5/6/2018. What happens when the smoke clears?

Size: px

Start display at page:

Download "5/6/2018. What happens when the smoke clears?"

Alvin Williams
6 years ago
Views:

to drug endangerment Identify sequelae related to drug endangerment and associated neglect Those who are at risk for suffering physical or emotional harm as a result of their caregiver s substance

1 What happens when the smoke clears? Kristen C. Iniguez, DO, FAAP May 4, 2018 Discuss the incidence of drug exposure in children Become familiar with the direct effects of drug exposure on the developing brain Recognize secondary exposures related to drug endangerment Identify sequelae related to drug endangerment and associated neglect Those who are at risk for suffering physical or emotional harm as a result of their caregiver s substance use, possession, manufacturing, cultivation, or distribution. They may also be children whose caretaker s substance misuse interferes with the caretaker s ability to parent and provide a safe and nurturing environment. National Alliance for Drug Endangered Children CBHSQ 2016 children live in a home with at least one parent with a substance use disorder children live in a home with at least one parent with an alcohol use disorder children diagnosed in past year with an illicit drug use disorder 10-11% of newborns exposed prenatally to alcohol or illicit drugs Approximately 400, ,000 infants 1 st trimester alcohol exposure as high as 1 in 5 Out-of-home Placement 31% of children placed because of parental alcohol or drug abuse 61% of infants and 41% of older children come from families with active illegal drug and alcohol abuse 29% of caregivers receiving in-home services need substance use disorder treatment services Young, 2014 National Survey of Child and Adolescent Well-being,

Brain growth occurs from conception to early adulthood Majority of growth occurs by 3 years of age Growth is a function of neuronal connections

function Insults in early growth will negatively impact higher functioning Certain drugs of abuse once considered safe for the developing fetus Limited

neurodevelopment as a result of prenatal exposure Early exposure brain structure Later exposure brain function Progenitor Cells Decreased proliferation

2 Brain growth occurs from conception to early adulthood Majority of growth occurs by 3 years of age Growth is a function of neuronal connections Connections based on experiences connections per second in infancy Repetition strengthens connections Bottom up development Basic to complex function Insults in early growth will negatively impact higher functioning Certain drugs of abuse once considered safe for the developing fetus Limited association between illicit drug use and congenital malformation Most illicit drugs passively diffuse across the placental barrier Direct effects on neurodevelopment as a result of prenatal exposure Early exposure brain structure Later exposure brain function Progenitor Cells Decreased proliferation Neuronal Cells Reduced growth Decreased migration Neurotransmitters Inhibited development Decreased receptor production Building Blocks Brain Structure Brain Function 2

Binds dopamine and serotonin receptors release of Serotonin and Dopamine reuptake of Serotonin and Dopamine Brain flooded with chemicals that cause sense of pleasure and well-being methamphetamine

3 Binds dopamine and serotonin receptors release of Serotonin and Dopamine reuptake of Serotonin and Dopamine Brain flooded with chemicals that cause sense of pleasure and well-being methamphetamine Halpin et al, 2015 Dopamine Serotonin Inflammation Altered EC System Oxidative Stress Glutamate Excitotoxicity Axonal damage & Cell death Metabolic Compromise Damages: Striatum Hippocampus Prefrontal cortex Impairs: Impulse control Working memory Attention Decision making Motor coordination Drug use Manufacture Trafficking Housing insecurity Lack of appropriate oversight Increased risk of co-occurring abuse Intoxicated caregivers are unable to provide the appropriate care and support Financial instability Food & housing insecurity Inadequate access to health care Insufficient/non-existent psychosocial interactions 3

Positive attachment drives a child s sense of Self as lovable, special, competent & worthy Others as loving, caring, responsive & trustworthy World as a

attachment may lead to: Developmental delays Poor intellectual outcomes Disruptive behaviors Difficulties with relationships and socialization Eventual

cause service providers to default to therapies that are ineffective There is currently no DSM diagnosis for trauma Removing the insult is the first step

Relationships & Connections Resources Selfactualization: Full Potential Esteem: Valued & Appreciated Belonging & Love: Relationships & Affiliation Physical

