ANNANDALE, Va. -- The inconsolable baby who flailed and twitched in the hospital nursery, who screamed when she was held and screamed when she was put down, is now almost 5 years old.
So demure in her Buster Brown haircut and school dress, so endearingly articulate, Josie couldn't possibly be the same child who brought terror to her foster home when she left the hospital at the age of 13 days.
Or could she? Her adoptive parents, Jim and Jamie Bachigalupi of Annandale, Va., say she's settled down considerably since she was an infant. But she's still a tantrum waiting to happen, a little girl wracked with neurological problems so disturbing she'd tax the patience of any skilled parent.
They believe Josie was brain-damaged from illicit drugs even before she emerged from the womb. By all accounts, her biological mother, a teen-age immigrant from Iran, was seen popping Dilaudid, an addictive painkiller, the very day she went into labor and probably took cocaine throughout the pregnancy.
An estimated 350,000 American children are entering the world each year already exposed to drugs of the street. The phenomenon isn't new, but it wasn't until the mid-1980s that doctors first started to notice connections between the drug epidemic and the increasing numbers of shivering, irritable newborns in hospital intensive-care units.
Lacking long-term studies, scientists hesitate to conclude that fetal drug exposure causes lasting effects like the irritability, seizures and strange fearlessness that Josie exhibits. But as the drug babies of the 1980s pass through toddlerhood into their school-age years, many therapists are watching these children closely to see if the legacy of their mothers' drug use will last for years, or forever.
Ever since Jim and Jamie Bachigalupi took Josie home from the hospital -- a foster child they would later adopt -- she's struggled with life.
* It took her three years to learn to sleep through the night. Until then, she'd awaken maybe eight or 10 times, rocking the house and all its inhabitants with her shrill screams.
* At times, she flies into rages that resemble the tantrums of a 2-year-old, only more intense and long-lasting. But she has an otherworldly tolerance for pain. At 18 months, when she tripped over her brother's leg and gashed her head on the sharp edge of the fireplace hearth, she didn't even whimper.
* At age 3, she turned on the electric range and held her hand to the hot burner. Her mother found her there, not crying or even wincing in pain. Less than a year ago, she cut her lip while experimenting with her father's razor. Her only words were, "Mommy, I bleed."
* Paradoxically, she'll scream, dance around and throw herself onto the floor if bothered by scratchy clothes or a stiff label. Her parents have learned to wash new clothes at least a dozen times before daring to try them on Josie; used clothes are safer still.
* She likes her food and her bath cold, but can't eat with the family because the stimulation of five people eating and talking sends her into a door-slamming rage. "If you saw one of her tantrums," Mrs. Bachigalupi says, "you'd say what a brat, that what she needs is a good whack. But there's no control when she's out of control."
Dr. Nancy Coletta, a psychologist at the University of Maryland's Center for Infant Psychiatry in Baltimore, said she has seen a range of problems in drug-exposed infants once they reach the ages of 3, 4 or 5. Many children have unusual difficulty connecting emotionally with their parents. Others fly into rages, exhibit high pain thresholds or suffer from seizures or short attention spans.
"But there are a sizable percentage that don't have problems," said Dr. Coletta, who practices both in Baltimore and Washington, where she works with the Bachigalupi family. "From reading the media, you'd assume there isn't a cocaine-exposed child who doesn't have problems."
And scientists are reluctant to blame cocaine or any particular drug for problems some do have.
First, many addicts take combinations of heroin, cocaine, alcohol and tobacco, so it's impossible to know which drug, if any, might cause a child's behavior to go haywire. And what about poor nutrition and the absence of prenatal care? These, too, often go along with drug use and can produce small babies with a host of learning and behavioral problems.
Many babies are further handicapped when they return to drug-using households where the parents lack the capacity to love, nurture and even feed them adequately.
"There's a lot we don't know," said Dr. Ira J. Chasnoff, president of the National Association of Perinatal Addiction Research and Education in Chicago. "A lot of people are running around saying it's this and that. But we're not in the position to tell what the effects are on the 4- or 5-year-old."