Background: This study explored the experiences of school leadership teams (principals, assistant principals, home-school advisors, and other selected school personnel) in regard to substance-impacted children. The participants were from ten urban area elementary schools in a large Mid-western city. The purpose of the study was to gain a current knowledge of substance-impacted children from a school-based, practitioner, "pedestrian" point of view. Children were considered substance-impacted if one or more of the following was true for them: (1) has or had a parent or guardian who historically abused or presently abuses substances; (2) was subjected in-utero to substances via the birth mother's use; and/or (3) abuses substances himself or herself.

Method: A focus group, led by the author, was conducted at each of the ten schools. Five key questions were posed to the participants to facilitate and focus the discussion of their experiences with substance-impacted children. The discussions were audio taped, and transcribed verbatim. The verbatim transcriptions were then analyzed through a four-step process. Step I consisted of indexing the participants' responses. Step II clustered like responses into data sets. Step III utilized grounded conceptual analysis on each data set for the purpose of identifying salient patterns of information. And, Step IV dialogued (when applicable) the identified patterns of information found in Step III with known, relevant, and established data to generate further conceptualization and useable knowledge without violating the data.

Results: Participant educators in the field had rich and distinct experiences with substance-impacted children. Clear patterns of experience were found in each of the five areas explored: presenting behavior, impact on classroom performance, impact on general school behavior, effective helping strategies, and perceived areas of blockage that hinder the school from taking more positive interventive action. Analysis of the data yielded five major findings from the viewpoint of the participant educators: (1) substance-impacted children could be identified; (2) substance-impacted children manifested salient problems in terms of their academic performance; (3) substance-impacted children presented distinct disruptions in terms of their general school behavior; (4) participant educators readily identified actions schools can take to help substance-impacted children; and yet, (5) at the present time, the issue of substance-impacted children is a mute and opaque topic, with schools lacking the resources and strategies to positively address these children's issues.

Conclusions: Due to the present emphasis in education on student performance and test scores, the sharp focus on substance-impacted students that was exercised by schools in the mid 1980s through the early 1990s has been obscured. However, the experiences of the study's participant educators strongly suggest that even though substance-impacted children are no longer a current focus of concern, they present schools with distinct problems and challenges in terms of their academic performance and general school behavior. Thus, the author suggests that if substance-impacted children are to be helped in an era of "high-stakes" testing, the strategies utilized to assist them must undergo a paradigm shift—from a service model to a student performance model that utilizes classroom as well as service interventions.

Introduction

In the 1980s and early 1990s, substance abuse and kids were at the forefront of national concern. In response, significant Federal and State dollars were allocated to schools to implement student assistance programs, and alcohol and drug prevention programs that attempted to break the grip that substance abuse was having on a significant number of school age youth. ‘Just Say No' clubs, DARE officers, and student assistance counselors were a few of the many ways schools tried to stem the tide of substance abuse during that decade and one half.

Many of the youth who were targeted for those interventive programs because of their abuse of substances are now the parents of the children who are entering and attending our elementary schools. With these children, the problem of alcohol/drug abuse and school is not necessarily due to their abuse of substances, but is more often due to the impact that their parents' substance abuse has on them. Thus, from the field perspective, the critical issue for schools is no longer substance abusing youth, as it was in the 1980s and early 1990s; the issue has widened to the significant, uncounted numbers of "substance-impacted" children of substance-abusing parents, and the affect this has on their academic performance and general school behavior.

We believe that this shift in the nature of the problem of substance abuse and schools has been largely unrecognized. And, because of the current focus on student achievement and "high-stakes" testing, the issue of substance-impacted students has been obscured. A literature search of the ERIC educational database bears this out. For example, in the past five years, 1998 through the current year, there are almost no articles on the subject of school-age substance-impacted children, their academic performance and general school behavior. The author found no studies pertaining to parental alcoholism or drug addiction and the impact that could have on their school-age children. No studies were found on substance-impacted school-age children and their impact on school climate and/or school culture. In other words, the author found almost nothing in the recent literature that focused on substance-impacted school-age children in the light of their day-to-day performance and behavior at school. Further, the author found nothing on substance-impacted children's performance on high-stakes tests.

The author did find, however, rather fragmented clusters of data and a few best practice intervention articles that tangentially touched on the issue of substance-impacted school-age children. For example, the author found articles that focused on distinct populations of non-school-age substance-impacted children—preschool children and programs (Florida's Challenge, 1998); parent substance abuse and children in foster care (McNichol & Tash, 2001); Child Protective Service (CPS) referred children (Semidei, Radel, & Nolan, 2001; and Sun, Shillington, Hohman, & Jones, 2001); substance exposed children in adoption (Barth, Freundlich & Brodzinsky, 2000); substance abuse and learning disabilities (NCASA, 2000; Tomblin, & Haring, 1999; Johnson & Lapadat, 2000); Fetal Alcohol Syndrome, learning and behavior (Ackerman, 1998; Gessner et al., 1998; Nadel & Uecker, 1998; Johnson & Lapadat, 2000); and, children of alcoholics (COA's)— general psychological and behavioral characteristics (Morey, 1999; Post & Robinson, 1998; Rodney & Mupier, 1999; Schwatrtz & Liddle, 2001; Loukas, et al., 2001); protective factors (Jordan & Chassin, 1998); family functioning (Alford, 1998; Robitschek & Kashubeck, 1999); and intervention (McNair & Arman, 2000). Bottom line, the author found almost no integration of these fragmented findings addressing the problem of substance-impacted children and school performance.

Thus, the motivation and concern of this study is to refocus and update the issue of substance abuse and the school from the widened perspective of substance-impacted children, while recognizing that the present concern of the school and community is on student achievement and overall school performance. More specifically, the purpose of the study is to gain current knowledge of substance-impacted children from a field-practitioner, "pedestrian" point of view by exploring participant educators' experiences with children who come to school substance-impacted. Five areas of concern are explored: (1) What presenting behaviors mark a child as substance-impacted? (2) How does being substance-impacted affect academic performance? (3) How does being substance-impacted affect general school behavior? (4) What have the participant educators found that helps substance-impacted children have a more "normal/successful" school experience? And, (5) What blocks schools from assisting these children?

