Cocaine use by pregnant women has stabilized at high rates in poor, urban, minority populations over the past decade, with resultant concern over the long-term negative effects of fetal cocaine exposure on the developing child. Maternal use of cocaine is also associated with numerous other risk conditions which can negatively affect child outcomes, such as increased risk for child abuse/neglect, greater maternal psychological distress, altered care-giving behavior, and violence exposure. In addition to documenting a range of child outcomes at preschool and early school ages, the proposed study aims to assess environmental and maternal psychological correlates of outcome in cocaine-exposed children. The proposed study will be a continuation of a longitudinal, prospective investigation (NIDA 07957) of the medical, environmental, and developmental correlates of cocaine exposure during the first two years of life. 377 infants (195 cocaine exposed; 182 non-exposed) and their mothers/care givers will be seen at 4 and 6 years of age, and given standardized assessments of growth, cognitive, emotional-behavioral, language, and neuropsychological outcomes. Cocaine exposure was determined by biologic (urine/meconium) and self-report measures, with all children drawn from the same race/social class population, and matched for very low birth weight status. At birth, demographic, medical, and prenatal substance abuse exposure were noted from chart review, clinical interview, and meconium analysis. Standardized questionnaires assessing maternal psychological status, coping style, social supports, intellectual ability, and exposure to violence which were previously assessed will be updated. Environmental risk, including abuse/neglect, growth failure, out of home placement, and characteristics of the home environment, will be documented throughout. Videotaped observations of child play and maternal child interactions will be conducted. Data will be evaluated descriptively, and through a series of MANOVAS/MANCOVAS (with repeated measures), and hierarchical multiple regression to describe the functioning of cocaine-exposed children at preschool and early school ages, and the relative impact of cocaine and other drug exposures to child outcomes, maternal psychological functioning, and environmental risk. Data sets from the prior longitudinal study will be merged with 4 and 6 year data to assess change over time and predictive models of infant risk, using HLM or structural equation models. The proposed research will provide information about long-term child developmental sequelae of fetal cocaine-exposure and maternal psychological status and care giving behaviors which can guide the design of effective maternal drug treatment and child intervention programs.
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