title: Behavioural, developmental and child protection outcomes following exposure to Class A drugs in pregnancy.
abstract: BACKGROUND
  The long-term consequences of intrauterine exposure to Class A drugs are still relatively undocumented, and much of the literature relates to the North American experience, where cocaine use predominates. In Britain, heroin and amphetamine use is more common and, within Britain, patterns of drug use vary. Clearly the long-term educational and welfare needs of these children will be enhanced if the behavioural, developmental and child-care outcomes are known. This study attempts to explore some of these issues.
  
  
  METHODS
  The developmental, behavioural and child protection outcomes in a group of 62 children exposed to Class A drugs in utero were investigated when the children were in full-time schooling.
  
  
  RESULTS
  Seventy-four per cent (46/62) of the children at the time of the study had no educational or behavioural problems, and 11 (17.7%) were receiving extra support in school. No child had a statement of special educational need. Twelve (19.3%) were reported to have behaviour and concentration problems, and in four cases, this was attributed to poor-quality parenting at the time of the study. Three of the 12 children had fetal alcohol syndrome. Twenty-six (42%) children were placed on the Child Protection Register, and care orders or residence orders were granted for 22 (35.5%) of those who were placed on the register. All of the 22 children went into substitute care at some stage. Of these children, nine were adopted and 10 were placed permanently with other family members. Ten of the 62 (16.1%) children at the time of the study were of concern to professionals for child protection reasons, and four of them were on the Child Protection Register.
  
  
  CONCLUSIONS
  This study suggests we can be reasonably optimistic about the developmental and behavioural outcomes for children exposed to Class A drugs in utero. Over 50% required an intervention by social services, and 31% were in substitute care at the time of the study. There were continuing child protection concerns in 16% at school entry.
authors.affiliation: Department of Community Child Health, United Bristol Healthcare Trust, Bristol, UK. antopley@btinternet.com
authors.forename: J
authors.initials: J
authors.lastname: Topley
authors.forename: D
authors.initials: D
authors.lastname: Windsor
authors.forename: R
authors.initials: R
authors.lastname: Williams
mesh_terms: D002648:Child; D002657:Child Development; D002669:Child Welfare; D002675:Child, Preschool; D002658:Developmental Disabilities / Q000453:epidemiology*; D004519:Education, Special; D005260:Female; D063647:Fetal Alcohol Spectrum Disorders / Q000453:epidemiology; D005581:Foster Home Care; D006801:Humans; D008297:Male; D011247:Pregnancy; D011297:Prenatal Exposure Delayed Effects; D019966:Substance-Related Disorders / Q000150:complications*