The Study Design

The study design is simple and direct—to conduct focus groups with the core leadership ("participant educators") at each of a Mid-western metropolitan area school district's ten elementary schools on the topic of substance-impacted children. Core school leadership was determined to be the school principal, the assistant principal, the home-school advisor or school counselor, and any other educational personnel that an individual school's principal deemed significant and helpful. The focus group format was selected to gather narrative data. This decision was made for the following reasons: (1) focus groups have been recognized as a good format for exploring specific sets of issues; (2) focus groups can yield enriched data through the use of the group dynamic in eliciting information—especially, in a smaller group of staff members who have been working together in the field; (3) focus groups provide "lived" grounded knowledge that is in line with the aims of the study; and (4) focus groups provide the means to collect the data in a non-cumbersome, timely, and cost-efficient manner.

The appropriate administrators of the school district were contacted to secure their permission for the study. Each individual school's core leadership could accept or decline the request to participate. All of the selected school district's ten elementary schools chose to participate. Data was collected by the author via audio tape. Confidentiality was maintained by having the participants use only their titles, and by refraining from using any student names. The author was the only one who knew what data belonged to what school. The tapes were transcribed into verbatim, narrative texts and the tapes were then erased. The ten focus groups were conducted within a five-week period in the winter of 2003. The groups met for approximately 40 to 50 minutes each, and were conducted during the regular school day.

For the purpose of the study, children were defined as "substance-impacted" if one or more of the following three categories were applicable to them: (1) children who came from homes where alcohol and/or other drugs had been or were being abused; (2) children whose mothers abused alcohol/drugs while the child was carried in-utero; and/or, (3) children who had been or were presently abusing alcohol and/or other drugs. These categories were presented to the study's participants before the focus group taping began.

Each of the focus groups centered their attention and discussions on the following five key questions:

1. How have you come to realize a child is living a substance-impacted life? (What is it that you hear and/or see that indicates to you a child is substance-impacted?)
2. What do you notice about substance-impacted children in terms of their academic/classroom performance?
3. What do you notice about substance-impacted children in terms of their general school behavior?
4. What have you found helps the most in giving substance-impacted children a "normal/successful" school experience?
5. What "blocks" schools from working with substance-impacted children? Where do you feel your hands are tied (if you do) in working with these children?

Methods of Analysis

This report is organized sequentially according to the data collected. There are five sections, one for each key question. Each section presents the participant educators' responses [see note below], and the author's analytical findings. Following the five sections of data analyses, a bipartite summary of the study's conclusions is presented.

Note: The participant educators' responses, which were audio taped and transcribed verbatim from the focus group discussions, reflect the informal nature of conversation among colleagues familiar with each other and with the topic under discussion. The participants did not always speak in clear, complete sentences, but the salient information imparted was evident to all present. In an effort to maintain the accuracy of the study data, the participants' spontaneous responses were not altered, but were transferred to this article verbatim.

Steps I and II of the data analysis, the indexing and clustering of like responses, yielded two distinct data sets embedded in the participants' responses—(1) impact manifestation (things noted by participant educators that potentially indicated a child was substance-impacted) and, (2) informing (the means by which participant educators were informed that a child was substance-impacted).

General Area Number One covers school-based indicators—irregular attendance, general academic performance and classroom behavior. General Area Two is made up of behavioral indicators including acting out, poor error detection and behavior correction, disengagement from school, forgetting things, not completing work, not bringing in homework, needing sleep and sleeping in class, and demeanor upon arrival in the morning. General Area Three consists of psychological indicators—feeling trapped, role reversal and feeling predestined to abuse. General Area Four is made up of domestic indicators consisting of lack of parental support and involvement, and home visits. Under General Area Five, congenital, developmental, & physical care indicators, classic congenital features, developmental anomalies, and poor physical care/appearance were identified.

The following are summaries of each general area. Each summary includes exemplar narrative highlights.

Area 1: School Based Indicators

Our study participants saw a child's irregular and erratic attendance as a potential marker for the presence of substance abuse problems in the home. As one participant put it, "Sometimes there's patterns that take place. A child, if their attendance is really poor, or the way they come dressed to school is…sometimes those are flags that you start really looking for. Maybe they don't come to school for four or five days and when they do, they dress poorly…They're tardy quite a bit and some of those are some signs sometime that there's something not [right]…"

Academic Performance—General
From the participant educators' perspective, the disruptive nature that substance abuse has on parents contributed to a general disruption of their child's ability to learn. As previously noted, one principal cast this problem in axiomatic terms, "Almost for every child, if there was substance abuse, particularly drugs, cocaine, heroine use with the mother, the child's academic progress is compromised. They don't have the same processing abilities as children whose mothers haven't used drugs." Another principal and an assistant principal added, "It's real difficult for them. Well, memory is usually impacted. They aren't able to remember things as easily as other children. Processing issues—just trying to understand new concepts, it takes repeated and varied approaches to help the children learn. And, I think then, application of skills, too. They may learn something and they may know it, but how to use that information doesn't come as easily to those kids."

"Their language development skills are real low, and we've got a lot of kids with fine and gross motor weaknesses, a lot more than we used to have." Also, mentioned by participants were "dramatic shifts" that could be seen in the substance-impacted students' academic performance—"all of a sudden there is a decline."

Classroom Behavior—General
As one counselor put it, "A lot of times, children will come to me because they can't function in the classroom. And, they can't do the work, or they're just upset, and then when I talk to them, I find out that there's a substance abuse problem in the family with one of the parents…They'll talk about mom's drinking, dad's drinking, or mom and dad's drug use, and they're aware of it, and they see it. And they know how it impacts their parents, and they bring that to school with them."

Participant observations were congruent with what has been known and well established for some time, living in a substance abusing family and/or environment is chaotic and can produce unbearable levels of pain and anxiety. Children bring that stress with them to school. It is very hard for them to concentrate under this intense emotional distress. Participants noted that it is especially difficult for the younger students who do not have the maturity of more complex coping schemes, and tend to hold in the emotional turmoil until it comes to its breaking point.

