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Willford JA, Kaufman JM. Through a teratological lens: A narrative review of exposure to stress and drugs of abuse during pregnancy on neurodevelopment. Neurotoxicol Teratol 2024:107384. [PMID: 39187031 DOI: 10.1016/j.ntt.2024.107384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 08/20/2024] [Accepted: 08/21/2024] [Indexed: 08/28/2024]
Abstract
Teratological research shows that both prenatal stress and prenatal substance exposure have a significant impact on neurodevelopmental outcomes in children. Using human research, the purpose of this narrative review is to explore the degree to which these exposures may represent complex prenatal and postnatal risks for the development of cognition and behavior in children. An understanding of the HPA axis and its function during pregnancy as well as the types and operationalization of prenatal stress provide a context for understanding the direct and indirect mechanisms by which prenatal stress affects brain and behavior development. In turn, prenatal substance exposure studies are evaluated for their importance in understanding variables that indicate a potential interaction with prenatal stress including reactivity to novelty, arousal, and stress reactivity during early childhood. The similarities and differences between prenatal stress exposure and prenatal substance exposure on neurodevelopmental outcomes including arousal and emotion regulation, cognition, behavior, stress reactivity, and risk for psychopathology are summarized. Further considerations for teratological studies of prenatal stress and/or substance exposure include identifying and addressing methodological challenges, embracing the complexity of pre-and postnatal environments in the research, and the importance of incorporating parenting and resilience into future studies.
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Affiliation(s)
- Jennifer A Willford
- Slippery Rock University, Department of Psychology, 1 Morrow Way, Slippery Rock, PA 16057, United States of America.
| | - Jesse M Kaufman
- Slippery Rock University, Department of Psychology, 1 Morrow Way, Slippery Rock, PA 16057, United States of America
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Maher BS, Bitsko RH, Claussen AH, O'Masta B, Cerles A, Holbrook JR, Mahmooth Z, Chen-Bowers N, Rojo ALA, Kaminski JW, Rush M. Systematic Review and Meta-analysis of the Relationship Between Exposure to Parental Substance Use and Attention-Deficit/Hyperactivity Disorder in Children. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2024; 25:291-315. [PMID: 37976008 PMCID: PMC11098969 DOI: 10.1007/s11121-023-01605-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/17/2023] [Indexed: 11/19/2023]
Abstract
Attention-deficit/hyperactivity disorder (ADHD) is characterized by persistent patterns of inattention, hyperactivity, and impulsiveness. Among US children and adolescents aged 3-17 years, 9.4% have a diagnosis of ADHD. Previous research suggests possible links between parental substance use and ADHD among children. We conducted a systematic review and meta-analysis of 86 longitudinal or retrospective studies of prenatal or postnatal alcohol, tobacco, or other parental substance use and substance use disorders and childhood ADHD and its related behavioral dimensions of inattention and hyperactivity-impulsivity. Meta-analyses were grouped by drug class and pre- and postnatal periods with combined sample sizes ranging from 789 to 135,732. Prenatal exposure to alcohol or tobacco and parent substance use disorders were consistently and significantly associated with ADHD among children. Other parental drug use exposures resulted in inconsistent or non-significant findings. Prevention and treatment of parental substance use may have potential for impacts on childhood ADHD.
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Affiliation(s)
- Brion S Maher
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Rebecca H Bitsko
- Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Angelika H Claussen
- Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | | | - Joseph R Holbrook
- Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Naomi Chen-Bowers
- Office Policy, Performance, and Evaluation, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Mailstop: H 21-11, Atlanta, GA, 30329, USA
| | | | - Jennifer W Kaminski
- Office Policy, Performance, and Evaluation, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Mailstop: H 21-11, Atlanta, GA, 30329, USA.
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Richardson GA, De Genna NM, Willford JA, Goldschmidt L. Pathways from prenatal cocaine exposure to adult substance use and behavior. Neurotoxicol Teratol 2024; 102:107335. [PMID: 38373556 PMCID: PMC10990782 DOI: 10.1016/j.ntt.2024.107335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 01/24/2024] [Accepted: 02/14/2024] [Indexed: 02/21/2024]
Abstract
This is a report from the most recent adult follow-up of the longest running cohort study of prenatal cocaine exposure (PCE), in which women were enrolled prenatally and offspring were assessed in infancy, childhood, adolescence, and young adulthood. In previous studies, PCE was linked to offspring behavior problems such as early substance use and externalizing behavior problems. The current analyses examine pathways from PCE to behavioral outcomes in offspring at the 25-year assessment. Prenatal cocaine exposure was moderate in this cohort; most women decreased or discontinued use after the first trimester. During the first and third trimesters, 38% and 11% used cocaine, respectively. This represents the most common pattern of PCE in non-treatment samples. At this phase, the adult offspring were, on average, 27.3 years old (range = 25-30), had 13.4 years of education, 83% were employed, 55% were Black, and 55% were female. Offspring who were exposed to cocaine during the first trimester were significantly more likely to use marijuana in the past year, report more arrests, and have poorer scores on a decision-making task, controlling for other prenatal substance exposure, demographic, and socioeconomic factors. In mediation analyses, there were indirect pathways from PCE to current marijuana use through early initiation of marijuana use and 21-year marijuana use, and through 15-year status offenses and 21-year marijuana use. There was also an indirect pathway from PCE to lifetime arrests through early initiation of marijuana use and 21-year Conduct Disorder, although the direct pathway from PCE to arrests also remained significant. These findings are consistent with those from previous phases and are an indication that there are detrimental associations with PCE that persist across developmental stages and into adulthood.
