perhaps just as many areas of the world who are really coping well with this sort of ciris. In South Africa which reportedly has the world’s highest rate of parental death due to the HIV long standing epidemic there, has mobilized what look to be very good child villages adequately staffed, that offer good care to infants, toddlers, children and teens all over the country. Other countries appear to be copying this kind of effort some with increasing from western and religious based groups who see and are nobly responding tot his worldwide recent need.
But I worry that in other areas, children will have spent 20 years in war torn areas such as Lebannon until recently, functioning as “child soldiers,” as has happened in civil war ravished areas of Africa still. These children have experienced continuous war as the entire normality of their lives. I fear and foresees a generation of new mercenaries who know nothing else, young assassins and killers who have no sense of right or wrong and will be social problems in their countries for decades to come.
So that is the impor of early childhood health bonding and attachment. Perhaps the United States’ policy toward refugees should be the opposite of what is being proposed and implemented nowadays. We should take in as many refugee orphans and families as we can. We should place them in friendly communities and work to establish government sponsored as well as much as possible, local and culturally based help efforts based on the refugees’ religions and social organizations to help them learn our language, work, educate and support the healthy development of their children. They and we will be the better for it.
in Mother Jones magazine
The Opioid Epidemic Is Literally Changing Kids’ Brains
One effect: These children are more likely to use drugs later in life.
Dr. Nadine Burke Harris/Center for Youth Wellness
This interview accompanies a feature from our July/August issue about the effects of the opioid epidemic on children. Read it here.
Working at a clinic in San Francisco’s poverty-stricken Bayview neighborhood a decade ago, pediatrician Dr. Nadine Burke Harris often saw patients who had experienced tough stuff, from incarcerated parents to violent homes to mentally ill caregivers. Many of these kids, she noticed, “failed to thrive”—they weren’t developing physically at a normal rate, despite parents’ best efforts to take care of them.
And then, in late 2008, Burke Harris read something that seemed to explain what she was seeing. In a study of more than 17,000 patients, researchers from the Centers for Disease Control and Kaiser Permanente found that those who had experienced more so-called Adverse Childhood Experiences—things like physical or emotional abuse, exposure to domestic violence, neglect, and parental substance abuse—were far more likely to experience a host of physical and psychological ailments down the line, from liver disease to emphysema to depression. Burke couldn’t sleep for weeks after reading the study. “It was just the key to understanding what was happening biologically, and why I was seeing a lot of the things I was seeing in clinics,” she later told SFGate.
In 2011, Burke Harris founded Bayview’s Center for Youth Wellness, a pediatric clinic where clinicians also study the effects of childhood trauma and develop ways to reverse the damage. Burke Harris and the Center have attracted big name donors and publicity. She was the subject of a 2011 New Yorker profile and featured in Paul Tough’s book, How Children Succeed. Burke Harris’ TED talk on ACEs has been seen nearly than three million times. Google and San Francisco-based donor Tipping Point have donated millions. In the meantime, dozens of studies have corroborated the relationship between childhood trauma and poor health.
I reached out to Burke Harris to talk about the developmental and physiological effects one might expect to see among the children of the opioid epidemic—and what doctors can do about it.
Mother Jones: How does growing up with a parent who’s using drugs affect a child’s development?
Dr. Nadine Burke Harris: Let’s start in infancy. One of the very important foundations of brain development is a phenomenon of serve and return. Babies look at their parents’ faces, and they coo or they babble or they make facial expressions. When you have a healthy caregiver, the caregiver will return that. And that actually serves critical function for infant brain development, which is that when the baby serves it up and the parent returns that smile, that facial expression, that emotion, that helps to lay down neurological pathways for the infant. If it doesn’t happen, that really harms infant brain development. So you could imagine that a parent who is impaired or clouded or blunted by heroin is not going to be doing as much of that serve and return.
The other thing that’s really critically important that starts in infancy is attachment. Kids need safe, stable and nurturing relationships to understand that they are safe in the world. Babies learn the world based on whether they’re going to be cared for and protected or whether they’re not going to be cared for and protected. The attachment that’s established in infancy has an impact on all of our relationships for the rest of our life.
MJ: And what about as kids get older?