Area 2: Behavior Indicators

Other participants noted that some children act out, in part, as a reaction to the continually broken promises of their using parents—broken because of their alcohol and/or drug dependency. One participant stated, "And then on the other hand, I see children who [weren't] born with those addictions, but there's some usage in the household, and a lot of times the parents are telling them, well, promising them that they'll do different things with them. Well, then the drug or alcohol takes control of the parent and…the child's all let down and they become angry at [their] parents, and refuse to process, and have a hard time opening up to us or anybody else." Fundamentally, in terms of the child's basic psychological functioning, his/her trust system has been violated, which creates depression and hurt, and the child then lashes out at others.

Poor Self-Correction
As the saying goes, "to err is human," yet, civil, functional behavior demands that the individual learns from his or her mistakes. It was pointed out by a number of participants that substance-impacted kids are often deficient in this area. As one principal put it, "I think there are varying levels of how it comes to our attention, ‘cause sometimes it starts out as the acting out in the classroom or bus referrals, that type of thing, and the behaviors just escalate. With some children who misbehave, once they understand there are consequences for their behavior, they will regroup and have better self-control. I think the kids that are impacted by substance abuse don't seem to have that capacity, so they're repeat offenders, violating school rules, and then end up in our offices frequently."

Disengagement
A marker that participants widely associated with young students who were known to be substance-impacted was "disengagement." One principal stated, "[A] student becomes disengaged with school as a whole, socially, academically, emotionally." Participants saw the disconnection manifested in the lack of care taken by substance-impacted students for the practical things that are necessary for success at school. From the participants' perspective, it was not so much that substance-impacted kids acted out that bothered them (even though that did), but more often participants were bothered that these children simply did "as little as possible." They noted that this type of behavior creates a drag on the corporate classroom experience and on the structure and momentum of curriculum delivery. "The child's going along nicely, then all of a sudden there's this dramatic [decline]."

Forgetting Things, Things Not Completed, Not Bringing Work
Tied closely to the "disengaged" behavior is the substance-impacted child's chronic forgetting. As one participant put it, "Things seem to be missing with the child, whether it be I forget this today, forget that tomorrow, or maybe I just don't care—unmotivated." Another participant noted, "I see some things in terms of not getting their work done; not bringing their work to school if they have a homework assignment; that it's not brought back. Work not completed is usually an issue." This marker is linked to the domestic marker of parents not showing care or support and involvement. When care is shown by watchful, close-monitoring adults, children seem to have more self-monitoring behavior, which makes "forgetting" things like homework less prevalent.

Sleeping/Lack of Sleep
Interestingly, most of the groups noted sleeping/lack of sleep as a significant indicator. "Sometimes sleepiness, where they can't get through the day without being tired and wanting to take a nap. We have some children that fall asleep in school and when we investigate, many times that's part of the issue." Another participant added, "Not up all night with parents, but because of parents not having the control to tell their children when to go to bed because the parents are too busy doing something else, and not concerned." Another administrator added the dimension of "lethargy and hyperactivity," due to the lack of sleep.

Participants also noted that for many of these kids mornings were tough—they had been up all night because of all the disruption due to their parents' using and fighting, etc.

Area 3: Psychological Indicators

Role Reversal
One of the psychological aspects that participants saw as negatively affecting substance-impacted children was role reversal. "I think sometimes, too, you hear them talk about role reversals. Where they kind of take on the role of the parent in the family, protecting and taking care of… They feel a tremendous responsibility to take care of that parent." Another participant added, "Right, so the kid is kind of taking care of himself or herself, and trying to make decisions. I think sometimes, too, you hear them talk about role reversals."

Feeling Predestined
One of the saddest factors mentioned about substance-impacted children was an extension of the child feeling trapped—the child's sense of being "predestined" to the same substance abusing life as his or her parent. One counselor put it this way, "I think many of them, well, I know from talking to the older children who do disclose it, they feel it's predestined that they're going to be the same way. They see no hope for their future. Because Mom did it, Dad did it, brother did it, uncle did it. Almost like a series of family members, and their path is, they're going to do the same thing, and it's like they feel that's their belief. And, so trying to impact that, or change that, is really hard to get them to understand, no, you have a choice about this. But then, we see them here, and we can give them all kinds of hope, and then they go home, and they live in that every single day, so it's like…our interventions are limited."

Area 4: Domestic Indicators

These same parents were reported by the participants to seem forgetful when the school worked with them. In the administrators' eyes, they often did not follow through with what was requested of them.

Home Visits
Most of the groups mentioned clues gleaned from home visits as an indicator that a child was substance-impacted. All of the participant schools had home-school advisors, a position charged with joining the school to the home in support of students having troubles with school. Because of this, visits to students' homes were done regularly for a wide range of problems. Most of the home-school advisors mentioned that the smell of substances—marijuana, alcohol—or seeing illegal drugs out in the home in plain view were ‘dead giveaways' that the child was living a substance-impacted life. As one participant put it, "And sometimes it's by the home that I can tell, too. Like if a parent comes, if I go to the door and the parent won't let me in or they want to carry on the conversation at the door, sometimes, I kind of…that sends a flag up, there's something going on in the home that I shouldn't know about. Some abuses, substance abuses have different, definite odors to them and sometimes you can pick them up that way when you go make a home visit. If you ever go to a home and it's very, very poorly taken care of and the children aren't coming to school regularly…that's definitely a flag."

Area 5: Congenital, Developmental & Physical Care Indicators

Developmental Anomalies
It was indicated that some children manifest marked delays in development and that these delays seemed to be linked with their known history of coming from substance-impacted homes. An assistant principal stated, "We had a child yesterday that we watched. She walked on her tiptoes. And then, as we looked into it, we find that the child's in foster care, substance abuse may have been involved with the parents earlier…"

Poor Physical Care/Appearance Disheveled
A number of administrators mentioned the child's physical care. "The real obvious is the kid that comes to school smelling bad and dirty, repeatedly, is one of the things that, is pretty much a signal that something's not working right." Participants noted, that many times kids who came from homes where alcohol or drugs were abused, came to school dirty and unkempt; their appearance was disheveled. The participants felt that substance-impacted children lack conscious care by the adults in their lives. The simple things so necessary for school success—to be sent off to school cared for and rested—were often missing with these kids. A home-school advisor phrased it this way, "They come to you disheveled. They're dirty or their clothes are not, you know, appropriate. Like for the younger children, their appearance is unkempt."