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Affiliation(s)
- Gale A Richardson
- University of Pittsburgh School of Medicine, Department of Psychiatry, 3811 O'Hara Street, Pittsburgh, PA 15213, United States of America.
| | - Natacha M De Genna
- University of Pittsburgh School of Medicine, Department of Psychiatry, 3811 O'Hara Street, Pittsburgh, PA 15213, United States of America
| | - Jennifer A Willford
- Department of Psychology, Slippery Rock University, 1 Morrow Way, Slippery Rock, PA 16057, United States of America
| | - Lidush Goldschmidt
- University of Pittsburgh Medical Center, 3811 O'Hara Street, Pittsburgh, PA 15213, United States of America
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Finger B, McNeill V, Schuetze P, Eiden RD. Sex moderated and RSA mediated effects of prenatal cocaine exposure on behavior problems at age 7. Neurotoxicol Teratol 2022; 89:107052. [PMID: 34826569 PMCID: PMC9053578 DOI: 10.1016/j.ntt.2021.107052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 11/03/2021] [Accepted: 11/18/2021] [Indexed: 01/03/2023]
Abstract
This study was designed to assess whether prenatal cocaine exposure (PCE) is associated with sex differences in behavior problems in middle childhood and whether there are sex differences in the way in which parasympathetic functioning mediates the relations between PCE and behavior problems within a diverse low-income sample. Participants included 164 high risk mother-child dyads including 89 PC exposed children and 75 control children participating in an ongoing longitudinal study. Respiratory sinus arrhythmia (RSA) was measured to assess parasympathetic functioning at 13 months of age and maternal reports of child behavior problems were collected at 7 years of age. Results revealed no significant association between PCE and behavior problems for the full sample. A 2 × 2 Anova revealed a significant interaction between PCE and child sex on internalizing, externalizing, and total behavior problems (F (3, 160) = 13.45, p < .001) with cocaine exposed females averaging the highest behavior problem scores. Results also revealed a statistically significant indirect effect linking cocaine exposure to lower externalizing problems via lower baseline RSA among males. Findings indicate that cocaine exposed females may be more vulnerable to developing behavior problems than cocaine exposed males and that high baseline RSA may present a sex specific risk factor for externalizing problems among exposed males.
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De Genna NM, Goldschmidt L, Richardson GA. Prenatal cocaine exposure, early cannabis use, and risky sexual behavior at age 25. Neurotoxicol Teratol 2022; 89:107060. [PMID: 34952173 PMCID: PMC8804968 DOI: 10.1016/j.ntt.2021.107060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 11/18/2021] [Accepted: 12/16/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND Prior research on prenatal cocaine exposure (PCE) indicates that exposed children experience behavioral dysregulation resulting in risky adolescent behavior including earlier initiation of cannabis use and sexual intercourse. The goal of this study was to examine the long-term effects of PCE on adult sexual behavior. METHODS This is a prospective cohort study of the association between PCE and risky adult sexual behavior and sexually transmitted infections (STIs) in 202 young adults (mean age = 27, SD = 0.98 years). The sample was 55% female, 46% White, and 54% Black. Data from the prenatal, childhood, and adolescent phases of the study were used to delineate pathways from PCE to adult sexual behavior. RESULTS The most common risky sexual behavior was having sex while drunk or high (63%). One-third of the sample reported that they "almost always" had sex while drunk or high. We found evidence for an indirect pathway from PCE to adult sex while drunk or high via early cannabis initiation. There were no other effects of PCE on adult risky sexual behavior or on risk for STIs, after controlling for sex assigned at birth, race, age at sexual initiation, and family history of drug and alcohol problems. CONCLUSIONS Although PCE has been associated with earlier initiation of sex in prior studies, PCE was not directly associated with risky adult sex or history of STI. Exposed individuals were at greater risk of sex under the influence of alcohol or drugs via earlier initiation of cannabis use during adolescence.
