-
nanaimo – In response to your comment earlier:
“Joyce63: I am so happy to tell you that it has been shown that there is no causal link between prenatal cocaine exposure and mental disorders. None. So you don’t have to worry about that being a factor any more. I’m frankly surprised your doctor didn’t tell you this.”
Whilst I don’t disagree with you here I worry about such a blunt statement. Whilst this may be comforting for Joyce63, if I were her I’d want to know much more – how did you reach that conclusion, what authority do you have to be so disparaging about her doctor not telling her this information…etc ……?
So to play devil’s advocate for a moment – only because I have taken my meds and am focusing on anything but what I am meant to be doing…. but that’s the ADHD life I suppose! So please don’t take offence nanaimo…….
In my mind, the problem with your sweeping statement is that whilst you are probably correct, such a blunt assertion can be dangerous. In biological (medical) science there is rarely such a cut and dried answer to anything – no issue is as ‘black and white’ as you make this one. Unfortunately citing a piece of journalistic writing and a YouTube video as supporting evidence is not ideal. Any scientist or educated lay-person would hear alarm bells ringing at this point! To be clear, I have no problem with the article per se – or with science journalism – but such a sweeping statement should be backed up with scientific fact.
Whilst there may not be many (if any) studies that link mental disorders (to use your term) with maternal cocaine use, there are plenty of current papers that admit that long-term studies have not been done and the ‘sleeper’ effects of maternal cocaine use (if any) have not been evaluated.
There are plenty of studies that look at the cognitive outcomes of cocaine-exposed children but the results are very inconsistent and meta-analyses of the data suggest that any effects are likely to be subtle (but not non-existent). Of course it depends on your definition of ‘mental disorder’ in your post; perhaps difficulties in regulatory processes and cognition don’t count for you (but does that mean ADHD isn’t a mental disorder then?).
More recently the idea of a dose-dependent effect of cocaine exposure on children has been suggested. Also, one key feature is that cocaine-insulted babies are often underweight when they are born. Some researchers think that most of their reported ‘issues’ arise from being under weight rather than from the cocaine itself. But a study by Singer et al. (2001 American Academy of Pediatrics) showed significant behavioral effects of fetal cocaine exposure on attentional abilities underlying auditory comprehension – in other words the precursors of receptive language. Earlier work by Mayes et al. (1995 American Academy of Pediatrics) found that the effects of prenatal cocaine exposure are likely to be on arousal and attention regulation.
Furthermore, the number of peer-reviewed papers in this area that acknowledge the limitations of their studies must in itself be an alarm bell suggesting that all is not ‘black and white’. For one thing, many of the studies rely on self-reporting of maternal cocaine use which is likely to be flawed, or urine assays which don’t show cumulative levels; so until accurate measurement of presence in maternal hair samples is routinely used then there will always be some doubt about the fetal exposure.
Other factors shouldn’t be forgotten either – e.g. mothers who use cocaine are likely to use other drugs including tobacco, alcohol, weed etc. – so differentiating between the effects of cocaine and a whole host of other poisons is difficult. But you do mention that in your follow up post.
So far, most studies have focused on effects on physical growth of the child, language skills, cognition, behavior and neurophysiology but the results published are very mixed.
Further, the effects of maternal behavior will have an effect. It has been shown that cocaine-positive children who are adopted into a good home can fare very well.
If you wanted to bias the argument towards there being no real observable effects of cocaine exposure then why not use a peer reviewed paper that’s readily available on line – e.g. the review by Frank et al. in the Journal of the American Medical Association, 2001, Vol. 285 (12), pp.1613-1625. The paper is called Growth, Development, and Behavior in Early Childhood Following Prenatal Cocaine Exposure – A Systematic Review. They review a good deal of the research available and the following is from the ‘data synthesis’ section of the abstract:
“After controlling for confounders, there was no consistent negative association between prenatal cocaine exposure and physical growth, developmental test scores, or receptive or expressive language. Less optimal motor scores have been found up to age 7 months but not thereafter, and may reflect heavy tobacco exposure. No independent cocaine effects have been shown on standardized parent and teacher reports of child behavior scored by accepted criteria. Experimental paradigms and novel statistical manipulations of standard instruments suggest an association between prenatal cocaine exposure and decreased attentiveness and emotional expressivity, as well as differences on neurophysiologic and attentional/affective findings.”
Despite the last sentence their overall conclusions were:
“Among children aged 6 years or younger, there is no convincing evidence that prenatal cocaine exposure is associated with developmental toxic effects that are different in severity, scope, or kind from the sequelae of multiple other risk factors. Many findings once thought to be specific effects of in utero cocaine exposure are correlated with other factors, including prenatal exposure to tobacco, marijuana, or alcohol, and the quality of the child’s environment. Further replication is required of preliminary neurologic findings.”
So this backs up your sweeping statement – or so it seems – until you read the comment in their paper:
“Before summarizing our findings, we must acknowledge the limitations of our approach. Studies that meet our methodologic criteria may still lead to overestimation or underestimation of cocaine’s impact.”
So….not really so ‘black and white’ then?
I should counter all this by saying I am not a medic and have no more idea about any of this than the next person! But I do like evidence and an honest appraisal of the evidence….. and it filled in an hour when I should have been doing something else…sigh.
REPORT ABUSE
Is the effect of caffeine similar to a stimulant medication?2012-02-17T03:49:58+00:00
Viewing 0 posts