I. CONTEXT/ENVIRONMENT

The Importance of Minority Institutions of Higher Education in the
Preparation of Special Education Personnel

Prenatal Exposure to Alcohol and Nicotine: Implications for Special
Education

######## 

The Importance of Minority Institutions of Higher Education in the
Preparation of Special Education Personnel[^1]

The U.S. teaching force is "at a demographic crossroads." From the late
1990s to 2008, more than 2.2 million more teachers will be needed,
simply as a result of increasing enrollments and a wave of retirements;
long-standing shortages in several subjects and specialties will expand
the need, as will attrition (Recruiting New Teachers, Inc., 1999, p. 1).
Special education already has a considerable quality shortage (of
teachers qualified for their positions) and quantity shortage (of
teachers to fill vacancies) (U.S. Department of Education, 1998).

In 1996, 35.8 percent of students enrolled in public elementary and
secondary schools were black, Hispanic, Asian/Pacific Islander, or
American Indian/Alaskan Native, 12 percent more than in 1976 (National
Center for Education Statistics, 1999).[^2] The proportion of such
students, including new immigrants, continues to increase rapidly (table
I-1) but, as reported in 1998, "only 20 percent of undergraduates in
teacher education are minority-group members" (Olson & Jerald, 1998, p.
16). By 2009, if trends continue, 40 percent of students but only about
12 percent of the teaching force will be from minority backgrounds
(Olson, 2000).

Although ideally all education personnel would be competent to instruct
the growing numbers of students from diverse backgrounds, a number of
factors impede efforts to provide personnel with the requisite skills
and knowledge to work effectively with these students. These factors
include lack of consensus on appropriate preparation in this arena;
instruction that overviews race, gender, language, and social class in
isolation from their relationships to the teaching/learning processes;
and a degree of trainee resistance (Artiles & Trent, 1997). Coupled with
current and impending shortages and demographic imbalances, this makes
it necessary both to recruit culturally/linguistically diverse
individuals and to increase the numbers of practitioners who are
culturally competent (Ishii-Jordan, 1997). Personnel from minority
backgrounds "(a) will enhance the capacity of schools to provide
appropriate instruction and will contribute, by their presence and
participation, to greater cultural competence among all personnel; (b)
will bring essential

Table I-1

######### Changes in the U.S. Population Under Age 18: 1980-2005

  ------------------- ------------ ------------ ------------ ------------ -----------
                      1980         1990         1995         Projection   Percent
                                                             2005         Change
                                                                          1995-2005

  White               50,085,021   47,628,229   45,732,900   44,208,100   -3

  African American    9,395,912    9,584,415    10,178,500   11,013,000   +8

  Hispanic/Latino     5,627,956    7,757,500    9,599,700    12,466,800   +30

  Asian/Pacific       1,044,601    2,083,387    2,555,600    3,563,000    +39
  Islander                                                                

  Native American     555,735      696,967      673,300      713,000      +6

  Other nonwhite      2,673,692    3,611,434    \-\--        \-\--        \-\--
  ------------------- ------------ ------------ ------------ ------------ -----------

Source: Annie E. Casey Foundation, 1992, 1997.

understandings to the task of restructuring schools where all students
can succeed; (and some) (c) will become part of the cadre that completes
the doctorate and subsequently influences preservice preparation, where
changes must occur so that future teachers will be culturally competent"
(Smith-Davis, 2000, p. 2).

Minority institutions of higher education (MIHEs) and other institutions
of higher education (IHEs) with substantial minority student enrollments
are an important source of these solutions.[^3] This chapter presents
data on these institutions' programs, overviews selected efforts in some
high-demand areas, and summarizes Federal initiatives.

# Minority Institutions of Higher Education

The Office of Special Education (OSEP) awards grants for preparation of
personnel in minority institutions to IHEs with minority student
enrollments of at least 25 percent (U.S. Department of Education, 2000).
Historically Black Colleges and Universities (HBCUs), Predominantly
Black Institutions (PBIs), Tribal colleges, and Hispanic/Latino-serving
institutions are among the IHEs that are eligible to receive these grant
awards.

Table I-2

Minority Institutions of Higher Education and Their Preservice Programs

  ------------------------- ---------- ------------- --------------------------------- ---------- ------------------ ------------------
                                       Special                                                                       
                                       Education                                                                     
                                       Preparation                                                                   

  Institution Type          Total      Number with   In Number of                      Largest    Number with        Number with \>1
                            MIHEs      Programs      Jurisdictions^[a]{.underline}/^   Clusters   Related-Services   Related-Services
                                                                                                  Programs           Program

  HBCUs^[b]{.underline}/^   104        52            19                                NC, TX     32                 16

  PBIs^[c]{.underline}/^    259        12            5                                 NY         23                 7

  Hispanic/\                133        16            4                                 TX         19                 8
  Latino                                                                                                             

  Tribal                    32         12            4                                 MT, ND,    0                  0
                                                                                       SD, WA                        

  Asian                     52         11            4                                 CA         11                 6

  Dual                      25         5             3                                 CA, NY, TX 4                  2

  Multiple                  378        62            17                                CA, NY     47                 30

  **Totals**                **983**    **170**                                                    **136**            **69**
  ------------------------- ---------- ------------- --------------------------------- ---------- ------------------ ------------------

Notes: [a]{.underline}/ The 50 States, the District of Columbia, and
Outlying Areas.

> [b]{.underline}/ Historically Black Colleges and Universities.
>
> [c]{.underline}/ Predominantly Black Institutions.

Source: The Alliance Project, 2000.

## *MIHEs' Preservice Programs in Special Education and Related Services*

Table I-2 shows data on MIHEs, by type, with details on those that
prepare special educators or paraprofessionals. The right-hand columns
add data on MIHE related-services programs in speech-language pathology,
audiology, occupational therapy, physical therapy, and school
psychology. Gallaudet University, which is designated as an MIHE because
its enrollment comprises students with disabilities, is not included.

Eight States have no MIHEs: Idaho, Maine, New Hampshire, Oregon, Rhode
Island, Utah, Vermont, and Wyoming. Thirteen others have none that
prepare special education teachers: Alaska, Arizona, Colorado,
Connecticut, Indiana, Kansas, Kentucky, Massachusetts, Minnesota,
Nebraska, Nevada, Wisconsin, and West Virginia.

# Preparation for High-Demand Positions

Demand for special education personnel involves general personnel
shortages and deployment barriers, as well as the need for personnel
with particular competencies. The need for personnel who are trained to
work with minority students with disabilities is most acute in rural,
remote, and urban districts. Across geographic settings, however, there
are striking needs for special educators and related-service personnel
who are qualified to work with minority students. There is also a high
demand for male practitioners**.** OSEP grants to MIHEs have been
supporting various efforts to meet these needs, a few of which are
profiled in this section. (Unless otherwise indicated, abstracts of OSEP
personnel preparation grants are the source of project summaries in this
section. Recent abstracts are also published in Orkwis, DeCarme, &
Glover, 1998.)