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Affiliation(s)
- Natacha M. De Genna
- Corresponding Author. Department of Psychiatry, University of Pittsburgh School of Medicine, 3811 O’Hara St, Pittsburgh, PA, 15213, USA
| | | | - Gale A. Richardson
- Department of Psychiatry, University of Pittsburgh School of Medicine, 3811 O’Hara St, Pittsburgh, PA, 15213, USA
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Karpova N, Zhang D, Beckwith AM, Bennett DS, Lewis M. Prenatal drug exposure and executive function in early adolescence. Neurotoxicol Teratol 2021; 88:107036. [PMID: 34648914 DOI: 10.1016/j.ntt.2021.107036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 09/15/2021] [Accepted: 09/30/2021] [Indexed: 12/31/2022]
Abstract
PURPOSE Study of the relationship between prenatal cocaine exposure (PCE) and executive function (EF) has yielded inconsistent results. The purpose of the current study is to examine whether PCE, biological sex, environmental risk, and their interaction predicted EF in early adolescence. METHODS 135 12-year-old adolescents (40.7% with PCE), who were followed prospectively from birth, attempted up to 8 Tower of Hanoi (ToH) puzzle trials of increasing complexity. The number of correctly completed puzzles served as the main outcome measure. Survival analysis was used to examine predictors of the number of successfully completed trials. RESULTS As trial difficulty increased, fewer adolescents were able to solve the TOH puzzle. Adolescents from high risk environments and with either prenatal alcohol or prenatal cannabis exposure completed fewer puzzles (p < .05). In addition, a hypothesized 3-way interaction of PCE x sex x environmental risk was found such that cocaine-exposed males with high environmental risk had the worst performance (p < .01). CONCLUSIONS The current findings are consistent with prior research indicating that males with PCE may be at particular risk of poorer functioning and highlight the potential importance of examining adolescent's sex and environmental risk as moderators of PCE effects.
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Affiliation(s)
- Natalia Karpova
- Rutgers Robert Wood Johnson Medical School, Institute for the Study of Child Development, Department of Pediatrics, 89 French Street, New Brunswick, NJ 08901, United States.
| | - Dake Zhang
- Rutgers the State University of New Jersey, Department of Educational Psychology, 10 Seminary Place, New Brunswick, NJ 08901, United States.
| | - Anna Malia Beckwith
- Children's Specialized Hospital, Rutgers Robert Wood Johnson Medical School, Department of Pediatrics, 150 New Providence Rd, Mountainside, NJ 07092, United States.
| | - David S Bennett
- Drexel University, GLAD Program, 4700 Wissahickon Avenue, Philadelphia, PA 19144, United States.
| | - Michael Lewis
- Rutgers Robert Wood Johnson Medical School, Institute for the Study of Child Development, 89 French Street, New Brunswick, NJ 08901, United States.
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Abstract
Prenatal exposure to alcohol and drugs is associated with physical, cognitive, and behavioral problems across the offspring's lifespan and an increased risk of alcohol and drug use in adolescent and young adult offspring. These prenatal effects continue to be evident after control for demographic background and parental alcohol and drug use. Behavior problems in childhood and adolescence associated with prenatal exposures may serve as a mediator of the prenatal exposure effects on offspring substance use.
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Prenatal cocaine exposure: Direct and indirect associations with 21-year-old offspring substance use and behavior problems. Drug Alcohol Depend 2019; 195:121-131. [PMID: 30622013 PMCID: PMC6430204 DOI: 10.1016/j.drugalcdep.2018.10.033] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 10/19/2018] [Accepted: 10/28/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND Prenatal cocaine exposure (PCE) has been linked to child/adolescent behavior problems and substance use in several longitudinal cohort studies. It is unclear whether these effects extend into adulthood and influence young adult behavior problems and substance use and, if so, whether they are mediated by childhood and adolescent experiences. METHODS These data are from an ongoing longitudinal study of individuals born to women who were recruited early in pregnancy. Trimester-specific data on prenatal drug exposure were obtained. Caregivers and offspring were assessed at delivery and at 1, 3, 7, 10, 15, and 21 years postpartum. This report is from age 21, when 225 offspring (52% females; 54% African American, 46% Caucasian) reported on behavior problems, emotion regulation, and substance use. RESULTS There were significant direct associations between PCE and early initiation of marijuana, 21-year emotion regulation problems, arrest history, and Conduct Disorder. The relation between PCE and young adult internalizing behavior was mediated by adolescent mood symptoms. The association between PCE and 21-year marijuana use was mediated by early initiation of marijuana use. CONCLUSIONS PCE has both direct and indirect long-term associations with young adult development. Using statistical models that considered the complex interrelationships among PCE and adult outcomes, we demonstrated that the direct effects of PCE on young adult emotion regulation problems, arrest history, and Conduct Disorder are not completely explained by earlier adolescent behavior. Moreover, the analyses suggesting mediated pathways from PCE to young adult problems identify crucial variables to target interventions for exposed children and adolescents.