NBH: Every time a child gets into a scary or dangerous situation, it activates their stress response. The repeated activation of their stress response is what leads to the biological condition that we, in pediatrics, are now calling toxic stress. Toxic stress are the long-term changes to not only brain structure and function, but also to the hormonal system, immune system, and even all the way down to the way our DNA is read and transcribed. And these changes lead to increased risk for mental health and behavioral health consequences—increased risk of depression, increased risk of suicidality, increased risk of anxiety. But also increased risk of things like substance dependence.
Kids who have parents who are substance dependent get a double whammy. They may have a genetic predisposition to substance susceptibility, and they also have both a psychological and a neurological increased susceptibility to substance abuse.
Often times, as a society, we look at the parent who is addicted and we say “Oh my goodness, how could you do this to your kid?” But if you go back far enough in time, you’re going to find that parent when they were a kid, they were experiencing all the same things. And we know that an individual with four or more adverse childhood experiences is ten times as likely to be an IV drug user as someone with zero adverse childhood experiences. When we look at the folks who are using, we have to understand that this is a cycle.
MJ: Is there an anecdote that comes to mind that helps illustrate the impact that the opioid crisis is having on kids?
NBH: When my team called me about this interview, the first thing that came to mind was the experience I had of having a patient who is a six-year-old, who could literally walk me through every step of cooking up and shooting up heroin—who could sit there and pantomime it for me in front of my clinic. It’s absolutely heartbreaking.
MJ: If you were to take a look at the brain of that six year old, or other kids who are growing up in similar situations, what sorts of differences would you expect to see, compared to a kid who is not going through that kind of trauma regularly?
NBH: The scientist in me will tell you that currently we don’t have reference research to measure this and say, “Ah, I see we have an enlarged amygdala.” But what we could expect to see is the activity and possibly the size of the amygdala would be increased. That’s the brain’s fear center. We would also expect to see decreased functioning of the nucleus accumbens, which is the brain’s pleasure and reward center. Many people think that people get addicted to substances because they just can’t get enough of it. And actually, interestingly, the brain’s pleasure center derives less pleasure in people who are substance dependent. They get less pleasure from the substance, and therefore they try to use more and more and more to get to that place.
We might see impaired executive functioning: difficulty with a lot of the things that kids need to be able to sit still in class and pay attention. Impulse control, judgment, the ability to weigh and balance a bunch of different inputs at a time—and then figure out which one you’re going to do and follow through on that. Those are all executive functioning tasks. And those reside in the prefrontal cortex, so we might see decreased prefrontal cortical activity.
If there was substance used while the child was in utero, then we might anticipate some other brain and body changes.
MJ: In some states, if a baby is born in opioid withdrawal because Mom was using during pregnancy—also known as neonatal abstinence syndrome—then the child is automatically removed from the home. What are your thoughts on that?
NBH: This is where I would love to see much more of science informing policy. You certainly cannot leave that child to be at risk in a household. But would a better statewide policy be to ensure that we have programs where young mothers are with babies? Rather than saying, “Automatically you lose your kid,” maybe it’s automatically you have to go to a mother-child rehab program that is focused on understanding what is the root cause—the driver behind the mom’s substance use to begin with. Because whatever that is, that is probably the most dangerous thing in the household—whether that’s mom’s history of abuse or neglect or sexual assault or whatever it is. That thing will continue to come back and haunt that caregiver and the child-caregiver relationship for a very long time unless it’s addressed. They have a program like that here in San Francisco called Jelani House.
MJ: How does the response to this epidemic compare to responses to past drug epidemics?
NBH: The conversations that are happening in the policy world on Capitol Hill around this opioid epidemic feel very different than the conversations that have happened in the past. It feels like people are much more able to frame the issue as a health issue than as a moral failing—or not even moral failing, but depravity that other substance use epidemics, like the crack epidemic that happened in the inner cities in the ’80’s. It seems like it’s a very different narrative and a very different response.
MJ: Do you think that’s because of race?
NBH: I think that there are multiple factors that play into it. This is America—undoubtedly race is one of those factors. But one really salient way in which that’s happening is that for many of the [politicians] who are responding, they see it as “us” as opposed to “them.” They see like “Oh my God, that’s my cousin.” For many people who are leading our national response in the United States, it’s something that feels close to them, so we see greater empathy in the response.
MJ: What public health responses to this epidemic would you like to see happen?
NBH: We’d like to see every pediatrician in America screening for adverse childhood experiences, and making sure that children who are exposed to ACES are getting the care that they need so that we can do prevention. It’s the old saying: “An ounce of prevention is worth a pound of cure.”
Pen and Psychiatrist 