This revised competing continuation seeks to extend through 11 years an ongoing longitudinal project (RO1 DA-06025) examining relations among prenatal cocaine exposure, environmental instability, and the neuropsychological development of 369 middle-school-aged children who have been followed longitudinally since birth. 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 attention and thereby affect the normal development of prefrontal cortical executive functions. In the first two phases of study, we have described a continuum of developmental impairment among prenatally cocaine-exposed children that includes emotional lability, impaired visuospatial processing and visual motor integration, delayed cognitive and receptive language development, impulsivity and difficulty inhibiting prepotent responses, attenuated stress response systems, and increased parental dysfunction. In the next phase of study, we propose to follow-up on these findings and assess children exposed prenatally to cocaine and two non-cocaine-exposed comparison groups twice yearly between the ages of 7 and 10 years with convergent measures of the following child-related domains: (1) cognitive and language functioning and academic achievement; (2) attention regulation and other aspects of executive functioning; (3) stress reactivity operationalized as the startle response; (4) adaptive and maladaptive behavior; (5) incidence of childhood psychopathology including early trauma, and (6) physical health and development including early high risk behavior. We will also assess ongoing changes in the child's environment by studying the following parent-related domains: (1) continuing drug use, social disruption, and psychiatric dysfunction; (2) parental stress; and (3) parental functioning. Early disruption of the regulation of arousal-modulated attention and executive functions may have effects that extend well into the school age years and alter the normal trajectory of cognitive, language, and social-emotional development. Additionally, because prenatally cocaine-exposed children often grow up in environmental discord, developmental impairments in these children also likely reflect the interactive effects of both prenatal cocaine exposure and often severe environmental dysfunction. Such interactions place cocaine-exposed children at higher risk for externalizing forms of psychopathology.
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