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Willford JA, Singhabahu D, Herat A, Richardson GA. An examination of the association between prenatal cocaine exposure and brain activation measures of arousal and attention in young adults: An fMRI study using the Attention Network Task. Neurotoxicol Teratol 2018; 69:1-10. [PMID: 29953942 DOI: 10.1016/j.ntt.2018.06.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Revised: 05/23/2018] [Accepted: 06/22/2018] [Indexed: 11/19/2022]
Abstract
Prenatal drug exposure, including cocaine, alcohol, marijuana, and tobacco, is associated with deficits in behavioral regulation and attention. Using fMRI, the objective of this study was to characterize the association between prenatal cocaine exposure (PCE) and the underlying neural substrates associated with behavioral outcomes of attention. Forty-seven young adults were recruited for this study from the ongoing Maternal Health Practices and Child Development (MHPCD) Project, a longitudinal study of the effects of PCE on growth, behavior, and cognitive function. Three groups were compared: 1) prenatal exposure to cocaine, alcohol, marijuana, and tobacco (CAMT, n = 15), 2) prenatal exposure to alcohol, marijuana, and tobacco (AMT, n = 17), and 3) no prenatal exposure to drugs (Controls, n = 15). Subjects were frequency matched on gender, race, handedness, and 15-year IQ. This study used the theoretical model proposed by Posner and Peterson (1990), which posits three dissociable components of attention: alerting, orienting, and executive attention. Subjects completed a functional MRI (fMRI) scan while performing the Attention Network Task, a validated neuroimaging measure of the 3-network model of attention. Behavioral and fMRI data revealed no associations between PCE and task accuracy, speed of processing, or activation in key brain regions associated with each of the attention networks. The results of this study show that any subtle differences in brain function associated with PCE are not detectable using the ANT task and fMRI. These results should be interpreted in the context of other studies that have found associations between PCE and arousal with emotionally arousing stimuli, compared to this study that found no associations using emotionally neutral stimuli.
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Affiliation(s)
- Jennifer A Willford
- Department of Psychology, Slippery Rock University, 1 Morrow Way, Slippery Rock, PA 16057, United States of America.
| | - Dil Singhabahu
- Department of Mathematics, Slippery Rock University, 1 Morrow Way, Slippery Rock, PA 16057, United States of America.
| | - Athula Herat
- Department of Physics, Slippery Rock University, 1 Morrow Way, Slippery Rock, PA 16057, United States of America.
| | - Gale A Richardson
- Department of Psychiatry, University of Pittsburgh School of Medicine, 3811 O'Hara Street, Pittsburgh, PA 15213, United States of America.
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Nock NL, Minnes S, Alberts JL. Neurobiology of substance use in adolescents and potential therapeutic effects of exercise for prevention and treatment of substance use disorders. Birth Defects Res 2018; 109:1711-1729. [PMID: 29251846 DOI: 10.1002/bdr2.1182] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 11/13/2017] [Indexed: 12/17/2022]
Abstract
Substance use (e.g., alcohol, marijuana, opioids, cocaine., etc,) use often initiates during adolescence, a critical period of physiological and social development marked by an increase in risk-taking due, in part, to heightened motivation to obtain arousal from rewards. Substance use during adolescence has been associated with a greater risk of substance use disorders (SUD) in adulthood. Although use rates for most substances have remained relatively stable, the frequency of marijuana use and the perception that regular marijuana use is not harmful has increased in adolescents. Furthermore, the nonmedical use of opioids has increased, particularly in the South, Midwest, and rural low-income communities. Substance use in adolescence has been associated with adverse structural and functional brain changes and, may exacerbate the natural "imbalance" between frontal/regulatory and cortical-subcortical circuits, leading to further heightened impulsive and reward-driven behaviors. Exercise increases growth and brain-derived neurotrophic factors that stimulate endogenous dopaminergic systems that, in turn, enhance general plasticity, learning, and memory. Exercise may help to reinforce the "naïve" or underdeveloped connections between neurological reward and regulatory processes in adolescence from the "bottom up" and "offset" reward seeking from substances, while concomitantly improving cardiovascular health, as well as academic and social achievement. In this review, we provide an overview of the current state of substance use in adolescents and rationale for the utilization of exercise, particularly "assisted" exercise, which we have shown increases neural activity in cortical-subcortical regions and may modulate brain dopamine levels during adolescence, a unique window of heightened reward sensitivity and neural plasticity, for the prevention and adjunctive treatment of SUD.
