The objective of this competing renewal is to delineate the effects of in utero cocaine exposure on integrated neuropsychological, behavior/emotional and academic functioning during the preschool and school-aged-years in a 90% retained cohort of 476 African American children enrolled prospectively at birth. A burgeoning literature has proved inconsistent in characterizing specific impairments related to prenatal cocaine exposure. Our own studies of cocaine exposed infants in the first two years of life have identified only transient findings of questionable clinical significance. Converging research in neuropsychology, however, strongly suggests that prenatal and early childhood neurological insults may only become evident as the brain matures functionally. This position has been particularly well articulated for frontal lobe development, an area potentially influenced by cocaine exposure during neuronal differentiation. Accordingly, it is hypothesized that cocaine exposed children will exhibit functional neurobehavioral deficits that emerge with development in the following domains: fine and gross motor function, language development, learning, memory, and aspects of frontal lobe function including affective/behavioral regulation, attentional prosessing, and emerging executive functions. In addition, it is postulated that prenatal cocaine exposure will increase risk for poorer outcome on global outcomes such as academic achievement and emotional/behavioral adjustment. The potential interactive role of continual exposure to a substance abusing parent is also recognized, and prenatally exposed children reared in such environments are hypothesized to exhibit poorer outcomes than other prenatally exposed and unexposed children reared in healthier environments. Family mechanisms hypothesized to characterize substance abusing families include impaired parenting, dysfunctional family interactions, and increased exposure to domestic and community violence. We will employ a longitudinal research design with an emphasis on comprehensive assessment of the child, mother/caregiver, and family to investigate these hypotheses. At yearly intervals, the neurobehavioral domains previously noted will be thoroughly assessed, with an emphasis on evaluating neuropsychological processing over time. On two separate occasions family interactions will also be formally observed in relationship to the variables of interest. Maternal/caregiver substance abuse will be characterized through yearly interviews and the use of hair analysis as a biologic marker. Additional confounding variables such as chronic medical illnesses, anemia, lead exposure, and maternal polydrug use will be considered in all analyses. The effects of pre- and postnatal cocaine exposure remain a significant public policy concern as many of these children reach school age, yet well controlled studies are lacking. The present proposed study benefits from the methodological strengths of our initial prospective design, and is in the unique position to begin characterizing the direct and indirect neurobehavioral effects of cocaine exposure in conjunction with other risk factors, as well as the transactional effects of chronic maternal/caregiver substance abuse and family dysfunction on the developing child.
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