Behavioral treatment of drug exposed infants: analyzing and treating aggression - includes related article

Children Today, Jan-Feb, 1992 by Mary R. Burch

In the past decade, human service agencies have been confronted with a new category of client: the drug-exposed infant. The President's National Drug Control Strategy Report estimates that 100,000 crack exposed infants are born each year. Some cocaine exposed infants who may have had a number of problems as newborns are now preschoolers who are being placed into educational settings.

These children often exhibit neurological and behavioral difficulties, attention deficits, learning disabilities, and language and other delays. Teachers report that drug-exposed infants in preschool classrooms seem to have an increased number of physical ailments, such as more frequent respiratory infections involving the ear, nose and throat, and gastrointestinal disorders.

In the educational environment, teachers relate that these children often have very short attention spans and are generally noncompliant. Of more serious concern are teacher accounts of frequent, severely maladaptive behaviors, including aggression toward other children and self-injurious actions. While teachers can usually handle the child who does not attend to tasks, coping with the child who engages in behavior that is harmful to himself or to others presents a more formidable and unmanageable situation.

Donnie

Donnie was three years old and the product of abuse and neglect. His 14-year-old mother was a regular user of crack, cocaine and a variety of other drugs. His 18year-old father had a history of alcohol and substance abuse. After being physically abused by his parents, Donnie suffered a concussion and a broken leg. He was removed from the home and placed in protective custody. Because Donnie cried for hours at a time and was destructive, eight foster placements over the course of several months failed.

Donnie's grandmother loved her grandchildren, and witnessing their moves from place to place caused her great anxiety and anguish. Finally, Donnie's grandmother could tolerate it no longer. She resigned from her job and moved so that she could raise Donnie and his 18-month-old brother. The first time she took Donnie to the doctor's office for a physical examination, he "rearranged" the room. The physician told the grandmother that Donnie was "animalistic" and would never be able to learn anything. Donnie's grandmother ran from the office crying.

At home, Donnie would climb on to countertops, open all the cabinets, and remove and break items. Everything had to be taped closed, locked, or secured. Kitchen cabinets were tied closed with ropes that extended from handle to handle. Because Donnie could not express himself with spoken language, it was difficult to communicate with him. After he was placed in a private day care setting, teachers reported that he was aggressive toward other children, and was not making any progress in mastering such functional skills as potty training.

Who You Gonna Call?

Developmental services agencies usually have access to behavioral consultants, who may offer some hope for children who are at risk of being discharged from preschool programs because they are exhibiting severe behavioral problems. Because Donnie was a Developmental Services client, he was entitled to behavioral aid. This is how the assistance of this article's author, an experienced behavioral analyst, came to be sought and contracted through the Department of Health and Rehabilitative Services.

Fixing the Problem

In both the preschool and home setting, Donnie's teachers and grandmother reported that his most serious problem was aggression. Frequently (six times every half hour, on the average), Donnie displayed aggressive, antisocial behaviors that included hitting, scratching, and pinching his peers and his 18-month-old brother. Often, Donnie's behavior was so intense that the child who was the target of his hostility would bleed or be bruised.

None of the therapists who had attempted to manage Donnie's aggression had succeeded in improving his behavior. While all had utilized different approaches, the one element that was common to all their methods was the recommendation that a particular procedure be used for any aggressive, antisocial incidents, regardless of the situation. They all viewed aggression as a critical problem that required immediate remediation.

Roots of Aggression

In order to treat Donnie's aggression, we first conducted an analysis of the specific situations in which the antisocial responses occurred. During "free play" periods in both the home and preschool settings, Donnie was engaging in aggressive behaviors an average of six times per half hour. Using a variety of data collection procedures, some very specific circumstances relating to aggression were pinpointed. These were 1) at school, when Donnie wanted a toy in the possession of another child; 2) at home or school, when another child took his toy; 3) at home, when his brother was receiving attention; and 4) for no apparent cause.

Because in Donnie's case the nature of the aggression was complex, it was clear that a solution would certainly not be as simple as employing one procedure for all situations. We treated his aggression by utilizing a combination of behavioral procedures and environmental solutions.