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Affiliation(s)
- Nora L Nock
- Department of Epidemiology and Biostatistics, Case Western Reserve University, Cleveland, Ohio
| | - Sonia Minnes
- Jack, Joseph and Morton Mandel School of Applied Sciences, Case Western Reserve University, Cleveland, Ohio
| | - Jay L Alberts
- Department of Biomedical Engineering, Cleveland Clinic, Cleveland, Ohio
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Lin B, Ostlund BD, Conradt E, Lagasse LL, Lester BM. Testing the programming of temperament and psychopathology in two independent samples of children with prenatal substance exposure. Dev Psychopathol 2018; 30:1023-1040. [PMID: 30068412 PMCID: PMC6074047 DOI: 10.1017/s0954579418000391] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Prenatal programming models have rarely been applied to research on children with prenatal substance exposure, despite evidence suggesting that prenatal drug exposure is a form of stress that impacts neurodevelopmental outcomes and risk for psychopathology. Utilizing data from two longitudinal multisite studies comprising children prenatally exposed to substances as well as a nonexposed comparison group (Maternal Lifestyle Study, n = 1,388; Infant Development, Environment, and Lifestyle study, n = 412), we tested whether early phenotypic indicators of hypothesized programming effects, indexed by growth parameters at birth and infant temperament, served as a link between prenatal substance exposure and internalizing and externalizing behavior at age 5. Latent profile analysis indicated that individual differences in reactivity and regulation for infants prenatally exposed to substances was best characterized by four temperament profiles. These profiles were virtually identical across two independent samples, and demonstrated unique associations with adjustment difficulties nearly 5 years later. Results of path analysis using structural equation modeling also showed that increased prenatal substance exposure was linked to poorer growth parameters at birth, profiles of temperamental reactivity in infancy, and internalizing and externalizing behavior at age 5. This pathway was partially replicated across samples. This study was among the first to link known individual-level correlates of prenatal substance exposure into a specific pathway to childhood problem behavior. Implications for the developmental origins of a child's susceptibility to psychopathology as a result of intrauterine substance exposure are discussed.
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Minnes S, Min MO, Kim JY, Francis MW, Lang A, Wu M, Singer LT. The association of prenatal cocaine exposure, externalizing behavior and adolescent substance use. Drug Alcohol Depend 2017; 176:33-43. [PMID: 28514694 PMCID: PMC5637277 DOI: 10.1016/j.drugalcdep.2017.01.027] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Revised: 01/04/2017] [Accepted: 01/08/2017] [Indexed: 10/19/2022]
Abstract
Prenatal cocaine exposure (PCE) may increase adolescent substance use through alterations of neurotransmitter systems affecting fetal brain development. The relationship between PCE and substance use at 15 and 17 years was examined. Subjects (365: 186 PCE; 179 non-cocaine exposed (NCE)) supplied biologic and self-report data using the Youth Risk Behavior Surveillance System (YRBSS) and Computerized Diagnostic Interview Schedule for Children (C-DISC 4) at ages 15 and 17. The relationship between PCE and substance use was assessed using General Estimating Equation (GEE) analyses controlling for confounding factors including violence exposure and preschool lead level. Teens with PCE vs. NCE teens were 2 times more likely to use tobacco (OR=2.1; 95% CI 1.21-3.63; p<.001) and marijuana (OR=1.85; CI 1.18-2.91; p<.001) and have a substance use disorder at age 17 (OR=2.51; CI 1.00-6.28; p<.05). Evaluation of PCE status by gender revealed an association between PCE and marijuana use that was more pronounced for boys than girls at 17 years. Violence exposure was also a significant predictor of alcohol (p<.001), tobacco (p<.05), and marijuana (p<.0006) use and substance abuse/dependence (p<.01). Externalizing behavior at age 12 fully mediated the effects of PCE on substance use disorder at age 17 and partially mediated effects of PCE on tobacco use, but did not mediate effects on marijuana use. The percentage of substance use reported increased between 15 and 17 years, with no differences between the PCE and NCE groups. Data suggest specialized drug use prevention measures for children with PCE may benefit this high risk group.
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Affiliation(s)
- Sonia Minnes
- The Jack, Joseph and Morton Mandel School of Applied Social Sciences, Case Western Reserve University, Cleveland, OH, United States.