Physician Report/Diagnosis
One school had the experience of learning by physician diagnosis that a child had been substance-impacted in-utero. A home-school advisor reported, "If the child is having problems from when they're really young, the pediatrician picks up on it, begins that initial referral, so that they can start getting them some pre-school, or they get involved with our pre-school—our special ed. pre-school program." Thus, when a family practice physician or a pediatrician makes a developmental or learning diagnosis, that information goes with the child when he/she is enrolled in school.

Foster Care Kids
Foster care was mentioned a number of times as a way schools may learn if a student was substance-impacted. A number of the schools reported that they were seeing an increase in kids enrolled in school by foster families, and remarked that, "from the get-go these are high-level-of-need kids." Participants stated that when foster children are brought to school by their families, the foster parents often come with paperwork of the child's history that states there had been alcohol and/or drug abuse in their family of origin. The good news in these cases, is that the administrators felt that they had information early enough to be proactive. It was noted that many of these kids had learning disability labels and that when the school knew this at admission it was an advantage because then the child's past school could be called and the IEP retrieved. The following quote from an assistant principal summarized the aforementioned, "We're getting a big influx of foster kids. All of a sudden, we have five or six families that are bringing in foster kids. High level of need foster kids, and then as soon as they walk in the door, they'll walk in with paperwork that says there's been alcohol abuse in this family. So, we have a heads-up way ahead of time with that."

Parent Report
Most of the focus groups mentioned parent reporting as one means of finding out that a child was, in some fashion, substance-impacted. The most common situation during which parent reporting seemed to occur, was in special education evaluations. A direct question on one form asks whether the mother used certain substances while pregnant with the child. Participants reported that in a few cases, parents gave honest and direct answers.

Overwhelmingly, though, participants reported that most substance abusing or co-dependent parents (the non-abusing parent who protects the abusing parent) did not divulge this information. Participants perceived parental reluctance to divulge problems with substances, especially in cases where the child was struggling in school, because of the fear of repercussions—that the authorities would be called, or the abusing spouse would find out that their abuse had been exposed.

Some participants reported that, in a few cases, they were able to break through the fear and/or denial of the substance-abusing parent, or the co-dependent, non-using spouse/partner by simply "pecking away" at the problem. That is, the administrative team unrelentingly worked with the parent on behalf of his/her child, and through that persistence, a sense of trust was slowly established, which resulted in one of the parents finally admitting the problem.

It was recognized by a number of groups, in a variety of ways, that working with parents of substance-impacted kids is a delicate situation. The school does not want to, "scare the parent off." They need the parent's support. Yet, on the other hand, if the source of the on-going problem is not identified and dealt with in an objective way, then the school can only react to the problem, and not address it proactively in a way that is beneficial to the student—a Catch-22.

Child Report
Participants reported that many times the children themselves revealed that their parents were abusing alcohol and/or drugs. In the words of a counselor, "I have kids who just tell me. I mean, I see kids in groups and individually and a lot of times they'll just tell me that this is going on." Another counselor, "Yeah, most of the time. They'll talk about mom's drinking, dad's drinking, or mom and dad's drug use, and they're aware of it, and they see it. And they know how it impacts their parents, and they bring that to school with them. Then you have kids who are sad, angry, having trouble in the classroom and are sent to the office and through conversation about the problem at hand and what led to it, let it be known that in their household the abuse of substances is causing problems."

The school counselors, especially in the schools that had higher levels of substance-impacted children, painted a picture of the tensions that often emerge when a child divulges his/her parent's alcohol and/or drug abuse. One participant put it this way, "The older the child, fifth and sixth grade, they hem-haw around about it, and then eventually it may come out, but they know not to say as much as a first or second grader does. That's true and with the older children, the older students, I find that the more I see them, then it will come out, and when we've developed some trust and then they're willing to share it, about what's going on at home. But, the younger children are much more willing to talk about it, ‘cause they'll say, this is what I saw, or this is what mom or dad is doing, and because they're just…they don't realize the ramifications of sharing that information. But, the older children, once you develop some trust with them, they talk about it because they don't know what to do about it. And they know that it bothers them, and it impacts their life, but they can't stop their parents, or get them the help that they want, and the biggest thing I see, is that they want their parents to get help, and the parent keeps promising that they will, and then they keep failing, and that's devastating for them."

Peer Report
A number of participants mentioned that, at times, peers would, out of concern for their friend, consult the adults at school on behalf of that friend. "We also find out through children sharing that information with other children and then maybe that child has a concern and so they will share with an adult, either their parent, or an adult at school and then we begin to hear about it that way, so we hear it through, just family sharing it with others, or student to student."

During Small Group Report
A home-school advisor indicated that for him, small groups provided significant information. "Well, I have two examples right off. I do attendance groups, children who are having trouble with attendance. They're either late a lot, or they're absent a lot, and a lot of times, we just brainstorm things that cause problems in homes. Things that cause absenteeism, and they don't always come out with alcohol, but eventually, you find out about mom and dad oversleeping or dad coming home late, or and sometimes…drinking too much."

Another small group venue that was mentioned across focus groups, primarily by counselors, was the "Banana Splits." Banana Splits are groups run by school counselors at most of the participant schools for children whose parents aren't living together. According to a counselor, "Especially if the group's been together a while, it's a fairly small group, children will say, you know, well, my mom's new boyfriend drinks, or we had to get out last night. Or, I'm living in a motel this week, so it's pretty open in those two cases." This context seemed to be one that enabled substance-impacted kids to open up and talk freely about the substance abuse that was going on.

Senior Citizen Report
Senior citizens are another source of information. They may be "senior caretakers," concerned for the children around them who they see are not getting proper care. "Sometimes it's older people that call, because they're home every day. They see what's going on in the neighborhood, and they will air some concerns about that. What they see, what they hear."