4 Positive attachment drives a child s sense of Self as lovable, special, competent & worthy Others as loving, caring, responsive & trustworthy World as a safe, exciting place to explore, live & learn Positive psychosocial interactions set the stage for appropriate growth and development Dysregulated attachment may lead to: Developmental delays Poor intellectual outcomes Disruptive behaviors Difficulties with relationships and socialization Eventual psychopathology Neurobiologic dysfunction is a great mimicker Labels can help a child to get services, but Labels fail to tell the entire story Labels can cause service providers to default to therapies that are ineffective There is currently no DSM diagnosis for trauma Removing the insult is the first step but definitely not the last Comprehensive evaluation Direct AND secondary effects of drug exposure must stay on the radar What we can positively effect? Relationships & Connections Resources Selfactualization: Full Potential Esteem: Valued & Appreciated Belonging & Love: Relationships & Affiliation Physical Safety: Shelter & Feeling Safe Ensure appropriate resources Physical Survival: Food, Water, Sleep, Warmth Self-fulfillment needs Basic Human Needs Psychological needs Basic needs 4

An interdisciplinary approach Treating children with complex trauma Providing high quality comprehensive care Medical Behavioral Health Education Wrap around Neurobiology Basic Needs Attachment Drug

poor nurturing and attachment Removing the exposure is not sufficient to solve the problem Direct and secondary effects of drug endangerment may have lasting negative effects on a child s overall

5 An interdisciplinary approach Treating children with complex trauma Providing high quality comprehensive care Medical Behavioral Health Education Wrap around Neurobiology Basic Needs Attachment Drug Endangered Children May be exposed to neurotoxic substances Live in unsafe environments Have increased risk for co-occurring abuse/adversity Are at increased risk of poor general & health care Suffer poor nurturing and attachment Removing the exposure is not sufficient to solve the problem Direct and secondary effects of drug endangerment may have lasting negative effects on a child s overall neurobiology To ensure best outcomes appropriate resources must be ensured It is easier to build strong children than to repair broken men. Frederick Douglas Jaques SC, Kingsbury A, Henshcke P, et al. Cannabis, the pregnant woman and her child: weeding out the myths. J Perinatol. 2014;34(6): pmid: Lipari, R.N. and Van Horn, S.L. Children living with parents who have a substance use disorder. The CBHSQ Report: August 24, Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration, Rockville, MD. National Alliance for Drug Endangered Children. The problem. Available at: www. nationaldec.org/theproblem. html. Accessed March 12, Smith VC, Wilson CR, AAP COMMITTEE ON SUBSTANCE USE AND PREVENTION. Families Affected by Parental Substance Use. Pediatrics. 2016;138(2):e Thompson, B., Levitt, P., and Stanwood, G. Prenatal exposure to drugs: Effects on brain development and implications for policy and education. Nat Rev Neurosci April ; 10(4): doi: /nrn

6 Van Gelder, M., Reefhuis, J., Caton, A., Werler, M., Druschel, C., Roeleveld, N. and the National Birth Defects Prevention Study. Maternal periconceptional illicit drug use and the risk of congenital malformations. Epidemiology. 2009, 20: Wulczyn, F., Ernst, M., & Fisher, P. (2011). Who are the infants in out-of-home care? An epidemiological and developmental snapshot. Chicago: Chapin Hall at the University of Chicago. Retrieved from publications/06_08_11_issue%20brief_f_1.pdf Young, N. K., Gardner, S., Otero, C., Dennis, K., Chang, R., Earle, K., & Amatetti, S. Substance Exposed Infants: State Responses to the Problem. HHS Pub. No. (SMA) Rockville, MD: Substance Abuse and Mental Health Services Administration,

Learning Objectives. Serving Pregnant Women Affected by Substance Use Disorders in Healing to Wellness Court: Sharing Lessons

Learning Objectives. Serving Pregnant Women Affected by Substance Use Disorders in Healing to Wellness Court: Sharing Lessons Serving Pregnant Women Affected by Substance Use Disorders in Healing to Wellness Court: Sharing Lessons Marianna Corona Jennifer Foley September 12, 2017 Learning Objectives 2017 Improving Family Outcomes