The goal of this competitive renewal is to identify the effect of prenatal cocaine exposure on the exposed offspring making the transition from toddlerhood to the early school years. This study will consider the possible combined effects of amount and timing of 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 at the time pregnant women entered the prenatal care system, anytime from conception to delivery, providing a range of prenatal care and drug use in our sample; 2) extensive data collected on dosage and timing of drug exposures; 3) target and control groups established using a strategy that minimized misclassification of users; 4) medical, neurodevelopmental, behavioral, psychosocial, and environmental data collected prenatally through age 3 with an average follow-up rate of 93%; 5) infant/child assessments made by examiners blinded to drug status; and 6) the uniqueness of a sample whose cocaine of choice is crack and whose only other illegal drug exposure is marijuana. A teratogenic model for the toxicity of cocaine leads to our hypotheses that prenatally exposed children between ages 5-7 will manifest specific neuropsychological deficits, the extent of which are modified by the amount of exposure and ongoing environmental influences. We propose to continue to collect data on the child, caregiver, and environment. Each child will be blindly assessed at ages 5 and 7 using measures of the following domains: Cognition/Intelligence; Memory/Learning; Language; Attention and other Executive Functions; Gross, Fine, Visual/Perceptual Motor; Readiness and School Achievement; and Psychosocial Functioning. In addition, the caregiver/family environment will be evaluated during home visits which take place prior to each child assessment. The proposed study will provide vital information regarding effects of prenatal cocaine exposure, including identification of specific outcomes affected by cocaine, clarification of the effect of dosage and timing of exposure, and description of the transactional effects cocaine exposure and other risk factors contribute to outcomes as the child develops.
