Whether there is a dose response relationship between levels of in- utero cocaine exposure and the neuropsychological, emotional, and behavioral status of elementary school children is unresolved. We propose to continue a longitudinal masked evaluation at 8.5, 9.5, and 10.5 years of age, of a predominantly African-American cohort of 160-170 caregiver/child dyads, followed prospectively since birth. The cohort is unique in the field in that level of cocaine exposure is characterized by both maternal interview and infant meconium assays. The study will evaluate whether, after potentially confounding biologic and social variables are controlled for statistically, there are independent relationships between level of in utero cocaine exposure and outcomes in multiple domains, including memory, attention and impulse control, complex motor skills, language, executive functions, cognitive abilities, and learning disabilities. Children's caregivers will be interviewed annually to measure potentially confounding or mediating environmental variables such as caregiver substance use, mental health, social support, and major and minor life stresses. We will monitor whether level of in utero cocaine exposure correlates with children's psychiatric diagnoses as assessed by the DICA-IV and child, parent, and teacher report symptom report measures (covering depression, behavioral problems, exposure to violence, and child substance exposure). Mixed linear regression models of this is a rich longitudinal data set, which will permit the identification of historical and concurrent biologic and social factors, which, in interaction with level of cocaine exposure, differentiate children who do and do not show adverse outcomes in elementary school years. This data can inform public policy choices for care of cocaine exposed elementary school children nationwide.
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