This competing continuation seeks to extend an ongoing longitudinal project (RO1 DA-06025) examining relations among prenatal cocaine exposure, postnatal environmental instability, and the cognitive and social development of infants and children from birth to 36 months. The proposed study series aims to extend the follow-up of these children through age 7 years with a particular focus on the regulation of arousal and attention. Because of cocaine's effect on the developing monoaminergic system, prenatal cocaine-exposure may interfere with the developmental ontogeny of the ability to regulate states of arousal and thereby affect the normal development of capacities to regulate attentional states and to respond to stressful events. Inasmuch as the regulation of arousal-modulated attention is crucial to perceptual, cognitive, language, and social development, early disruption in the developmental ontogeny of arousal and attentional regulatory capacities may have effects that extend well into the school-aged years and alter the normal trajectory of cognitive, language, and social-emotional development. In the last 4 years, 411 children (233 prenatally cocaine-exposed and 178 non-cocaine-exposed) now ranging in age from 3 to 48 months have been recruited and maintained. Extensive data have been gathered on the associations of prenatal cocaine (and other drug) exposure with arousal and attention regulatory capacities, and cognitive, language, and adaptive behavior development, and the effects of maternal substance abuse on mother-child interactions. Findings from the first phase of follow-up suggest an association between cocaine exposure and impairments in the regulation of arousal and attentional states and also point to the disruptive effects of substance abuse on the parenting environment. The objective of this competing renewal is to continue through age 7 years, the follow-up of this cohort of cocaine-exposed and non-cocaine-exposed children with repeated assessments of: (1) arousal regulation operationalized behaviorally and neurophysiologically as the startle response and heart rate variability; (2) attention regulation operationalized as the ability to sustain attention, identify stimuli, and inhibit responses; (3) executive function (4) cognitive and language development, (5) adaptive and maladaptive behavior, (6) school achievement (7) social adjustment, (8) the incidence of childhood psychiatric disorders of attention, anxiety, and conduct and (9) social and environmental risks including continued maternal drug use, parental stress and dysfunction, and family disruption. The follow-up continues to build on an interactive model in which children with developmental risks are more or less vulnerable to poor outcomes depending on the severity of their environmental disruption and stress.
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