| | - Meeyoung O Min
- The Jack, Joseph and Morton Mandel School of Applied Social Sciences, Case Western Reserve University, Cleveland, OH, United States
| | - June-Yung Kim
- Department of Psychological Sciences, Case Western Reserve University, Cleveland, OH, United States
| | - Meredith W Francis
- Department of Psychological Sciences, Case Western Reserve University, Cleveland, OH, United States
| | - Adelaide Lang
- The Jack, Joseph and Morton Mandel School of Applied Social Sciences, Case Western Reserve University, Cleveland, OH, United States
| | - Miaoping Wu
- The Jack, Joseph and Morton Mandel School of Applied Social Sciences, Case Western Reserve University, Cleveland, OH, United States
| | - Lynn T Singer
- School of Medicine, Department of Epidemiology and Biostatistics, Case Western Reserve University, Cleveland, OH, United States
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Garrison L, Leeman L, Savich RD, Gutierrez H, Rayburn WF, Bakhireva LN. Fetal Growth Outcomes in a Cohort of Polydrug- and Opioid-Dependent Patients. THE JOURNAL OF REPRODUCTIVE MEDICINE 2016; 61:311-319. [PMID: 29075045 PMCID: PMC5654486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVES To evaluate the effects of prenatal polydrug and exclusive opioid use on fetal growth outcomes. METHODS This analysis relied on the data obtained from two prospective cohorts at the University of New Mexico. For both cohorts, pregnant women were recruited during one of their prenatal care visits and followed up to delivery. The merged sample included 59 polydrug users, 22 exclusive opioid users, and 278 abstinent controls. Continuous growth measures (birth weight, height, occipital frontal circumference [OFC], and corresponding sex-specific percentiles) were compared by ANOVA and ANCOVA in bivariate and multivariable analyses, respectively. Categorical outcomes (prevalence of small-for-gestational age [SGA] for weight, length, and OFC) were compared among groups by Chi-square and multivariable logistic regression analyses.. RESULTS The sample included a large proportion of ethnic minorities (78.8% Hispanic) and patients with low educational attainment (68% ≤ high school). The risk of microcephaly (OFC<10th percentile) was significantly greater in the polydrug (OR=4.7; 95% CI: 2.0; 10.8) and exclusive opioid (OR=2.8; 95% CI: 1.0; 8.1) groups compared to abstinent controls. CONCLUSION Given that microcephaly is often associated with serious neurocognitive and behavioral deficits later in life, our finding of 49.2% incidence of microcephaly among polydrug users is alarming and requires further investigation.
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Barthelemy OJ, Richardson MA, Cabral HJ, Frank DA. Prenatal, perinatal, and adolescent exposure to marijuana: Relationships with aggressive behavior. Neurotoxicol Teratol 2016; 58:60-77. [PMID: 27345271 DOI: 10.1016/j.ntt.2016.06.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Revised: 05/25/2016] [Accepted: 06/22/2016] [Indexed: 10/21/2022]
Abstract
This manuscript reviews research exploring the relationship between prenatal, perinatal, and adolescent exposure to marijuana and aggressive behavior, including physical aggression. Areas of inquiry include animal research, as well as human research, on prenatal exposure and on marijuana use during adolescence. Potential psychosocial and psychopharmacological mechanisms are identified, as well as relevant confounds. The prenatal marijuana exposure literature provides minimal support for a direct relationship with aggressive behavior in childhood. The adolescent use literature suggests a marginal (at best) association between acute intoxication and aggressive behavior, and an association between chronic use and aggressive behavior heavily influenced by demographic variables, rather than direct, psychopharmacological mechanisms. Cannabis withdrawal symptoms also may include aggression and anger, but there is little evidence to suggest that these effects are large or specific to withdrawal from marijuana compared to other substances. This review will offer recommendations for clinical care and public policy, as well as important questions for future research.
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Affiliation(s)
- Olivier J Barthelemy
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, United States
| | - Mark A Richardson
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, United States; Division of Psychiatry, Boston University School of Medicine, Boston, MA, United States
| | - Howard J Cabral
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, United States
| | - Deborah A Frank
- Department of Pediatrics, Boston University School of Medicine, Boston, MA, United States.
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Parolin M, Simonelli A, Mapelli D, Sacco M, Cristofalo P. Parental Substance Abuse As an Early Traumatic Event. Preliminary Findings on Neuropsychological and Personality Functioning in Young Drug Addicts Exposed to Drugs Early. Front Psychol 2016; 7:887. [PMID: 27378983 PMCID: PMC4909766 DOI: 10.3389/fpsyg.2016.00887] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Accepted: 05/30/2016] [Indexed: 12/02/2022] Open
Abstract
Parental substance use is a major risk factor for child development, heightening the risk of drug problems in adolescence and young adulthood, and exposing offspring to several types of traumatic events. First, prenatal drug exposure can be considered a form of trauma itself, with subtle but long-lasting sequelae at the neuro-behavioral level. Second, parents' addiction often entails a childrearing environment characterized by poor parenting skills, disadvantaged contexts and adverse childhood experiences (ACEs), leading to dysfunctional outcomes. Young adults born from/raised by parents with drug problems and diagnosed with a Substance Used Disorder (SUD) themselves might display a particularly severe condition in terms of cognitive deficits and impaired personality function. This preliminary study aims to investigate the role of early exposure to drugs as a traumatic event, capable of affecting the psychological status of young drug addicts. In particular, it intends to examine the neuropsychological functioning and personality profile of young adults with severe SUDs who were exposed to drugs early in their family context. The research involved three groups, each consisting of 15 young adults (aged 18–24): a group of inpatients diagnosed with SUDs and exposed to drugs early, a comparison group of non-exposed inpatients and a group of non-exposed youth without SUDs. A neuropsychological battery (Esame Neuropsicologico Breve-2), an assessment procedure for personality disorders (Shedler-Westen Assessment Procedure-200) and the Symptom CheckList-90-Revised were administered. According to present preliminary results, young drug addicts exposed to drugs during their developmental age were characterized by elevated rates of neuropsychological impairments, especially at the expense of attentive and executive functions (EF); personality disorders were also common but did not differentiate them from non-exposed youth with SUDs. Alternative multi-focused prevention and intervention programs are needed for children of drug-misusing parents, addressing EF and adopting a trauma-focused approach.
