Our previous studies demonstrated that prenatal cocaine exposure is associated with substantial problems in school-age children. After controlling for covariates, we identified relationships between prenatal cocaine exposure and growth deficits, poor expressive language, increased problem behaviors and lower achievement, all in the absence of IQ deficits. Problems in boys and girls with prenatal cocaine exposure included exposure-level dependent poor behavioral control. Boys with heavy exposure had poor conduct, hyperactivity and central processing problems. Girls with heavy exposure had deficits in achievement that were likely related to behavior problems. These early school age abnormalities, especially under-controlled behavior, raise serious concerns about the risks faced by these children in adolescence. Using one of the oldest, well-studied cohorts of prospectively identified children exposed prenatally to varying levels of cocaine, the proposed research will evaluate adolescent behaviors, early initiation of substance use and attention problems in this cohort. We hypothesize that prenatal cocaine exposure will be associated with 1) higher levels of externalizing types of behavior; 2) earlier initiation of substance use; and 3) more problems with attention and impulsivity. We also hypothesize that the effects of prenatal cocaine exposure will be related to level of exposure, and moderated by gender. The hypotheses will be tested by evaluating approximately 500 adolescents and their primary caregivers who were previously evaluated at birth and at 6 to 7 years old. Starting in Year 1, these subjects will be recruited to participate at ages 13 to 14. The well-validated outcome measures will include DSM-IV diagnoses for disruptive behavior disorders, substance abuse/dependency, a health profile, behavior reports, and various specific laboratory tasks. Hypotheses will be evaluated with model-specified control variables, namely various potential confounders (e.g., prenatal and current alcohol exposure, other substance exposures, maternal comorbidities), mediators (e.g., birth weight, gestational age, child violence exposure), moderators (e.g., child gender, self-concept, custody status), and covariates (e.g., socioeconomic status, parity). Hierarchical linear and structural equation modeling will be the primary methods of data analysis. The proposed research will provide data critical to understanding the impact of prenatal cocaine exposure in adolescence, and to shape future studies of problem behaviors in late adolescence and early adulthood.
