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

Abstract

Prenatal cocaine exposure has been linked to increased child behavior difficulties in some studies but not others. Objective The primary aim was to estimate the relationship between in utero cocaine exposure and child behavioral functioning at age 7 years with ratings made by blinded examiners during a structured testing session. A second aim was to examine whether caregiver drug use and psychological problems might mediate suspected relationships between prenatal cocaine exposure and aspects of examiner-rated behavior. Methods 407 children (212 cocaine-exposed, 195 non-exposed) participating in the longitudinal Miami Prenatal Cocaine Study (MPCS) were rated with regard to their behavior during a neuropsychological assessment conducted at age 7 years. Raters were trained research psychometricians blinded to drug exposure. Individual behavioral items were summarized and the cocaine-behavior relationship was estimated within the context of latent variable modeling, using Mplus software. Results Two latent variables, Behavioral Regulation and Sociability, were derived via exploratory latent structure analysis with promax rotation. Prenatal cocaine exposure, statistically controlling for child sex, test age, and prenatal exposure to alcohol, tobacco, and marijuana, was associated with Behavioral Regulation (estimated slope ß = -0.25; 95% CI = -0.48, -0.02; p = 0.04) but not Sociability (estimated slope ß = -0.03; 95% CI = -0.26, 0.20; p = 0.79). Neither postnatal drug use by caregivers nor the severity of their psychological problems at age 5 follow-up predicted levels of child Behavioral Regulation or Sociability at age 7 years (p>0.10). Conclusions Examiner ratings of child behavior at age 7 revealed less optimal behavioral regulation for prenatally cocaine-exposed compared to non-exposed children, in contrast with what had been previously found from parent-report data. This evidence highlights the potential value of trained observers in assessing behavioral outcomes of children exposed in utero to drugs and other toxicants.

Externalizing behavior and substance use related problems at 15 years in prenatally cocaine exposed adolescents

“…In a study of 244 7 year‐olds, PCE during the third trimester was related to both caregiver and teacher reported externalizing behavior problems (Richardson, Goldschmidt, Leech, & Willford, 2011). At the same age (7), Accornero and colleagues found no evidence linking PCE and behavior problems via parent report (Accornero, Anthony, Morrow, Xue, & Bandstra, 2006), but increased behavioral problems among PCE children were noted when behavior was rated by examiners blinded to exposure status (Accornero et al, 2011). Our previous studies also indicated PCE effects.…”

Stimulant Use in Pregnancy: An Under-recognized Epidemic Among Pregnant Women

“…66 Definitive studies of long-term outcomes among children with cocaine exposure remain elusive. Some studies have found that children with prenatal exposure have dysregulated behavior, 33,67 growth, 68 inhibitory control, 69 attention 70 and abstract reasoning. 68 In a systematic review of 36 studies of children younger than six years of age assessing physical growth, cognition, language skills, motor skills, attention, affect and neurophysiology, Frank et al did not find compelling evidence that prenatal cocaine exposure is associated with adverse outcomes that cannot be attributed to gestational age at delivery, caregiver psychiatric co-morbidities, other prenatal exposures (tobacco, marijuana or alcohol) or quality of postnatal environment.…”

Prenatal Exposures Associated with Neurodevelopmental Delay and Disabilities

“…Prenatal cocaine exposure was associated with deficits in the attention and the inhibition tasks in boys [Carmody et al, ]. Prenatal cocaine exposure was associated with behavioral regulation at 7 years but not sociability [Accornero et al, ]. Prenatal cocaine exposure was associated with less optimal overall mother–child interactions at 3 and 5 years [Mansoor et al, ].…”