## *Rural and Remote Areas*

Isolation makes recruitment and retention a substantial problem for many
rural and remote districts, particularly for Bureau of Indian Affairs
schools and Tribal schools (Pavel, Curtin, Christenson, & Rudes, 1995).
In addressing these shortages, it appears more effective to provide a
Tribal member with teacher training than to teach the Tribal culture
and, in some cases, language to an outsider (U.S. Department of
Education, 1994). Moreover, career ladders, uses of technology, and
regional support groups show promise of improving the supply of
personnel in remote districts (National Association of State Directors
of Special Education, 1996). The 13 OSEP personnel preparation grants
awarded to Tribal colleges since 1992 have incorporated one or more of
these strategies. For example:

**A consortium of Tribal colleges** in North Dakota received an OSEP
grant for an associate degree program for paraprofessionals. The project
joined Cankdeska Cikana Community College, as fiscal agent, with Turtle
Mountain Community College and Fort Berthold Community College. Minot
State University, which is not an MIHE, acted as a subcontractor.
Curricula were examined, new courses were developed where necessary, and
faculty have mentored and consulted with new course instructors. The
colleges had already integrated cultural elements into their overall
curricula, and these have been extended to special education training.
Fort Berthold hired faculty who lived in the remote sites where teacher
aides are already working, so that college courses can be offered at
their work sites (Green, 2000).

**Career ladder programming** is a feature of Fort Peck Community
College's comprehensive effort to improve education on its Montana
reservation. Since 1995, Fort Peck has offered special education
professional development to Native Americans on the reservation to
encourage opportunities to earn degrees and to employ more Native
American special educators and paraprofessionals in the reservation's
schools. In 1997, the college started its special education program for
teacher aides and substitutes, and, in 1998, it finalized an agreement
with Montana State University-Billings for delivery of the endorsement
program in special education. The Tribal Education Department provides
incentives for Tribal members, including monetary awards for milestones,
such as high school diploma, GED, and 1-year certificates (Belvin,
1999).

**Distance learning technologies** are used by Montana's Little Big Horn
College to deliver special education training for aides at a remote
reservation site. Little Big Horn also trains paraprofessionals on
campus and coordinates distance learning from Montana State
University-Billings, which awards bachelor's and master's degrees in
special education to those who complete the program. In all, 24 Native
Americans have recently completed training at one of these three levels
(Belvin, 1999).

## *Urban/Inner City Schools*

Approximately 43 percent of cultural or language minority public school
students live in urban areas, and "most of them attend schools in which
more than half the students are poor and that are predominantly, often
completely, minority" (Edwards, 1998, p. 6). Urban districts have
difficulty filling vacancies, especially in undersupplied fields (Olson
& Jerald, 1998), are twice as likely as others to hire teachers who hold
emergency license or no license (Edwards, 1998), and have high rates of
disengagement and attrition among teachers (Van Horn, 1999). In
addition, "high turnover in urban districts, where many of the older,
more experienced African American teachers are concentrated, will
necessitate hiring from a pool of new teachers that is increasingly
white" (Murnane et al., 1991, as cited in U.S. Department of Education,
1996, pp. 95-96). Various MIHEs are endeavoring to improve these
conditions.

**Full qualifications and career ladders.** Coppin State College in
Maryland trains annual cohorts of 65 long-term substitutes,
provisionally certified teachers, teachers in surplus disciplines, and
teacher aides for special education positions in the Baltimore City
Public Schools. Personnel are trained with concentrations in mild/\
moderate disabilities, severe disabilities, or speech and hearing. The
improved curriculum is relevant to special education for a predominantly
inner-city population of African Americans and smaller numbers of other
minority students.

**Victims of substance abuse.** At Hampton University in Virginia,
minority students receive training to provide speech, language, and
hearing services for infants, toddlers, and preschool children, with a
special focus on children affected by substance abuse and on African
American children in inner cities. The project supports seven graduate
students per year over 4 years.

**Incarcerated youth.** Hunter College, City University of New York is
preparing 30 individuals to educate incarcerated minority youth who have
emotional and behavioral disorders. Because New York City area
correctional facilities are seriously deficient in teachers trained to
work with disabled juvenile offenders, this project is expected to have
a decisive impact.

**Technologies for delivery of training.** The goal of DIALS (Distance
Instruction for All Learners) is to increase the number of inner city
and rural special educators who are qualified in high-incidence
disabilities. Developed by a partnership of three University of South
Florida campuses and a consortium of school districts, DIALS uses
synchronous two-way interactive video and audio in real time, with
remote-site mentors and Internet and email support. Many participants
are from minority populations and/or are working in high-poverty areas.

**Doctoral concentration.** Preparing Urban Leaders in Special Education
(PULSE) at the University of San Francisco provides doctoral preparation
in research and college teaching, with an emphasis on urban,
multicultural special education and recruitment of candidates from
diverse and bilingual populations. Up to 12 individuals are expected to
complete the doctorate, and 10 are expected to earn master's degrees in
teaching culturally diverse children with mild/moderate disabilities.

## *Linguistic Diversity*

Between 1990 and 1997, "the number of students with limited English
proficiency (LEP) . . . increased by an estimated 57 percent\--to
approximately 3.5 million. These children are among the most
educationally disadvantaged of all populations" (Johnson & Vanderlinde,
1999, p. 1). "About one-third of school-age Hispanics are new
immigrants, a demographic group that typically does not do well in
school" (Blair, 2000, p. 6). Linguistic diversity is increasing as a
result of immigration. Some large districts have students from more than
150 countries of origin who speak 130 or more languages and dialects;
many small districts are also experiencing the impact of immigration
(Smith-Davis, 1999). The need for personnel who speak the languages of
LEP students is clear. Equally important are personnel who can
distinguish between language limitations and disabilities in working
with students who have limited proficiency in English.

About 80 percent of districts report "some" to "a lot of" difficulty
recruiting bilingual teachers, and 53 percent report difficulties in
recruiting English-as-a-second language (ESL) teachers (Johnson &
Vanderlinde, 1999). Since it is still more difficult to hire special
education personnel with these linguistic competencies, affected
districts must often rely on bilingual aides to mediate instruction in
languages that other personnel do not understand (Smith-Davis, 1999).
Although relatively few IHEs have programs in linguistic diversity,
MIHEs are fairly well represented.

**Cross-cultural special education.** Loyola Marymount University in
California has expanded its Cross-Cultural Special Education Program for
greater emphasis on urban education in a service area that includes 80
language groups. The project is preparing 60 candidates to educate LEP
and bilingual students with disabilities, a large proportion of whom are
minority students.

**Trainees of Haitian origin.** The University of Miami has enrolled 38
students, mainly from the Haitian community, to complete a master's
program in both early childhood special education and teaching ESL.
Since only one early childhood special education teacher in Dade County
is a primary speaker of Haitian Creole, there is a great demand for
these graduates.

**Linguistic diversity and hearing impairment.** New Mexico State
University offers interdisciplinary master's degree preparation for
racially and linguistically diverse trainees in the education of
students with deafness and hearing impairments and with an emphasis on
bilingual education and ESL. Recruitment is conducted in cooperation
with IHEs in New Mexico and South Texas. The goal is to improve the
supply of personnel to work with the Southwest's tricultural/trilingual
population.

