In the 1970’s and 1980’s the dreadful phenomenon of newborn babies withdrawing from cocaine began to emerge on an increasing basis. This was fairly rapidly recognized in areas in which heroin addiction in pregnant mothers and the withdrawal of their newborns was already well known. As the blight of cocaine spread across the country as the cartels and then somewhat later the national and regional gangs moved violently into the cocaine distribution and territorial control of the cocaine world, this became more widespread outside the proverbial ‘big city,’ largest urban areas where it had seemed until that epoch of time that those cities were the centers of drug abuse in general, which was of course partially a myth. that myth, pejorative as it was, came to be diluted and less true as the meth epidemic hit with the recessions of the late 1990’s and the Great Housing Bubble and Financial Meltdown Recession starting in 2008 or so, thanks ironically to the richest brokerage brethren in New York City.We learned to detox newborns and treat them and their mothers in the cocaine era as we had done starting in the 1960’s in the heroin era. We began to learn though, that the effects of children exposed in utero and born into withdrawal, manifested developmental problems in their early and later childhood years. It became more obvious to the child developmental researchers in all those affiliated disciplines that detoxing the baby was only the start of the developmental treatment needs that these children would come to need. Issues of lower intelligence in certain areas, developmental delays in general in everything from learning to read and grasp the fundamental concepts presented in preschools such as shapes, colors, and even their art productions were hindered, delayed and markedly different from developmental norms. These children began to manifest aggression, hyperactivity and higher levels of aggression, inability to exhibit ordinary levels of self-inhibition, delay of rewards, ordinary sharing with others and many other social behaviors and skills that we often take for granted. In my mind these children represented a modern partial equivalent and new cohort of severe ADHD children much like the post Economo’s encephalitis that occurred in 1919 during the Spanish/Russian influenza pandemic that left many thousands of children ‘brain damaged,’ and hyperactive, and stimulated the earliest ‘child guidance clinics,’ in this country such as the Judge Baker Clinic in Boston. [This almost more than any other ‘event’ gave one of the biggest pushes to starting the discipline of child psychiatry].
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 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.