The goal ofthis competitive renewal is to identify the effect ofprenatal 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 ofprenatal cocaine exposure, other drug exposure, caregiver psychosocial functioning and the quality ofthe environment on the child's outcome. Strengths ofour cohort are: Ijsubjects enrolled when women entered the prenatal care system, providing a range ofprenatal care and drug use; 2) extensive data collected on amount and timing ofuse; 3)target and control groups established using a strategy that minimized misclassification ofusers; 4) extensive data from numerous domains ofinterest collected prenatally through age 7, with an average follow-up rate of 93% of the surviving cohort; 5) blinded assessments of child at all timepoints; 6) the uniqueness of a sample whose cocaine ofchoice was crack and whose only other illegal drug exposure was marijuana. Blending aspectsof the teratogenic model for the toxicity ofcocaine with the transactional model for child development leads to a refinement ofour 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. Wepropose 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 ofthe following domains: cognition/intelligence; memory/learning; language; attention and other executive functions; behavior; school achievement and functioning; and psychosocial functioning. The caregiver/familyenvironment 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 ofprenatal 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 ofthe 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.