**Master teachers with cultural/linguistic competence.** The University
of Texas-El Paso trains master teachers to assist diagnosticians and
school psychologists in differentiating between disabilities and
cultural/linguistic differences and in identifying LEP children who have
special needs. Thirty educators from nine local districts and two Apache
reservations are enrolled in the program. Summer institutes near the
Apache reservations and in El Paso provide experience in teaching
strategies that are effective with specific cultural and language
characteristics, as well as those that are generally useful with diverse
children.

**Doctoral preparation.** Over a 5-year period at California State
University-Fresno, 15 Spanish-speaking and/or culturally diverse
participants are expected to receive a doctorate in educational
leadership, and 22 are expected to earn master's degrees, both with a
specialization in minority special education. Collaboration involves
four University of California campuses, local school districts, and the
California Department of Education.

## *Related Services*

The supply of culturally and linguistically diverse related-services
personnel is not adequate. For example, only 7.3 percent of members of
the American Speech-Language-Hearing Association (ASHA) are from
minority backgrounds (ASHA, 1998, as cited by Guillory, in press) while,
at the same time, the numbers of minority-group members with speech and
language problems are increasing (Guillory, in press). Among members of
the National Association of School Psychologists (NASP), 8 percent are
from minority populations (NASP, 1999). Programs in speech-language
pathology or communication disorders are the most prevalent MIHE
preservice programs in related services, but school psychology,
occupational and physical therapy, and other disciplines are also
represented.

**Communication disorders and cultural/linguistic diversity.** At
Louisiana's Southern University, Project Access addresses the
underrepresentation of speech pathologists and audiologists competent to
work with culturally diverse children and youth. Undergraduate and
graduate programs emphasize recruitment of students from
underrepresented groups, particularly African Americans. Up to 8
undergraduate and 16 master's students are expected to complete this
program (Guillory, in press). The University of the District of Columbia
prepares Spanish/\
English bilingual trainees to become speech-language pathologists to
serve Hispanic infants, toddlers, children, and youth. The curriculum
includes courses and practica on bilingualism, language acquisition in
bilingual children, and assessment and treatment of bilingual and LEP
students. At Howard University in the District of Columbia, preservice
speech-language pathologists learn to provide quality services for
minority nonspeaking children who use augmentative and alternative
communication (AAC) and are developing literacy skills. Eighteen
individuals are gaining competencies in the range of AAC services, with
emphasis on literacy acquisition and development of culturally diverse
children and youth.

**School psychology.** The Multicultural/Cross-Cultural School
Psychology Project at San Diego State University supports the
preparation of 39 school psychology trainees to work with
ethnolinguistically diverse students with disabilities and their
families and teachers. The project has revised the school psychology
program and created new partnerships with school districts.

**School counselors.** At Florida International University, culturally
and linguistically diverse graduate students in school counseling gain
competencies for working with students who have disabilities. Each year,
10 trainees enter the specialization track in exceptional student
education of the master's program in school counseling, which emphasizes
collaboration among students, faculty, families, schools, and the
community, as well as clinical field experiences in culturally diverse
urban schools.

## *Male Practitioners*

Among the most distressing shortages is the declining proportion of
males in the teaching force. For example, African American males
comprise only 0.4 percent of elementary special education teachers and
2.2 percent at the secondary level (Townsend, Thomas, Witty, & Lee, as
cited by Voltz, 1998). Absence of males of all races is a particular
loss for economically disadvantaged children in inner cities, many of
whom need positive male role models in their lives.

**Male-targeted projects.** The University of South Florida's Chrysalis
Project is collaborating with county agencies to train, support, and
provide teaching positions for African American, Hispanic, and white men
to teach urban children with disabilities. Over a 3-year period, 60
males will be enrolled. Bethune Cookman College in Florida prepares
African American men to teach and serve as role models for preschoolers
with disabilities. The training model emphasizes competencies in
providing culturally and linguistically relevant education to young
children with disabilities.

# Partnerships

Partnerships between MIHEs and other institutions, local education
agencies, and State education agencies (SEAs) are enabling factors in
capacity building, and many MIHE's have been creating and extending
these connections. Partnerships of selected institutions have been
mentioned in the foregoing profiles. Others are described below.

**MIHE and non-MIHE partnership.** Tuskegee University in Alabama has
formed a partnership with Auburn University to prepare students from
minority backgrounds for special education and for faculty teaching
exchanges. Through this agreement, Auburn also recruits Tuskegee
University graduates to enroll in its advanced preparation programs.

**MIHE school district partnerships.** In partnership with three urban,
multi-ethnic districts, Kean College of New Jersey is developing a
collaborative model for successful identification, recruitment,
retention, and preparation of culturally and linguistically diverse
trainees for special education careers. North Carolina Central
University is increasing the number of licensed special educators in
emotional/\
behavioral disabilities, including those from minority populations. The
program is based on a model for providing school-wide services to
racially and culturally diverse students who have emotional/behavioral
disabilities that was developed in partnership with the Wright School
Re-Ed Center and Durham Public Schools. The partnership includes
development of demonstration programs in five Durham schools. At South
Carolina State University, the Department of Educational Administration
and Special Education Program have joined with public schools in South
Carolina, North Carolina, and Georgia to increase the number of minority
school leaders in rural areas with minority populations and to improve
the multicultural competencies of currently employed administrators.
Fifteen participants of each type are recruited annually (Monteith, in
press).

Although many more examples of institutional cooperation and public
school partnerships could be cited, it generally appears that MIHEs'
relationships with SEAs are neither as numerous nor as strong. Interest
and cooperation by the National Association of State Directors of
Special Education shows promise of incorporating the talents of MIHE
faculty members, and the values of their personnel preparation programs,
into comprehensive systems of personnel development, planning and
implementation of State Improvement Grants, and other initiatives of
greater numbers of SEAs in the future.

# Federal Initiatives

The role of MIHEs in preparing personnel for special education has been
enhanced by efforts of MIHE faculty members and administrators and by
the stimulus from OSEP. OSEP originated a priority on "preparation of
personnel for minority handicapped children" in fiscal 1987. Although
the terminology of the priority has changed over time, and is now the
Minority Institutions priority, its intent has been to advance the
preparation of greater numbers of qualified personnel from historically
underrepresented populations. The current Minority Institutions priority
encompasses all categories of personnel preparation at all degree
levels, but MIHEs are able to submit applications under any other OSEP
personnel preparation priority for which postsecondary institutions are
eligible.

The IDEA Amendments of 1990 (Public Law 101-476) required the Secretary
of Education to develop and implement a plan to provide outreach
services to minority entities to assist them in participating more fully
in the discretionary programs under the Act (Section 610(j)). Under a
subsequent OSEP priority to implement this requirement, the first grant
for the Alliance Project was awarded in 1991 for the purpose of
supporting MIHE efforts to participate more fully in OSEP's personnel
preparation program. This intent of Public Law 101-476 was restated in
the 1997 amendments (Public Law 105-17). Section 661(d)(2) of the 1997
amendments emphasized the role of HBCUs and other MIHEs in improving
results for students with disabilities. The Alliance Project's current
cycle is scheduled to continue until 2002.