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Affiliation(s)
- Micol Parolin
- Department of Developmental Psychology and Socialization, University of Padova Padua, Italy
| | - Alessandra Simonelli
- Department of Developmental Psychology and Socialization, University of Padova Padua, Italy
| | - Daniela Mapelli
- Department of General Psychology, University of Padova Padua, Italy
| | - Marianna Sacco
- Department of Developmental Psychology and Socialization, University of Padova Padua, Italy
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Barthelemy OJ, Richardson MA, Rose-Jacobs R, Forman LS, Cabral HJ, Frank DA. Effects of intrauterine substance and postnatal violence exposure on aggression in children. Aggress Behav 2016; 42:209-21. [PMID: 26660077 DOI: 10.1002/ab.21607] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2015] [Revised: 06/09/2015] [Accepted: 06/25/2015] [Indexed: 01/31/2023]
Abstract
During the cocaine epidemic of the 1980s and early 1990s, many expressed fears that children with intrauterine cocaine exposure (IUCE) would grow up to be unusually violent. The present study examines the relationship of caregiver reports of school-age children's aggressive behavior with IUCE and postnatal exposure to violence. Respondents were 140 low-income, primarily African American children, ages 8-11, and each child's current primary caregiver from a longitudinal study evaluating potential long term sequelae of IUCE. Multiple regression analyses were used to investigate the independent and interactive effects of level of IUCE (None (n = 69), Lighter (n = 47), Heavier (n = 24)) and exposure to violence (Violence Exposure Scale for Children-Revised) on aggressive behavior (Child Behavior Checklist), while also controlling for other intrauterine substance exposures and additional contextual factors. Children's self-reported exposure to violence was significantly positively associated with caregivers' reports of aggressive behavior (β = 2.17, P = .05), as was concurrent caregiver's psychiatric distress (β = .15, P = .003). However, neither IUCE nor its interaction with exposure to violence showed a significant association with aggressive behavior. Findings suggest the importance of postnatal social environment rather than IUCE in predicting aggressive behavior in childhood.
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Affiliation(s)
- Olivier J. Barthelemy
- Department of Psychological and Brain Sciences; Boston University; Boston Massachusetts
| | - Mark A. Richardson
- Department of Psychological and Brain Sciences; Boston University; Boston Massachusetts
- Division of Psychiatry; Boston University School of Medicine; Boston Massachusetts
| | - Ruth Rose-Jacobs
- Department of Pediatrics; Boston University School of Medicine; Boston Massachusetts
| | - Leah S. Forman
- Data Coordinating Center; Boston University School of Public Health; Boston Massachusetts
| | - Howard J. Cabral
- Department of Biostatistics; Boston University School of Public Health; Boston Massachusetts
| | - Deborah A. Frank
- Department of Pediatrics; Boston University School of Medicine; Boston Massachusetts
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Eze N, Smith LM, LaGasse LL, Derauf C, Newman E, Arria A, Huestis MA, Della Grotta SA, Dansereau LM, Neal C, Lester BM. School-Aged Outcomes following Prenatal Methamphetamine Exposure: 7.5-Year Follow-Up from the Infant Development, Environment, and Lifestyle Study. J Pediatr 2016; 170:34-8.e1. [PMID: 26781836 PMCID: PMC4769906 DOI: 10.1016/j.jpeds.2015.11.070] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Revised: 10/28/2015] [Accepted: 11/24/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To assess the relationship between prenatal methamphetamine exposure (PME) and behavior problems at age 7.5 years and the extent to which early adversity mediated this relationship. STUDY DESIGN The multicenter, longitudinal Infant Development, Environment, and Lifestyle study enrolled 412 mother-infant pairs at 4 sites. Methamphetamine-exposed participants (n = 204) were identified by self-report and/or gas chromatography/mass spectrometry confirmation of amphetamine and metabolites in infant meconium. Matched participants (n = 208) denied methamphetamine use and had a negative meconium screen. At the 7.5-year follow-up, 290 children with complete Child Behavior Checklist data and an early adversity index score were available for analysis (n = 146 exposed). RESULTS PME was significantly associated with an increased early adversity index score (P < .001) and with increased externalizing, rule-breaking behavior, and aggressive behavior (P < .05). Early adversity was also associated with higher externalizing behavior scores. Early adversity significantly mediated the relationship between PME and behavioral problems. After adjusting the mediation model for sex, prenatal tobacco, alcohol, and marijuana exposures, and study site, the association of PME with early adversity remained significant. CONCLUSIONS Though PME is associated with behavioral problems, early adversity may be a strong determinant of behavioral outcome for children exposed to methamphetamine in utero. Early adversity significantly mediated the relationship between PME and behavioral problems.