Grandparent Report
One of the most consistently mentioned sources of report was substance-impacted children's grandparents, since they were often called upon to take over the parenting of their grandchildren, due to their children's alcoholism or drug addiction. According to the participant educators, grandparents were quite straightforward with information concerning their child's substance abuse, reportedly out of concern for their grandchild and, disgust with their own child's behavior. "We see that in a lot of cases where the grandparent will actually come in and take over and start to parent the kids. Simply because the parents are no longer capable of doing so."

Community Member Report
Certain participants shared that, on occasion, community members anonymously called the school to report concerns over particular students and substance abuse. These citizens would inform the school of their first-hand knowledge that a student was living within a substance abusing home, and that the abuse was at such levels that they felt the need to inform the school for the child's benefit.

Personal Use of Gateway Drugs Report
Participants reported that a few children simply told them that they were involved with gateway drugs. "Those are the kids I know, too, that tend to use the gateway things—nicotine, they're cigarette smokers, they'll tell us they've been drinking before. The older ones, again, fifth and sixth graders." A home-school advisor cited her experience, "As far as the student use, now and then, you just stumble onto it, like driving in the neighborhood in the afternoon to make visits, and you see one of your kids hanging out on the corner with junior high kids, just puffing away. Sometimes, they come in and they smell so strong. Usually, I think there's a difference between the smell from the home, it's a more of an acid smell, and the smell from fresh smoke. So now and then, you smell smoke, then you think, oh gosh, was the parent smoking in the car, or is this kid smoking, which is more the fresh smoke. So you find out that way."

Parent Comes to School Intoxicated or Under the Influence
One of the most direct ways that participants learned a child was living within a substance-impacted home was when the parent came to school in an intoxicated state. A couple of principals noted, "And there have been some times, on several occasions where the parents have come to school in an elevated state of mind. And then it's very noticeable, either that, either you can smell it or they're just way out there." And, "We also have had a few incidents where we have had alcoholic parents come, and they are drinking and so a parent, well not a parent, but a teacher, has smelled alcohol on a parent's breath, and so we've addressed that. We had one parent arrested last year wanting to come and pick a child up and there was a concern, and then we called the police this year on a mother, and she left before we could do anything about that, so…"

When considering the aforementioned array of factors/behaviors, two issues of importance emerged:

1. The list of factors participants gave paralleled factors cited in the literature that indicate a child is "at-risk," but, it should be noted, not necessarily substance-impacted. This is significant because the use of these factors to identify substance-impacted children could yield many false positives, an undesirable outcome. On the other hand, it suggests that substance-impacted children might respond positively to a rigorous application of interventions designed to assist and bolster the functioning of at-risk children in general—e.g., boundary work, procedurally learned response-set building, cognitive behavioral work, face reading, visual organizers, and error detection work.
2. Discerning that a child is substance-impacted, even if he/she has already been recognized as at-risk (which is the case most of the time), is crucial for the provision of specific services that can address those needs that arise from a child's parents' substance abuse, and that can strengthen resiliency within the child. Identification of the substance-impacted child would facilitate the targeted delivery of an ever-shrinking supply of services within the school.

   Our participant educators made it clear that one of the primary avenues by which they learned that a child was substance-impacted was through someone reporting that fact to them, not simply through the identification of associated factors. They indicated that keeping the door open and establishing relationships with family members, community members and professionals is crucial, both to accurate identification and to provision of services. It should be remembered that the range of individuals that report information included grandparents, senior citizens and neighbors. These persons could be mobilized by the school as informative and supportive resources.

   Finally, it is instructive to note an overall logic inherent within our participants' responses—participant educators used an intuitive process whereby they converged (i.e., triangulated) the factors/behaviors they witnessed and experienced directly in their work with the child, with reports that they received from others to confirm that a child was substance-impacted.

Area 1: Fundamental Neuropsychological Processes

Language Development & Motor Skills
Another fundamental area that participant educators often focused upon was the substance-impacted children's language development delays and motor skills deficits. An assistant principal observed, "Their language development skills are real low, and we've got a lot of kids with fine and gross motor weaknesses, a lot more than we used to have." A counselor added, "And, to me, I'd also noticed that although they may be six or seven, they function more like someone who's three or four years old. You know, their cognitive development isn't where…but is that…because maybe they were impacted by drugs in-utero? Or is that…because their environment didn't give them the opportunities to learn?"

ADHD & LD Type of Behavior<br> A number of responses to Question Two touched on Attention Deficit Hyperactivity Disorder (ADHD) and Learning Disabled (LD) types of behavior and learning problems. As one participant commented, "Then again, probably more non-scientific, but, they start to exhibit behaviors that are in keeping with children that are LD, ADHD, ADD, you know and, you'd love to see some kind of scientific evidence come out to say that, hey, if they abuse drugs [in-utero] they're going to have a child that's going to be x, y or z…Some kids stick out. And when you stick out in that kind of environment it tends to send up a flag."

Another participant responded, "I think in what we're seeing again in special education referrals, then finding out mother is not diagnosed [with substance dependence], but through talks of the grandmothers or mothers or friends, or even the kids, themselves, that we are seeing a lot of patterns of attention, lack of focus, lack of motivation that mimic ADHD as well as depression, you know, looking at bipolar characteristics, and especially with [fetal] alcohol syndrome, too. And we do have a specific case now that moved in with us that that's suspected, and physically you kind of wonder because the physical traits that this child shows is very flat affect, a lot of attention focus, below grade level academics, wide spread eyes, flat forehead, flat nose bridge, so this is probably the first one I've seen that actually has the physical attributes, as well as the cognitive…"

Still another participant, "In doing special education intakes, one of the questions we ask is, ‘Did you use any illegal drugs or prescription drugs or smoking or alcohol during your pregnancy?' And, very few say that they have, but the ones who have, have been kids who we've seen with attention deficit problems or general behavior problems and learning problems."

Fragmented Learning<br> A special education teacher who participated in one focus group observed, "I was going to say I think they're so hard to teach because, I don't know, I'm not a doctor, but I'm assuming, maybe it's whatever is messed up neurologically, like they can get pieces of information that they, like they don't get the whole, they can't for whatever reason learn everything about it. So, they can learn parts of something, but not all of it…or build on it or whatever. So then, they feel really good about their letter identification ‘cause they finally got that, but you know, then they start throwing a chair because you ask them to say what sound it is, ‘cause they know they can't get that far. I mean, especially as they get older, they recognize that, you know, they should know stuff that they don't know. And so, I just feel like they can't, they don't get the same education because they can't do it all."