The Alliance Project provides grant-writing workshops, individual
mentoring, seminars, other professional development activities, and
information services to MIHEs that prepare special education teachers,
administrators, and related-services personnel or have underpinnings to
initiate or expand such offerings. Between 1992 and 1999, 1,253 faculty
members from 261 MIHEs participated in Alliance activities.

Collectively, MIHEs represent 24 percent of the nation's special
education personnel preparation programs. In 1991, 19.6 percent of
OSEP's personnel preparation projects were located at MIHEs (176 of a
total of 897 projects). In 1999, 30.6 percent of OSEP's projects were
located at MIHEs (184 of a total of 602). MIHE grants have increasingly
been awarded not only under the Minority Institutions priority but also
in response to all of OSEP's other personnel preparation priorities
(Alliance Project, 1999). The level of MIHE participation in OSEP-funded
personnel preparation is a promising indicator of OSEP and MIHE efforts
to improve results for children with disabilities.

# Conclusion

MIHEs' programs in special education and related services are serving
their communities and States well, and some are providing personnel
and/or training models at the regional and national level. Many of these
programs use innovative and successful practices for recruiting,
retaining, preparing, and inspiring trainees to make a difference in the
lives of children. MIHE graduates may aid progress in educating
culturally and linguistically diverse students with disabilities and
contribute to the development of greater cultural competence among their
colleagues. Some alumni are already having a positive impact on the
preparation of future personnel and on local, State, and national
policy. Colleagues in other preservice programs, local districts, and
SEAs can learn from the MIHE experience and can benefit through new
relationships with MIHEs to advance the education of students with
disabilities in America's valuable multicultural communities.

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Prenatal Exposure to Alcohol and Nicotine: Implications for Special
Education

In the past decade, a great deal of media attention has been focused on
women who use illicit drugs during pregnancy; this has been particularly
true of crack cocaine. However, research suggests that rates of alcohol
and tobacco use during pregnancy are far higher than those of cocaine or
other illegal drugs (e.g., see Brady, Posner, Lang, & Rosati, 1994;
Mathias, 1995; Slotkin, 1998). The literature on maternal alcohol and
tobacco use during pregnancy clearly delineates the harmful effects
these substances may have on the developing fetus and on the child's
subsequent academic, behavioral, social, and emotional development.
Accordingly, this module will focus on the substantial body of research
regarding prenatal exposure to alcohol and nicotine and on the
implications of such exposure for special education.

Prenatal substance exposure has proven to be a complicated issue for
researchers and educators alike. For a number of reasons, it is often
difficult to determine whether a child has been prenatally exposed to
alcohol, nicotine, illegal drugs, or a combination of these substances.
For example, women may underreport their use of alcohol and other
substances during pregnancy (Ventura, Martin, Curtin, & Mathews, 1997),
and there is no single biological marker for fetal exposure to alcohol
(Bagheri, Burd, Martsolf, & Klug, 1998; Wekselman, Spiering, Hetteberg,
Kenner, & Flandermeyer, 1995). In addition, there is evidence that the
effects of prenatal alcohol exposure on infants are underrecognized by
physicians, even among infants born to women with a history of alcohol
abuse. Stoler and Holmes (1999) note that this underrecognition may be
due to doctors' reluctance to label women as substance users or to a
lack of training in making such diagnoses. In many instances, it is also
difficult to separate the effects of a single substance such as alcohol
from those of polydrug use, which may include tobacco and illegal drugs
(Brady et al., 1994), or from other prenatal conditions that may
increase the negative effects of prenatal exposure to alcohol, such as
maternal undernutrition (Abel, 1998) or lack of prenatal care (Day,
Cottreau, & Richardson, 1993). Finally, it is difficult to separate the
effects of prenatal exposure to a given substance from the effects of a
child's postnatal environment (Brady et al., 1994; Roebuck, Mattson, &
Riley, 1999; Weinberg, 1997).

# Prenatal Exposure to Alcohol

A report on a joint project of the U.S. Department of Health and Human
Services and the U.S. Department of Education notes that "although
prenatal \[illicit\] drug exposure has captured a great deal of public
attention, prenatal exposure to alcohol is more widespread and has
perhaps an even more serious impact" (Brady et al., 1994, p. 1).
Research on the level of alcohol exposure needed to cause significant
impairment has yielded varying results, but the U.S. Centers for Disease
Control and Prevention (CDC) note that "even low to moderate alcohol use
has been shown to negatively impact birth outcome, independent of other
risk factors" (Ventura et al., 1997, p. 12). There is no known safe
level of alcohol consumption during pregnancy (Bagheri et al., 1998;
Bauer, 1999). It has been estimated that more than 2.6 million infants
are prenatally exposed to alcohol each year in the United States (Gomby
& Shiono, 1991). This section of the module reviews a number of large
studies that have attempted to estimate the national prevalence of
alcohol exposure during pregnancy.

## *Prevalence of Alcohol Use During Pregnancy*

Brady and her colleagues (1994) note that prevalence studies of maternal
drinking during pregnancy are subject to a number of limitations. Most
hospitals lack protocols for screening pregnant women for alcohol and
drug use. Where protocols do exist, they tend to rely on pregnant
women's self-reports regarding their alcohol and drug use. Such
protocols are of limited use because women are reluctant to admit using
alcohol or drugs during pregnancy. In addition to the problems posed by
self-report, relatively few researchers have used population-based
samples (Mayes, Bornstein, & Zuckerman, as cited in Brady et al., 1994).
The studies reported here have generally been population-based and have
relied on self-reported data.

The 1988 National Maternal and Infant Health Survey (NMIHS) studied
9,953 women who had given birth to a live infant in 1988. Overall, 45.4
percent of respondents reported drinking alcohol during the 3 months
prior to learning they were pregnant, and 20.7 percent reported
continuing to drink after learning they were pregnant. In addition, 16.8
percent reported having three or fewer drinks per month during
pregnancy, and 0.6 percent reported that they consumed six or more
drinks per week during pregnancy (CDC, 1995).

Respondents who reported drinking at any time during pregnancy were
categorized as "prenatal drinkers," while those who reported consuming
six or more drinks per week during pregnancy were categorized as
"frequent drinkers." The likelihood of drinking during pregnancy
increased directly with age and was highest among white, non-Hispanic
women. In addition, likelihood of prenatal drinking was higher among
women with 16 or more years of education and those with annual household
incomes of \$40,000 or more. Prenatal drinking was reported by 38.2
percent of women who smoked more than 10 cigarettes per day, compared
with 17.2 percent of women who were nonsmokers. In contrast, "frequent
drinking" was more likely among women age 35 or older, those who were
members of racial/ethnic minority groups, and those whose household
incomes were \$10,000 or less. The likelihood of frequent drinking
increased as smoking levels increased and was more than three times
higher among women who received no prenatal care than among those who
did receive prenatal care (CDC, 1995).

