Externalizing behavior problems among polydrug cocaine-exposed children: Indirect pathways via maternal harshness and self-regulation in early childhood.

Abstract

This study examined direct and indirect associations between prenatal cocaine exposure (CE) and children’s externalizing problems in kindergarten via higher maternal harshness and lower self-regulation in early childhood. Other environmental risk variables such as child exposure to community violence and experience of hunger were used as additional predictors. The sample consisted of 216 mother-infant dyads recruited at delivery from local area hospitals (116 cocaine-exposed, 100 non-exposed). Maternal harshness was coded from observations of mother-toddler interactions at 2 years of age, and children’s self-regulation was measured at 3 years of age using several laboratory paradigms. Maternal reports of externalizing behavior problems were obtained at both time points and at kindergarten. Teacher reports were obtained and classroom observations of externalizing behaviors were conducted in the kindergarten classroom. Results indicated significant indirect associations between CE and maternal reports of externalizing problems via higher maternal harshness at 2 years and higher externalizing problems at 3 years of child age. A second indirect path from CE to externalizing problems in the school setting via higher maternal harshness at 2 years and lower self-regulation at 3 years was also significant. There were significant associations between community violence exposure and maternal reports of externalizing problems, and between hunger and externalizing problems in the school setting. Results highlight the role of parenting and self-regulation in early childhood as critical process variables in the indirect association between CE and externalizing behavior problems in kindergarten.

Characterizing adverse prenatal and postnatal experiences in children

“…However, the frequent co‐occurrence of prenatal and postnatal exposures (Astley, ; Astley et al, ; Gibbard, ; Hyter, ; Koponena et al, ) suggests that models should incorporate both time periods. In addition to the small number of studies that have examined interactions between PAE and other prenatal exposures (Price et al, ), a few studies outside the PAE literature have examined the combined effects of prenatal cocaine exposure and postnatal adversity on development (Eiden, Coles, Schuetze, & Colder, ; Eiden, Godleski, Colder, & Schuetze, ; Eiden, Granger, Schuetze, & Veira, ; Liebschutz et al, ) or the differential impacts of stress during prenatal and postnatal periods (Jensen et al, ; Jensen et al, ). Together, this literature highlights the importance of incorporating information from both prenatal and postnatal periods into the assessment of individual exposure profiles.…”

Prenatal and Neighborhood Correlates of Oppositional Defiant Disorder (ODD)

“…Eiden and colleagues (2013) noted that the link between witnessing violent acts and increased behavior problems in preschool children is well established. Results indicated community violence as one of the predictors of problem behaviors in their sample (Eiden et al, 2013). Vanfossen, Brown, Kellam, Sokoloff, and Doering (2010) found neighborhood violence was a salient factor in the development of aggression in boys and girls, primarily during the transition from primary school into middle school.…”

The effect of prenatal substance use and maternal contingent responsiveness on infant affect

“…The importance of postnatal factors was demonstrated in a study of children exposed to heroin during pregnancy, which found that children adopted at a young age had intellectual skills similar to non-exposed controls; however, heroin-exposed children who remained with their biological parents had lower intellectual test scores compared to non-exposed controls (19). In another study, toddlers prenatally exposed to polysubstance use were found to have adverse outcomes, such as lower self-regulation and increased externalizing problems at 3 years of age, when their mothers were observed using harsh behaviors during a video-taped free play paradigm (20). Heightened infant reactivity and distress, mother-infant attachment disorders, and decreased sensitivity and responsiveness towards the child have been associated in research with parenting practices among mothers with various substance use disorders (21–26).…”