Area 2: Associated Behavior

Other participants discussed the problem as tied to the lack of parental support. An assistant principal commented, "Like my basketball team; I've got four or five boys that still, even though for a semester, we've asked them to get a physical, and we've got them $5 physicals, they still haven't got that step done yet." And, as a home-school advisor affirmed, "Usually, they're the ones, like I said, that are neglected as far as getting homework or assignment books signed…or turned in, help at home, you know, my mom wouldn't help me." (See page 13 for the Lack of Support & Priority section.)

Detachment
"Detachment" problems by substance-impacted kids also came up in participants' answers to Question Two. A principal pointed to the detachment he sees in these kids, "I think that we see sometimes, withdrawal. Where kids just don't participate and engage in what's going on in the classroom, that they withdraw from the social kinds of things, and they're kind of on the outskirts of what happens at school."

Daydreaming & Lack of Focus
A number of participants commented on how substance-impacted kids oftentimes daydream and can be plagued by problems with focusing. "I was going to say, you'd see them probably daydreaming, and then the teacher has to say something to them, you know, redirect them, and then, they're angry, and they don't want anybody to say anything to them, so they get an attitude, and then it just like…"

"That's what I was going to say, lack of focus. They have trouble concentrating or getting themselves organized, or even having priorities, I mean when you've got those things that they're worried about all the time, it's hard for them to make school a priority when they're so worried about what's happening with the family."

Regulation Problems & Flooding<br> A participant principal characterized substance-impacted kids' problems with self-regulation as a cyclic behavior, "The younger kids, especially, I think are very impulsive, have difficulty sitting still, they don't, they can't do those sustained activities that other kids can do that have had some of these different experiences. They come across to us, I think teachers think they're hyperactive, and a lot of times, we suspect they're hyperactive when there are a lot of other things going on that we don't know about, so…When I'm talking about this as a whole group, I'm not thinking of anybody in particular, but, they cry easily, they don't have good connections with other kids, they don't have good connections with teachers, they don't see consequences to their actions or feel sorry after they've done something. And then they end up shutting down in a tearful ball and I call the at-risk counselor and we work them through it. Really. I mean that's probably the whole cycle, and then we start all over again." A counselor added insight from another angle, "They overload, don't they. The environment overloads them. Quickly!"

Sleeping & Lethargy
One counselor summed up a number of participants' responses as to what substance-impacted children are doing in the classroom and how it affects academic performance when she said, "Lots of times they're sleeping, or real lethargic. That's one of the big ones; they're just not with us. Another thing that impacts their performance is behavior, because when they're tired or something's bothering them at home or something happened the night before, then their focus is not on academics." And, a principal added, "I think you hear from the teacher where children aren't doing their homework, they're sleepy in class or they're lethargic, those type of things, and that's very good clues that something's going on with this little child, and typically the ones that aren't doing very well in school, ‘cause they're not completing, they're not keeping up with their grades, and so typically they're falling behind."

Poor Interaction
One of the things that educators have worked very hard on in the past decade and one half is to make classrooms more dynamic and to get students more actively involved in the learning process. Today's classrooms involve students in cooperating and collaborating with their peers as they work. The problem with substance-impacted kids, as noted by the participants, is that they lack the fundamental social skills to take advantage of these types of strategies in the classroom. As one participant framed it, "I see them also as kids having trouble with eye contact, and if you just start a neutral conversation with them that doesn't have anything to do with their behavior, they are…they don't know how to have that kind of conversation with an adult. They don't know how to have just a normal, how was your day, kind of conversation. That's really extremely difficult for them. You can feel their discomfort with that." And, a principal observed, "I think that we see sometimes, withdrawal. Where kids just don't participate and engage in what's going on in the classroom, that they withdraw from the social kinds of things, and they're kind of on the outskirts of what happens at school."

Area 3: Adjunct Issues

The accounting of this problem continued, "When the kids make comments about, ‘I stayed up until midnight playing with my X-Box,' or even some things that have come to light recently about things that have happened in their home that they are freely able to observe, they…and they talk about it. We learn about those kinds of things, but that just indicates that parenting skills are probably not what they need to be because people in the family are involved in substance abuse or that takes up their attention instead of parenting." And, "Again, I think a lot of it really depends on the child, but if parents are using, and that causes lots of ups and downs, lots of volatility in mood, if the child is afraid that they might step wrong or run afoul of their parent, if their resiliency isn't very high, then they are definitely going to have more issues here at school. There have been cases where I've been amazed at how well a child has done, once I find out things that happen in the home. Specifics, homework not getting done,or not getting looked over and no feedback on it, papers not being signed, either because it's chaotic and the child forgets, or because the child is afraid to give papers, poor tests, behavior papers to their parent. And those kinds of mood swings can go along with substance use but it can also go along with lots of other stuff. But there would definitely be an impact there. Difficulty in reaching and following up with parents, to share behavior concerns or academic concerns, so the child either maybe does more ‘cause they know we can't reach the parent, or we can't get permissions to do follow-up testing." And finally, an exasperated principal added, "I had a little boy the other day come in and he said, ‘I begged my mom to sign this,' and so I checked his homework and I signed it, you know, so we try to just work around it. You know, well, you're in a good place; we'll help you out, but that's where it really starts showing up to us, is homework signed, field trips, you know we'll not get any correspondence or support in any way."

Poor Attendance
To learn, students need to be at school consistently and in a timely manner. Substance-impacted children characteristically exhibited the opposite. A home-school advisor noted, "Another concrete impact is attendance and tardiness. If parents aren't getting up, kids aren't necessarily getting up, or kids who are having to be parentally responsible before their time. Fifth and sixth grade kids having to care for younger kids." An assistant principal commented, "Sometimes attendance plays a part here. If they have a high non-attendance, then we talk to the teachers, we talk to the parents and we're finding out, hmm, they're not in school, they're having problems in the classroom, can't get parents to call us back. It all just plays hand in hand. And usually, the discipline comes in there somewhere, because they're frustrated and they cause a problem in the classroom."