Floyd, Decoufle, and Hungerford (1999) used the 1988 NMIHS data set to
study women's reported alcohol use during the 3 months prior to learning
they were pregnant. Overall, 45 percent of participants reported
drinking during that period, and 5 percent reported consuming six or
more drinks per week. In addition, 60 percent of the women who drank
reported that they did not learn they were pregnant until after the
fourth week of gestation. Once participants realized they were pregnant,
many of them stopped drinking altogether; those who continued to drink
reported significant reductions in the amount of alcohol they consumed.
For example, prior to pregnancy recognition, 56 percent of the women who
used alcohol reported consuming less than one drink per week; after
pregnancy recognition, 81 percent of drinkers fell into this category.
Five percent of all women reported having six or more drinks per week
prior to pregnancy recognition, but fewer than 1 percent continued to
drink at this level after realizing they were pregnant. Overall, alcohol
use dropped from a prevalence rate of 45 percent during the 3 months
prior to pregnancy recognition to 21 percent following pregnancy
recognition (Floyd et al., 1999). These findings suggest that drinking
during the earliest stages of pregnancy is more common than drinking
after pregnancy recognition. Since half of all pregnancies in the United
States are unplanned (Forrest, as cited in CDC, 1997), the NMIHS data
raise questions about the number of women who consume moderate or even
heavy amounts of alcohol during the early stages of an unrecognized
pregnancy.

More recently, the National Institute on Drug Abuse (NIDA) studied 2,613
women who gave birth in 1992 for the National Pregnancy and Health
Survey and found that 18.8 percent of participants consumed alcohol at
some point during their pregnancy. Nearly 23 percent of white women
reported drinking during pregnancy, compared with 15.8 percent of
African American women and 8.7 percent of Hispanic women (Mathias,
1995).

The CDC compared 1991 and 1995 data from the Behavioral Risk Factor
Surveillance System (BRFSS), an ongoing, State-based, random-dialed
telephone survey of the U.S. population, to determine trends in the
prevalence of alcohol use during pregnancy. In 1995, 33,585 women
between the ages of 18 and 44 were interviewed by telephone about their
alcohol consumption during the previous month; 1,053 respondents, or 4.7
percent, reported being pregnant at the time of the interview. Pregnant
women who reported consuming at least one alcoholic drink during the
preceding month were categorized as "any drinking," and those who
reported consuming an average of seven or more drinks per week or five
or more drinks on at least one occasion were classed as "frequent
drinking" (CDC, 1997).

In 1995, 16.3 percent of pregnant women reported "any drinking" during
the previous month, compared with 12.4 percent in 1991. "Frequent
drinking" was approximately four times more common in 1995 than in 1991
(3.5 percent versus\
0.8 percent). This difference in the rate of frequent drinking persisted
after the researchers controlled for age, race, household income,
marital status, employment status, education level, and smoking status
(CDC, 1997).

It should be noted that many of the studies described above relied on
self-reported data that may be subject to both recall and reporting
bias. Despite these limitations, researchers have learned a great deal
about alcohol consumption during pregnancy. Studies examining data
collected over the past 12 years have suggested that anywhere from 16.3
percent to 45.4 percent of women drink alcohol during pregnancy (CDC,
1995, 1997). In the latter study, 20.7 percent of women reported that
they continued to drink after learning they were pregnant. Variation in
reported rates of maternal drinking does not obscure the fact that a
significant number of infants are prenatally exposed to alcohol each
year. The next section of this module examines the potential effects of
alcohol on the developing fetus, with a particular focus on the
implications of such exposure for the field of special education.

## *Effects of Alcohol Use During Pregnancy*

It is well-documented that alcohol is teratogenic, or toxic, to a
developing fetus, and the effects of maternal alcohol consumption during
pregnancy are "potentially devastating" (Wekselman et al., 1995, p.
296). Possible consequences of alcohol consumption during pregnancy
include physical birth defects, cognitive or learning problems,
attention deficits, behavioral and emotional problems, growth
retardation, and the triad of anomalies that comprise fetal alcohol
syndrome (FAS). Specific abnormalities are linked to alcohol use at
particular times during pregnancy (National Institute on Alcohol Abuse
and Alcoholism (NIAAA), 1997). For example, physical birth defects are
more likely when alcohol is used during the first trimester, while
growth restriction is associated with alcohol use late in pregnancy
(Bauer, 1999).

### *Fetal Alcohol Syndrome and Fetal Alcohol Effects*

In 1973, two University of Washington researchers described a condition
marked by the co-occurrence of three primary characteristics: growth
deficiency, a distinctive pattern of abnormalities primarily observable
in the face, and central nervous system (CNS) dysfunction. The
researchers named this condition fetal alcohol syndrome (Streissguth et
al., 1997). Children who manifest some but not all of the
characteristics of FAS, and who were exposed prenatally to alcohol, may
be referred to as exhibiting fetal alcohol effects (FAE). FAEs represent
the "partial or incomplete expression of alcohol's teratogenic influence
on the developing fetus" (Bauer, 1999, p. 97). The full spectrum of
characteristics resulting from fetal alcohol exposure may also be
referred to as alcohol-related neurodevelopmental disorders (ARND)
(Institute of Medicine, 1996). The characteristics associated with fetal
alcohol exposure are most often observed along a continuum ranging from
milder effects to full fetal alcohol syndrome (NIAAA, 1997).

A 1996 Institute of Medicine report estimates the incidence of full FAS
at 0.5 to 3 births per l,000, with higher rates in some populations.
Among heavy drinkers, the rate of FAS occurrence has been placed at 4.3
percent (Abel, 1998). If FAEs are considered, the incidence is much
greater. A recent study concluded that the incidence of FAS and other
alcohol-related neurodevelopmental disabilities reached almost 1 in 100
live births (Sampson et al., as cited in Streissguth, Barr, Bookstein,
Sampson, & Olson, 1999). In the United States, the incidence of FAS is
higher among African Americans and American Indians (CDC, 1996; NIAAA,
1994), in lower socioeconomic classes (NIAAA, 1994), and among women who
have previously given birth to a child with FAS (NIAAA, 1997).

Cognitive impairment is one characteristic of FAS. FAS is the leading
known cause of mental retardation in the United States (Bagheri et al.,
1998; Streissguth et al., 1999; Weinberg, 1997). Among all the major
causes of mental retardation, FAS alone is completely preventable
(Bauer, 1999). In addition to cognitive deficits, FAS and FAE are
associated with a number of secondary conditions that are related to
fetal alcohol exposure. Streissguth and her colleagues (1997) sought to
determine the prevalence and range of these conditions in persons
diagnosed with FAS or FAE.[^4] The researchers defined primary
conditions as "functional deficits that reflect the central nervous
system (CNS) dysfunctions inherent in the FAS or FAE diagnosis" (i.e.,
those that result directly from the teratogenic effects of alcohol on
the developing fetus), while secondary conditions were defined as "those
that arise after birth and presumably could be ameliorated through
better understanding and appropriate interventions" (p. 27). Primary
conditions were measured through the use of intelligence, achievement,
and adaptive behavior tests; secondary conditions were assessed using a
life history questionnaire.

### *Primary Conditions*

Of the 473 participants who were assessed for primary conditions, 178
had a diagnosis of FAS, and 295 had a diagnosis of FAE.

