Whether in utero cocaine exposure (IUCE) exerts effects on neurocognitive and social behavioral functions that can only be definitively measured with the increasing neuromaturation and social demands of adolescence is unresolved. This proposal, Prenatal Cocaine Exposure: Adolescent Follow-Up, is a competing renewal to DA065320, a masked prospective longitudinal study which has followed a cohort of approximately 140 caregiver/child dyads from birth in 1990-93 through elementary school. We have studied the possible multidimensional effect of IUCE using multiple informants, confirmation of substance exposure by infant meconium and repeated measures of caregivers' urine, repeated behavioral and neuropsychological assessments, and less common measures such as attachment classification in infancy, psychiatric diagnoses in middle childhood, repeated caregiver and child assessments of exposure to violence (EV). The goals of the current proposal are to extend this rich longitudinal data set to document trajectories of development from earlier epochs to early (12-14.4 years) middle (14.5-16.4 years) and late (16.5-18 years) adolescence in domains which theory and prior data suggest may be particularly vulnerable to IUCE. These include cognition, expressive language, components of executive cognitive function, attention arousal/regulation, and psychiatric and behavioral disorders and symptoms, measured by standard assessments and reports of adolescents, caregivers, and teachers. Adolescents' early initiation of alcohol, tobacco, and other drug use and evolution of associated risk behaviors and later substance use disorders are the focus of detailed assessment using confidential computerized voiced interviews and repeated urine assays for tobacco, opiate, cocaine, marijuana, and amphetamine metabolites. The adolescent s caregivers' current substance use, psychological distress and other important family characteristics which have been documented in this cohort since infancy will also be measured. Complex statistical longitudinal models will permit evaluation of developmental and concurrent EV and other biologic and social factors which, as covariates, confounds, mediators, or moderators of IUCE contribute to adaptive or maladaptive adolescent outcomes. Such data can inform clinical interventions and public policy choices for care of youngsters with IUCE from infancy to adolescence.
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