Lack of Confidence & Low Esteem
One of the observations participant educators made about substance-impacted kids was that they could not account for their strengths, which led to negative feelings about themselves. "Yeah, they don't feel so good about themselves; the kids know." The kids do know that something is wrong and their experience is not normal. As one counselor put it, "And I don't think I'm very good at saying, you know if I say to a child that I know, maybe, lives in this environment, has this problem, what are you really good at at school? What do you really like? They have trouble identifying their strengths. And they have trouble identifying their good qualities, so if you can get a child like that to even say, you know I'm really, even if it's, I tell jokes really well. And, so I like to write jokes, or I'm very good at spelling. They have a hard time even voicing what their strengths are. And then as teachers, we need, that's our job, then, is to tell them, well I've noticed you're really good at…'Cause they're not getting a lot of internal…they don't give themselves recognition, so then we have to find what it is. Some kids it's easier than others, but if I see the kids that are somewhat successful, it's because they've had that special teacher that has found that quality about them that's a positive and then they can build around that. Those kids seem to function better in school."

Summary of Question 2 Findings:

More specifically, our participant educators' responses to Question Two concerning substance-impacted children's academic classroom performance, in many cases, resembled a list of behaviors usually associated with general and specific learning deficits—delayed language and motor skills, attentional difficulties, hyperactivity, impulsivity, poor task perseverance, lack of motivation, poor error correction, and fragmented learning. There is a threefold implication to this finding: (1) many of the teaching strategies that would be effective for learning disabled children might very well show a good utility with substance-impacted children; (2) it is very likely there are substance-impacted children who have learning problems that need referral, assessment and specific special education services; and, (3) not all substance-impacted children who have learning problems should be labeled learning disabled, because the learning difficulties of some may be primarily due to the stress they chronically experience in their substance–impacted homes.

It should be noted that many of the academic, performance/learning factors that our participants strongly associated with a child being substance-impacted, paralleled recent findings in the neuropsychological and neurobehavioral literature concerning children impacted in-utero. For example, the December 2000 publication of the National Institute on Alcohol Abuse and Alcoholism's (NIAA) Alcohol Alert bulletin on fetal alcohol exposure and the brain outlined recent findings concerning the "specific cognitive and behavioral impairments" associated with alcohol related neurodevelopmental disorders (ARND). NIAA noted that historically, a broad range of cognitive and behavioral disabilities associated with prenatal alcohol exposure were attributed by many researchers to a generalized impairment of mental functioning. However, they pointed out that recent studies on fetal alcohol syndrome (FAS) and ARND reveal that, "specific neurobehavioral functions are consistently impaired, whereas others are spared." The areas of impaired functioning are as follows:

• Verbal learning-alcohol exposed children exhibit a variety of problems with language and memory. They learned fewer words on word tasks than normal controls—but both groups performed equally well on recall of what they learned. This, the authors note, "seems to be an encoding problem not a forgetting problem." Notice how our study's participants used delay of language development as an associated factor possibly cuing them that a child is substance-impacted. This finding could have direct implications for the classroom teacher if he or she is going to be generally successful with an in-utero, substance-exposed child—for example, slower rates of teaching language-based information, with more repetition to affirm what the child has assimilated (i.e., encoded), and the utilization of methods to further consolidate that knowledge by building small amounts of new information carefully upon it could be helpful.
• Visual-spatial learning-NIAA reported that children exposed to alcohol in-utero, tend to perform poorly on tests of the visual-spatial relationship between objects. When small household and school objects (e.g., paper clip, spoon) were placed on a table, and then taken away, substance-exposed children did poorer than controls in restoring objects to their original positions. NIAA suggests that substance-exposed children have a harder time holding the placement of "things" in their minds. The practical implication is that these children are going to need more "visual organizers" to see placements, patterns and interconnections.
• Attention—alcohol exposed children tend to have attention problems (a historical hallmark of alcohol-impacted children). The NIAA authors point out that many times alcohol exposed children are misdiagnosed and treated inappropriately for ADHD. They cited studies that have differentiated ADHD from the attentional difficulties associated with in-utero alcohol exposure. Researchers found that ADHD children exhibited difficulty focusing and sustaining their attention over time, while alcohol exposed children (ARND) were able to focus and maintain attention, but had difficulty shifting their attention from one task to another (i.e., set shifting), leaving the impression that they could not pay attention. This author has seen, of late, children who are described by educators not only as ADHD-like, but also as oppositional and defiant. Careful observations of these children showed that they were unable to leave one task to focus on the next—the child kept going on with what he or she was doing—and this, unfortunately, was interpreted as willful defiance.

  Advance organizers that prepare a child to end the task he/she is on before the rest of the class is notified can smooth the transition from one task to another by providing the substance-impacted child the extra processing time and focus he/she needs to keep up with the activity changes of the classroom, begin the new task promptly, and ease the emotional stress on both child and teacher.

• Reaction time—it has been known for some time that alcohol exposure in children is associated with slower, less efficient information processing. In fact, a group of researchers have found similar problems in infants as young as six and one half months of age. These researchers recorded eye movements of alcohol-exposed infants and normal control infants in response to moving, disappearing and then reappearing colors and geometric shapes on a video screen. The alcohol-exposed infants were significantly slower at responding to what they were seeing. Slow information processing, once again, has implications for how one goes about teaching substance-exposed children. Setting up clear and distinct learning blocks, where new patterns of information are extended and consolidated with previously learned information is crucial for these kids. Also, clear blocking of content and experience into progressive patterns that are clearly and slowly interconnected is essential for these children to stay engaged and do well.
• Executive functioning—alcohol-exposed kids have been found to have important deficits in executive functioning (i.e., activities that require abstract thinking, such as planning and organizing). The authors of the NIAA article point out that one of the important executive deficits revolves around "set shifting," on a cognitive level rather than a simple attentional level, as previously discussed. For example, researchers found that alcohol-exposed children had problems shifting from an activity naming furniture types, back to the original task of naming animals. Notice that our participant educators associated a child who had task perseverance problems, lack of focus, and flooding with being substance-impacted (all of which are associated with lack of sufficient executive functioning).