The 178 participants with a FAS diagnosis had an average IQ of 79 and an
average adaptive behavior score standard score of 61.[^5] On the
achievement tests, the average reading score was 78, the average
spelling score was 75, and the average mathematics score was 70. The 295
participants with a FAE diagnosis had an average IQ of 90, with a VABS
score of 67. Their achievement test scores averaged 84 on reading, 81 on
spelling, and 76 on mathematics.

### *Secondary Conditions*

Secondary conditions related to fetal alcohol exposure were assessed in
415 participants with FAS or FAE who ranged in age from 6 to 51. Six
main secondary conditions were studied (see figure I-1):

-   *Mental health problems*, defined as having any one of a list of
    mental health problems or as ever having gone to a psychotherapist
    or counselor for a mental health problem.

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-   *Disrupted school experience,* defined as having been suspended or
    expelled from school or having dropped out of school.

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-   *Trouble with the law* was defined as ever having been in trouble
    with the authorities, charged, or convicted of a crime.

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-   *Confinement*, including inpatient treatment for mental health,
    alcohol, or drug problems, or ever having been incarcerated for a
    crime.

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-   *Inappropriate sexual behavior* was defined as having had repeated
    problems with one or more of 10 inappropriate sexual behaviors or
    ever having been sentenced to a sexual offenders' treatment program.

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```
-   *Alcohol/drug problems* was defined as having ever been in treatment
    for an alcohol or drug problem or as having an alcohol or drug
    problem.

Figure I-1

Secondary Conditions Among Persons with FAS or FAE

![](media/image1.wmf){width="5.492361111111111in"
height="4.334722222222222in"}

Note: N = 415.

Source: Streissguth et al., 1997.

Male participants had higher rates of disrupted school experience,
trouble with the law, and confinement than did female participants.
Rates of other secondary conditions generally did not differ
significantly by sex (Streissguth et al., 1997).

Finally, to determine how many persons with FAS or FAE were living
independent lives as adults, the researchers evaluated two additional
secondary conditions for the 90 participants who were 21 or older.
Eighty-three percent of those participants were in dependent living
situations, and 79 percent reported problems with employment. Only 7 of
the 90 participants age 21 or older were living independently and did
not have employment problems (Streissguth et al., 1997).

An important finding of this study was that although participants with
FAE had less cognitive impairment than those with FAS, they actually had
more secondary conditions related to fetal alcohol exposure than did the
FAS group. The authors suggest that this difference is partly due to the
fact that the FAE group tended to be diagnosed later than the
participants who had FAS; early diagnosis appeared to protect
participants against the development of secondary conditions. Overall,
the authors found that "people with FAS and FAE have an unacceptable
level of secondary \[conditions\] that severely impairs their quality of
life and is extremely costly to society" (Streissguth et al., 1997, p.
38).

Weinberg (1997) recommended systematic study of the prevalence of
persons with FAS and FAE in specialized settings. The findings of
Streissguth and her colleagues (1997) suggested that disproportionate
numbers of alcohol-affected individuals have problems with the law.
Accordingly, Fast, Conry, and Loock (1999) studied the prevalence of FAS
and FAE among youth between the ages of 12 and 18 who had pleaded guilty
to or been found guilty of committing a criminal offense and had
subsequently been remanded for a forensic psychiatric/psychological
assessment. Of the 287 young people remanded for evaluation, 67 (23.3
percent) had an alcohol-related diagnosis. The majority (n = 64) were
diagnosed with FAE, and three had a diagnosis of FAS. In this sample,
the occurrence of FAS was 3 to 10 times the accepted worldwide rate,
which the authors cite as 1 to 3 per 1,000 births; the occurrence of FAE
was 10 to 40 times the accepted worldwide incidence. The researchers
noted that only 3 of the 67 youth with an alcohol-related diagnosis had
received such a diagnosis prior to this special assessment, which
resulted from an encounter with the juvenile justice system (Fast et
al., 1999).

## *Other Effects of Prenatal Alcohol Exposure*

FAS represents the most extreme end of a spectrum of negative effects
resulting from prenatal exposure to alcohol (Stoler & Holmes, 1999). The
NIAAA reports that "outcome is a function of prenatal dose" (1997, p.
9). Carmichael Olson and her colleagues (1997) note that "effects of
lower levels ('doses') of alcohol exposure most often emerge as problems
in behavior and adaptive function" (p. 1187). For example, a team of
researchers from San Diego State University found that children who were
prenatally exposed to alcohol are likely to exhibit many psychosocial
and behavioral problems, even if they do not meet criteria for a
diagnosis of FAS (Roebuck et al., 1999).

Similarly, in their long-term follow-up study of a birth cohort of
approximately 500 children through age 14,[^6] Streissguth and her
colleagues (1999) found attention, memory, and information processing
deficits in the alcohol-exposed children that persisted over time. In
addition, the researchers reported antisocial and delinquent behaviors,
as well as difficulties with classroom learning and behaviors, from
school age through age 14. Using the same sample, Carmichael Olson et
al. (1997) found a correlation between greater reported prenatal alcohol
use and increased behavior and learning difficulties during early
adolescence. In addition, two maternal drinking patterns\--"binge"
drinking and alcohol exposure early in pregnancy\--were associated with
greater risk of adolescent behavior and learning problems.

Over the past 25 years, a substantial body of multidisciplinary research
has emerged to suggest that prenatal alcohol exposure can have
significant physical, behavioral, intellectual, and emotional effects.
Many of these effects, particularly mental retardation and behavioral
and social deficits such as poor judgment, impulsivity, hyperactivity,
and poor social skills, manifest themselves in the classroom and may
involve the provision of special education and related services
(Thompson & Thompson, 1998).

# Prenatal Exposure to Nicotine

"The effect of cigarette exposure on the developing fetus may be the
most underrated, at least in public opinion," Eyler and Behnke (1999)
note. Tobacco is used worldwide by people of all socioeconomic classes;
it is perhaps for this reason that "tobacco use prenatally does not
receive the press that crack smoking does"\
(p. 108). This section of the module discusses prevalence studies of
maternal smoking during pregnancy and describes the effects of prenatal
nicotine exposure.

## *Prevalence of Tobacco Use During Pregnancy*

The same caveats that apply to prevalence studies of maternal drinking
during pregnancy must also be considered in relation to studies of
tobacco use. Relatively few studies have attempted to determine the
prevalence of this behavior. NIDA's 1992 National Pregnancy and Health
Survey reported that 20.4 percent of women smoked during pregnancy.
Tobacco use was reported by 24.4 percent of white participants, compared
with 19.8 percent of African American women and 5.8 percent of Hispanic
women (Mathias, 1995).

Table I-3

Percentage of Women Who Smoked During Pregnancy by Race, Hispanic
Origin, and Age

  --------------- ---------- ------- ------- ------- ------- ------- ------- ------- ------
                  Mother's                                                           
                  Age                                                                

  Race/Hispanic   \< 15      15-17   18-19   20-24   25-29   30-34   35-39   40-49   All
  Origin                                                                             Ages

  Hispanic        3.3        4.5     4.8     4.5     3.8     4.2     5.0     4.0     4.3

  White, non-\    21.5       27.3    28.6    23.9    14.8    12.0    12.4    10.6    17.1
  Hispanic                                                                           

  Black, non-\    2.4        4.3     5.9     8.8     12.6    16.2    18.2    14.8    10.6
  Hispanic                                                                           
  --------------- ---------- ------- ------- ------- ------- ------- ------- ------- ------

Notes: Data collected from birth certificates in 46 States, the District
of Columbia, and New York City in 1995, and analyzed by CDC/NCHS.

