Conjuring a New Category of Disability from Prenatal Cocaine Exposure

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Abstract
The paper reviews the available literature on the biological mechanisms and effects of cocaine exposure impacting pregnant women, the fetus, the neonate, and the infant. The potential causal mechanisms for neural damage to the fetus are quite robust; however, the empirical literature does not support an inevitable developmental consequence for infants exposed in utero to cocaine. The most impaired of the cocaine-exposed infants do not seem to differ, behaviorally, from other groups of neurologically impaired infants. However, the infant exposed to cocaine in utero may have the added disadvantage of a dysfunctional caregiving environment focused more on drug habit maintenance than on caretaking. This combination of biological vulnerability and caretaking inadequacy increases the odds that a child will be a “caretaking casualty.” Classifications of children are useful only if they organize and name individuals with the same biological or behavioral characteristics. The classification of infants and young children as prenatally cocaine-exposed does not constitute a coherent cluster of either biological or behavioral characteristics. Hence, the construct of “cocaine babies” that has received considerable attention in the popular and professional press is neither descriptive nor predictive of behavior. Recommendations are offered for classification of behavior rather than labeling of the child. In addition, an overview of types of early intervention appropriate for various kinds of behavior exhibited by some children exposed to cocaine is presented. Finally, the development of empowerment strategies and professional partnerships with families of infants exposed to cocaine in utero is discussed.