Whether in utero cocaine exposure effects children's cognitive and social competence in pre and primary school is a question of major public policy concern.. This early competing renewal will continue longitudinal prospective evaluation of a unique predominantly African-American full term cohort of approximately 200 low income caretaker-child dyads already studied from birth to age 2. To address issues of dose effects,maternal interviews and radioimmunoassays of maternal urine and neonatal meconium were used to categorize this sample as unexposed, lightly, or. heavily exposed to cocaine. Three assessments will minimize respondent burden and characterize multiple domains without basement effect. The 48 month assessment focusses on cognitive competence using the WPSSI-R and on sustained attention using a computerized continuance performance task. The Goodman Lock Box and a care giver child problem solving task will assess rudimentary executive functions including planning, self regulation and affect modulation. At 60 months the Test of Language Development Primary and the Peabody Developmental Motor Skills will provide detailed assessment of language and motor domains. At 72 months school readiness and learning disabilities will be tested with the WIAT and the WRAML. Social and environmental factors which may modify or exacerbate cocaine effects will be documented with a preschool HOME assessment and yearly caretaker interviews . covering the child's behavior problems (CBCL) ,health,educational experience,changes in caretakers, and exposure to violence and their own alcohol and illicit drug use, stress, depression, and social support. Multiple variable analysis, including path analysis and clustering techniques, will be used to assess whether there are independent dose response effects of in utero cocaine exposure upon the child's risk for cognitive and social dysfunction. These data will inform public Policy choices for the care of cocaine exposed pre and primary school children nationwide.
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