Do “We Just Know”? Masked Assessors’ Ability to Accurately Identify Children with Prenatal Cocaine Exposure

Abstract

This study evaluated perceptions of masked assessors to determine whether there are subtle differences in cocaine-exposed and unexposed children who might be identified by those interacting with children. As part of a longitudinal study, developmental assessors were masked to 163 4-year-old children's actual in utero cocaine exposure status and developmental history. After each battery, assessors documented their guesses of the child's cocaine exposure. Thirty-seven percent of the children who were exposed were misclassified as unexposed, whereas 74% of those unexposed were incorrectly classified as exposed. Although the sample did not differ on assessment scores when results were analyzed by actual cocaine exposure status ( >.3), children who did less well on assessments were more likely to be labeled by assessors as cocaine-exposed ( <.001). Results highlight the potential of stereotyping and negative attributions that might distort observations, both in unmasked studies of prenatal cocaine exposure and in clinical settings.

Estimated effect of prenatal cocaine exposure on examiner-rated behavior at age 7years

“…One study investigated the relationship between measures of social desirability and the parent-report CBCL and found an inverse association between measures; that is, parents with higher scores on social desirability instruments (adapted to reflect social desirability with regard to their child’s behavior) reported fewer behavior problems on the CBCL, particularly for externalizing behavior [Merydith et al, 2003]. Laboratory measures, including tester ratings, may circumvent some of the potential biases associated with parent-report and teacher report, although it is critical that psychometricians remain blinded to prenatal drug exposure status and other key characteristics that might influence their ratings or interpretation of tests/tasks [Rose-Jacobs et al, 2002]. Moreover, well-trained examiners knowledgeable about child development may be able to detect subtle behavioral difficulties not perceived by the parent, and behavioral regulation deficits may be more apparent in the clinic setting in the context of the highly structured, demanding nature of neuropsychological testing.…”

Perinatal substance abuse and human subjects research: Are privacy protections adequate?

“…Indeed, healthy children born to women with drug problems may face different threats of harm such as stigmatization based on myths perpetuated by media coverage, and unjustified placement in foster care. [Paone and Alpern, 1998;Rose-Jacobs, 2002]. A recent study found that poverty has a greater impact than cocaine on a child's developing brain [Hurt, 1999].…”

Neuropathology of the cerebral cortex observed in a range of animal models of prenatal cocaine exposure may reflect alterations in genes involved in the Wnt and cadherin systems

“…After more than 20 years of intensive research, the capacity of prenatal cocaine exposure to affect brain development is still a matter of significant debate. While some researchers argue that children exposed to cocaine in utero do not display noticeable neurologic or psychiatric abnormalities (Eyler et al, 2001;Frank et al, 2001;Haasen and Krausz, 2001;Rose-Jacobs et al, 2002), others contend that women using this drug during pregnancy run the risk of giving birth to babies with significant cognitive, emotional, motor, and other deficits (Bendersky et al, 2003;Heffelfinger et al, 2002;Mayes, 2002;Singer et al, 2002;Jones et al, 2004;Lewis et al, 2004). The difficulty in resolving this dispute in human studies lies in the multiplicity of confounding factors such as dose and timing of cocaine administration during pregnancy, socioeconomic status, nutrition, level of prenatal care, other drug use, etc.…”