  This set shifting problem is also seen in alcohol-exposed kids who have difficulty abandoning demonstrably ineffective strategies when approaching problem-solving tasks (i.e., perseveration). Many times, substance-exposed children hang on to an old strategy that has not worked for them, persisting with what is clearly not effective. And note, one of the things that participant educators saw that suggested that a child could be substance-impacted was the child's poor ability to self-correct. The participants spoke of substance-impacted children who kept using a strategy that was clearly not working for them, yet the more it didn't work, the more they seemed to lock on to it—forming self-defeating behavior.

  As one can see, the identification of the above alcohol-impact learning difficulties in a student could alert educational professionals to several possibilities—the presence of a learning disability, a substance-impacted child, or both. The recent research in the neuropsychological and neurobehavioral fields is quite instructive, and will necessitate concerted thought on the part of special educators, psychologists and social workers to address this issue in the school.

Area 1: Core Behaviors

Escalatory Behavior & Lack of Self-Control
The progressive elevation of an emotional-behavioral state is at the heart of escalation, which was a core behavior in a number of participants' minds regarding the general school behavior of substance-impacted children. An assistant principal reflected, "And, they're loud. They're very loud. They think the louder they get, the better they're heard. Sometimes they even complicated situations. We have a couple twin girls that have this situation. And they can take the smallest, small incident, and next thing you know, it's a major, and we have to call security. They can take something teeny-weeny and blow it totally out of proportion. They have no stopping in their system to stop." The principal added, "They'll become discipline problems here because they know there's no enforcement at home."

Another principal further described substance-impacted kids and their escalatory behavior, "Those are the ones that are typically, you're going to see more often they'll escalate quick. And, they, when they escalate, they can't pull it back together. It's hard for them to learn how to get control of those emotions, so they just escalate, they get out of control, they run out of the class, or they get aggressive or they just melt down, and unlike a lot of students who can say what they need to do, they can pull it back together and calm down, and self-soothe…these children don't self-soothe." A home-school advisor observed, "Just the uncontrollable behavior. It's almost like you know you can tell the child, well you know you need to behave, it's almost like they don't have the control over it. And it gets kind of sad because they're trying to figure out why they can't control their behavior. I can think of this, several cases where they just did not have the control, and there was really nothing that they could do about it."

Withdrawal<br> A home-school advisor brought up the converse of escalatory and aggressive behavior as he reminded the facilitator, "It can go one of two ways. It can be either that acting out, getting attention, you know, aggressive kind of things, or it can be the withdrawn, kind of hanging back…" The facilitator queried, "Blend into the woodwork, or the wallpaper?" "Disappear," was the home-school advisor's sad response. A principal added an insight into withdrawal behavior that reflected observations made in the research literature, and elicited strong agreement from the other participants present, "You know, it seems like girls become withdrawn and boys act out, not always, but…"

Boundary Problems
It makes psychological sense that as aggression, withdrawal, and escalation are brought up by participants to describe substance-impacted children's general school behavior, the issue of boundaries also arises, because aggression and withdrawal, by their very nature, utilize either the over-extension or under-extension of boundaries. A principal observed, "So it really seems like they have no boundaries. They might come in here and just explode and call you or I a name, or the next day they'll come in and be just fine. We never know. But, I mean it just seems like whatever is on their mind at that time, that's how they react to what they do." The home-school advisor added, "And they can be consistently inconsistent."

Sadness
Another general school behavior mentioned as significant with substance-impacted kids was sadness. A principal gave this account, "One of the saddest ones that I dealt with, the little girl had been sad in class, so her teacher sent her down to me, and we talked, and we developed this rapport, and she came in one day, and was sad, and so she and I were talking, and I said, well, you know, what makes you sad today? And she said well my dad and my step-mom always fight, and I said, well what do you do? She said I take my little sister upstairs and I read to her, and if it gets too loud, we get in the closet and I read to her." And, the assistant principal added, "[It] breaks your heart." The principal replied, "Yeah, it did, I mean it makes me sad to even think about it." The assistant principal continued, "There's probably more of that than we ever see."

Area 2: Associated Behaviors

Street-Wise Behavior
Three of the participant schools' attendance areas included some rough, drug and crime infested neighborhoods. Many of their kids came from the "streets." An assistant principal noted, "They seem to be very street-wise and very, almost casual, in some cases about like it's so much a part of their life that they don't miss much of it. And sometimes, I have wondered if when schools present information to them about drug-free kinds of programs that conflicts with what they're used to seeing in their home, how that affects their thinking, because they see it at home, and probably think it's ok at home, because mom and dad, who they idolize, are doing it, so it must be ok. And they come to school and they hear a different message, and so they're ultimately going to be forced to decide which message is appropriate, and I've wondered many years what the affects of that is."

Drug Use Behavior
A few participants mentioned direct abuse of drugs by students as an associated behavior. "Well, we have expelled a couple children here because of drug usage, testing positive, not just once, but numerous times, for a drug, actually marijuana. I think, marijuana and cocaine. And their behavior was quite bad. Quite erratic, explosive almost. And like you said, almost manic because then when they would come down, they would sleep or become somewhat depressed." An assistant principal weighed in on the topic, "This was a boy who was already diagnosed as emotionally disabled, and he was using, I believe his counselor called, Optima, was the drug." The counselor added in explanation, "It's where they put stuff in the marijuana cigarette and then put it in the formaldehyde…" A fellow participant hitchhiked on his comments, "Crack and cocaine, or crack and marijuana wrapped in a cigar leaf and dipped in formaldehyde." Then the principal continued, "And we do know that family had a history of using drugs. The older brother had been killed from a drug deal that had gone wrong, so he had all types of issues surrounding drug use. Or, as a result of drug use."

What is interesting about the core cluster of behaviors is that, once again, as in their responses to Question One, the behaviors participant educators noted were consistent with the behaviors generally associated with students who are at-risk. The implication of this is parallel to our previous observations for Question One—strategies that stabilize at-risk children and those with behavioral and/or emotional problems would likely be helpful with substance-impacted children.

Also, the general school behaviors our participants described as characteristic of substance-impacted children make sense when interpreted