The goal of this competitive renewal is to identify the effect of prenatal cocaine exposure on exposed offspring making the transition from elementary school to the middle school years. This study will evaluate the possible combined effects of amount of prenatal cocaine exposure, other drug exposure, caregiver psychosocial functioning and the quality of the environment on the child's outcome. Strengths of our cohort are: 1) subjects enrolled when women entered the prenatal care system, providing a range of prenatal care and drug use; 2) extensive data collected on amount and timing of use; 3) target and control groups established using a strategy that minimized misclassification of users; 4) extensive data from numerous domains of interest collected prenatally through age 7, with an average follow-up rate of 93 percent of the surviving cohort; 5) blinded assessments of child at all timepoints; 6) the uniqueness of a sample whose cocaine of choice was crack and whose only other illegal drug exposure was marijuana. Blending aspects of the teratogenic model for the toxicity of cocaine with the transactional model for child development leads to a refinement of our hypotheses that prenatally cocaine-exposed children between the ages of 10-13 will manifest specific neuropsychological, behavioral, and psychosocial deficits, the extent to which are modified by the amount of exposure and on-going environmental influences. We propose to continue to collect data on the child, caregiver, and environment with a heavier emphasis on the child during this cycle. Each child will be blindly assessed at ages 10 and 12 using measures of the following domains: cognition/intelligence; memory/learning; language; attention and other executive functions; behavior; school achievement and functioning; and psychosocial functioning. The caregiver/family environment will be evaluated during home visits which take place prior to each child assessment. Finally, the children will be repeatedly interviewed throughout the study to determine their psychosocial functioning and development, their perception of stressful life events and supportive activities and relationships. The proposed study will provide vital information regarding effects of prenatal cocaine exposure on the developing child, including identification of specific outcomes affected by cocaine and clarification of the effect of amount of prenatal exposure and ongoing passive exposure. It will also provide a description of the transactional effects cocaine exposure and other risk factors (as well as possible protective factors) contribute to outcomes as the child transitions from early childhood to pre-adolescence.