Source: Ventura et al., 1997.

A CDC analysis of data reported on the birth certificates of the 3.9
million births that occurred in 1995 found that smoking during pregnancy
was reported by 13.9 percent of women giving birth that year.[^7]
Patterns of tobacco use during pregnancy differed by race and ethnicity,
with non-Hispanic white women ages 18-19 years having the highest rate
(29 percent). Under the age of 30, smoking rates were considerably
higher for non-Hispanic white women than for non-Hispanic black or
Hispanic women. However, smoking rates for women age 30 or older were
highest for non-Hispanic black women. Hispanic women, regardless of age,
had consistently low smoking rates of 3 percent to 5 percent (Ventura et
al., 1997). Table I-3 illustrates differences in smoking rates by race,
Hispanic origin, and age.

Other publications have noted higher smoking rates; for example, Slotkin
(1998) reported that 25 percent of all pregnant women in the United
States who smoke continue to smoke after they learn they are pregnant.
National Center for Health Statistics data cited in Chomitz, Cheung, and
Lieberman (1995) suggest that 20 to 25 percent of American women smoke
during pregnancy. The U.S. Department of Health and Human Services
(DHHS, 1990) reported that about one-quarter of women who smoke prior to
pregnancy stop smoking when they learn they are pregnant; another third
reduce their smoking level upon learning they are pregnant. However, as
Eyler and Behnke (1999) note, "Most women who smoke have difficulty and
rarely accomplish abstaining from tobacco use throughout pregnancy" (p.
108).

## *Effects of Tobacco Use During Pregnancy*

A number of studies related to prenatal alcohol or illegal drug exposure
have used maternal smoking as a covariate and reported significant
results related to smoking. Animal studies have also demonstrated the
teratogenic effects of nicotine (Slotkin, 1998). It is difficult to
separate the effects of prenatal exposure from those of postnatal
exposure to secondhand smoke, since, as Eyler and Behnke (1999) state,
"It is likely that, when born to a smoking mother, a child will also be
reared within a home filled with smoke" (p. 108). Nonetheless, research
does suggest that a number of adverse effects are associated with
prenatal exposure to nicotine.

Low birth weight, a condition that is responsible for approximately half
of all infant deaths, is a characteristic of prenatal nicotine exposure
(Bauer, 1999). Chomitz and her colleagues (1995) note that approximately
one-fifth of all low birth weight cases could be prevented if women did
not smoke during pregnancy. In 1995, 12.2 percent of infants born to
women who smoked during pregnancy weighed less than 2,500 grams (5 lb. 8
oz.), compared with 6.8 percent of births to nonsmokers. The risk of low
birth weight associated with maternal smoking increases with maternal
age. Among women age 30 and older, the low birth weight rate for births
to women who smoked was at least 2.3 times that for births to
nonsmokers. The risk of low birth weight also increases with the number
of cigarettes smoked (Ventura et al., 1997). Other possible physical
effects of maternal smoking during pregnancy include preterm delivery
(Kramer, 1991), perinatal mortality (Slotkin, 1998), increased risk of
Sudden Infant Death Syndrome (Schoendorf & Kiely, 1992), and childhood
asthma (Weitzman, Gortmaker, Walker, & Sobol, 1990).

Aside from these physical problems, children whose mothers smoke during
pregnancy may also develop a number of learning and behavioral problems,
many of which may not appear until childhood and adolescence (Slotkin,
1998). For example, Wakschlag and her colleagues (1997) conducted a
6-year longitudinal study on the relationship between maternal smoking
during pregnancy and conduct disorder. Participants included 177 boys
who were ages 7 to 12 at the time of the first assessment. The
researchers found that women who smoked were significantly more likely
to have a child with conduct disorder than women who did not smoke
during pregnancy. Subsequent logistic regression analyses found that
smoking more than half a pack of cigarettes daily during pregnancy
remained a significant predictor of conduct disorder even after
controlling for socioeconomic status, parental psychopathology, other
pregnancy risk factors, and parenting risk factors.

Milberger and her colleagues have published two studies examining a
hypothesized link between maternal smoking during pregnancy and
attention deficit hyperactivity disorder (ADHD). The first study
compared 140 children with a diagnosis of ADHD to 120 children without
an attention deficit diagnosis. All participants were white,
non-Hispanic boys between the ages of 6 and 17. Twenty-two percent of
the boys with ADHD had a history of maternal smoking during pregnancy,
compared with 8 percent of the control group. The correlation remained
statistically significant after controlling for socioeconomic status,
maternal IQ, maternal ADHD, paternal IQ, and paternal ADHD (Milberger,
Biederman, Faraone, Chen, & Jones, 1996).

In the second study, Milberger and her colleagues sought to determine
whether the association between ADHD and maternal smoking in pregnancy
previously seen in boys with ADHD would hold true for their high-risk
siblings[^8]. The researchers compared high-risk siblings with siblings
of a non-ADHD control group. Fifty-one percent of the siblings in this
study were boys (n = 158), 57 percent were siblings of children with
ADHD (n = 171), and 13 percent had ADHD themselves (n = 38). The
researchers found that 47 percent of the high-risk siblings with ADHD
had a history of maternal smoking during pregnancy (n = 15), compared
with 24 percent of the siblings without ADHD (n = 33). This relationship
remained significant after controlling for socioeconomic status,
parental IQ, and parental ADHD (Milberger, Biederman, Faraone, & Jones,
1998).

The effects of prenatal nicotine exposure on long-term cognitive
development are still unclear. Lassen and Oei (1998) reviewed 16
longitudinal studies that looked at the cognitive effects of prenatal
nicotine exposure. Twelve of those studies reported significant
cognitive deficiencies in children whose mothers smoked during
pregnancy. Of the four studies that found no significant cognitive
deficits, the pattern of results "reflected subtle deficits in the
intellectual function of children associated with maternal smoking
during pregnancy" (p. 650). The authors concluded that the long-term
effects of prenatal smoking on children's intellectual functioning are
difficult to isolate because the majority of studies to date have not
controlled for the postnatal effects of passive smoking.

The studies summarized above describe a number of physical and
behavioral effects that result from tobacco use during pregnancy. These
effects, together with those related to maternal alcohol use during
pregnancy, may pose challenges for regular and special educators alike.
The next section of this module describes some of the research on
service delivery for prenatally exposed children and discusses barriers
to effective service provision.

# Effective Service Delivery for Prenatally Exposed Children

Sinclair (1998) notes that "each \[prenatally exposed\] child must be
assessed and educated with particular attention to his or her individual
strengths and vulnerabilities" (p. 125). Individualized assessment is
one of the practices that practitioners have found helpful in working
with exposed children.

Although there is no "typical profile" of a prenatally exposed child,
researchers have described several specific behaviors and psychosocial
impairments frequently exhibited by these children in the classroom,
including:

-   difficulty forming attachments,

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-   impulsivity,

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-   impaired social skills,

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-   extremes of classroom aggression or introversion,

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-   inability to handle multiple stimuli, and

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-   inability to recognize verbal cues (Sinclair, 1998; Sluder, Kinnison
    & Cates, 1996/1997).

These special needs and behaviors suggest a number of particular
classroom practices that may be useful. For example, researchers have
determined that these children need a small, individual workspace that
remains unchanged from day to day (Meyer & Morris, 1994; Sluder et al.
1996/1997). Adherence to a routine is also important for many children
(Thompson & Thompson, 1998). Smooth transitions between activities allow
children to stay focused and reduce the likelihood of extreme mood and
behavior swings; thus, practitioners suggest announcing that an activity
will end in a specific amount of time so that the children are prepared
for the change (Sluder et al., 1996/1997; Thompson & Thompson, 1998).

# OSEP Research Initiatives

In response to the challenges of providing effective special education
services to prenatally exposed children, the Office of Special Education
Programs (OSEP) currently funds several research and personnel
preparation projects intended to improve results for this population.
Researchers at the University of Kansas, the University of Minnesota,
and the University of South Dakota are collaborating on a longitudinal
study of the early elementary school experiences and developmental
outcomes of children prenatally exposed to alcohol and drugs. The
researchers hypothesized that the effects of prenatal exposure are
compounded by environmental risk factors. Accordingly, the study has
focused on five such factors: poverty, limited parental education, large
family size, minority status, and single parent status. Initial analyses
have confirmed that exposure to a greater number of environmental risk
factors has increasingly negative effects on developmental age and
growth rate. Results from the study will be incorporated into preservice
training in graduate coursework and disseminated through publications
and conference presentations.

Another OSEP-funded project will provide master's-level preparation to
48 students to serve infants and toddlers with low-incidence
disabilities, including FAS, in rural Alaska. The 36-credit,
competency-based program will include a two-course distance learning
sequence; a summer intensive clinical course and practicum; a
six-semester clinical study in autism, FAS/FAE, and severe disabilities;
and leadership activities in the areas of care coordination,
consultation, and in-service training.

The Alaska Early Childhood High Incidence Master's Training Program will
prepare rural special educators and related services personnel to serve
children ages 3 through 6 with disabilities and their families. The
program will recruit rural underrepresented Alaskan natives and train 48
students, plus an additional 16 who will graduate after the grant period
ends, with the skills necessary to provide effective early childhood
services. An intensive clinical study and practicum in FAS and FAE is a
major component of the program.

In addition to these research efforts, OSEP funded the National Early
Childhood Technical Assistance System (NECTAS) through a cooperative
agreement to produce and distribute a publication entitled *Resources
Related to Children and Their Families Affected by Alcohol and Other
Drugs* (3rd Edition). This publication includes national training and
information resources, state programs and agencies, and Federal and
private funding sources and is available from NECTAS
(www.nectas.unc.edu/pubs/pubslist2.html#resor).

Department of Education Participation in Other Federal Initiatives

A representative of the Office of Special Education and Rehabilitative
Services (OSERS) serves as the chairperson of a Fetal Alcohol
Syndrome/Alcohol-Related Neurodevelopmental Disorders (FAS/ARND) Work
Group. The purpose of this group is to improve educational interventions
and services for children ages birth through 8 with FAS/ARND and their
families. The work group reports to the Federal Interagency Coordinating
Council and the Interagency Coordinating Committee on Fetal Alcohol
Syndrome (ICCFAS) of the NIAAA and the National Institutes of Health
(NIH).

The goals of the FAS/ARND Work Group include the following:

-   develop methods for the early screening, referral and diagnosis of
    children with FAS/ARND;

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-   clarify the ethical and confidentiality issues involved with
    screening and assessment in schools and early intervention settings;

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-   identify and refine appropriate intervention strategies to
    effectively serve children with FAS/ARND and their families and to
    prevent secondary conditions related to fetal alcohol exposure; and

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-   collaborate to provide intensive, effective, and on-going training
    and technical assistance.

The work group comprises representatives from a number of Federal
agencies, including NIAAA, the Department of Education, the CDC, NIH,
the Substance Abuse and Mental Health Services Administration, Head
Start, the Bureau of Indian Affairs, the Indian Health Service, and the
Office of Juvenile Justice and Delinquency Prevention. It also includes
parents, educational practitioners from the field, and representatives
of different advocacy and health groups. Medical and research personnel
from the University of Washington, Emory University School of Medicine,
and UCLA Neuropsychiatric Institute and Hospital are also members of the
work group.

In addition to chairing the FAS/ARND Work Group, OSERS has appointed a
representative to the ICCFAS. This committee coordinates the efforts of
government agencies to address FAS, FAE, ARND, and alcohol-related birth
defects. Its mission is to facilitate communication and cooperation
among the different disciplines and organizations that address the
health, education, developmental disabilities, and social service issues
related to these disorders.

# Summary

Although the deleterious effects of both alcohol and nicotine on
developing fetuses have long been recognized and documented, high
numbers of children continue to be prenatally exposed to alcohol and
nicotine\--often before their mothers realize they are pregnant.
Prenatal exposure to both of these legal substances can result in
significant and far-ranging intellectual, behavioral, and emotional
effects and thus have particular implications for special education. A
1996 Institute of Medicine report on FAS pointed out the need for
research related to early identification and concomitant early
intervention services and to the provision of special education and
related services. Although it is unclear how many children are
prenatally exposed to alcohol and nicotine each year, it is apparent
that significant numbers of these children will continue to require
special education and related services. Further efforts are necessary in
order to better understand the prevalence and scope of the problem, to
develop improved assessment and identification methods, and to determine
the most effective academic and behavioral interventions for this
population of students.

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[^1]: This module was developed by the Alliance Project under Grant No.
    H929T1000F between Peabody College/Vanderbilt University and OSEP,
    U.S. Department of Education.

[^2]: The 1996 figures were taken from the Common Core of Data survey
    and reported in table 46-1 of the *Condition of Education 1999*, by
    NCES.

[^3]: For the purposes of this module, IHEs with minority student
    enrollments of 25 percent or more will be referred to as MIHEs.

[^4]: Streissguth and her colleagues (1997) referred to these conditions
    as "primary and secondary disabilities." To avoid confusion with the
    term "disabilities" as defined under IDEA, the word "conditions" is
    used here instead.

[^5]: Participants were given an age-appropriate IQ test and the Wide
    Range Achievement Test-Revised (WRAT-R). The Vineland Adaptive
    Behavior Scale (VABS) was administered to a caregiver or other
    person who knew the participant well. For both IQ and adaptive
    behavior, a score of 100 is normal.

[^6]: The cohort was composed of children whose mothers reported a range
    of prenatal drinking patterns, including absention.

[^7]: In 1995, tobacco use during pregnancy was reported on birth
    certificates in 46 States, the District of Columbia, and New York
    City, comprising 80 percent of U.S. births during the year.

[^8]: In this study, siblings of children with ADHD were referred to as
    "high risk" because they have been shown to be at high risk for
    ADHD, comorbid psychiatric disorders, and cognitive impairments
    (Milberger et al., 1998).