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Affiliation(s)
- Nwando Eze
- Department of Pediatrics, David Geffen School of Medicine at University of California, Los Angeles (UCLA) and Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA
| | - Lynne M Smith
- Department of Pediatrics, David Geffen School of Medicine at University of California, Los Angeles (UCLA) and Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA.
| | - Linda L LaGasse
- Pediatrics Division, Brown Center for the Study of Children at Risk, Warren Alpert Medical School of Brown University, Women and Infants Hospital, Providence, RI
| | - Chris Derauf
- John A. Burns School of Medicine, University of Hawaii, Honolulu, HI
| | - Elana Newman
- Department of Psychology, The University of Tulsa, Tulsa, OK
| | - Amelia Arria
- Center for Substance Abuse Research, University of Maryland, College Park, MD
| | - Marilyn A Huestis
- Section on Chemistry and Drug Metabolism, National Institute on Drug Abuse, Bethesda, MD
| | - Sheri A Della Grotta
- Pediatrics Division, Brown Center for the Study of Children at Risk, Warren Alpert Medical School of Brown University, Women and Infants Hospital, Providence, RI
| | - Lynne M Dansereau
- Pediatrics Division, Brown Center for the Study of Children at Risk, Warren Alpert Medical School of Brown University, Women and Infants Hospital, Providence, RI
| | - Charles Neal
- John A. Burns School of Medicine, University of Hawaii, Honolulu, HI
| | - Barry M Lester
- Pediatrics Division, Brown Center for the Study of Children at Risk, Warren Alpert Medical School of Brown University, Women and Infants Hospital, Providence, RI
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Richardson GA, Goldschmidt L, Larkby C, Day NL. Response to Pemberton and Hart "Consistent use of precise language decreases misunderstandings". Neurotoxicol Teratol 2015; 50:89-90. [PMID: 26141221 DOI: 10.1016/j.ntt.2015.06.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Accepted: 06/24/2015] [Indexed: 10/23/2022]
Affiliation(s)
- Gale A Richardson
- University of Pittsburgh School of Medicine, Western Psychiatric Institute and Clinic, 3811 O'Hara Street, Pittsburgh, PA 15213, United States.
| | - Lidush Goldschmidt
- University of Pittsburgh Medical Center, Western Psychiatric Institute and Clinic, 3811 O'Hara Street, Pittsburgh, PA 15213, United States
| | - Cynthia Larkby
- University of Pittsburgh School of Medicine, Western Psychiatric Institute and Clinic, 3811 O'Hara Street, Pittsburgh, PA 15213, United States
| | - Nancy L Day
- University of Pittsburgh School of Medicine, Western Psychiatric Institute and Clinic, 3811 O'Hara Street, Pittsburgh, PA 15213, United States
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Liebschutz J, Crooks D, Rose-Jacobs R, Cabral HJ, Heeren TC, Gerteis J, Appugliese DP, Heymann OD, Lange AV, Frank DA. Prenatal substance exposure: What predicts behavioral resilience by early adolescence? PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2015; 29:329-37. [PMID: 26076097 PMCID: PMC4593628 DOI: 10.1037/adb0000082] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Understanding behavioral resilience among at-risk adolescents may guide public policy decisions and future programs. We examined factors predicting behavioral resilience following intrauterine substance exposure in a prospective longitudinal birth-cohort study of 136 early adolescents (ages 12.4-15.9 years) at risk for poor behavioral outcomes. We defined behavioral resilience as a composite measure of lack of early substance use initiation (before age 14), lack of risky sexual behavior, or lack of delinquency. Intrauterine substance exposures included in this analysis were cocaine, tobacco, alcohol, and marijuana. We recruited participants from Boston Medical Center as mother-infant dyads between 1990 and 1993. The majority of the sample was African American/Caribbean (88%) and 49% female. In bivariate analyses, none and lower intrauterine cocaine exposure level predicted resilience compared with higher cocaine exposure, but this effect was not found in an adjusted model. Instead, strict caregiver supervision (adjusted odds ratio [AOR] = 6.02, 95% confidence interval (CI) [1.90, 19.00], p = .002), lower violence exposure (AOR = 4.07, 95% CI [1.77, 9.38], p < .001), and absence of intrauterine tobacco exposure (AOR = 3.71, 95% CI [1.28, 10.74], p = .02) predicted behavioral resilience. In conclusion, caregiver supervision in early adolescence, lower violence exposure in childhood, and lack of intrauterine tobacco exposure predicted behavioral resilience among a cohort of early adolescents with significant social and environmental risk. Future interventions should work to enhance parental supervision as a way to mitigate the effects of adversity on high-risk groups of adolescents. (PsycINFO Database Record
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Affiliation(s)
- Jane Liebschutz
- Clinical Addiction Research and Education Unit, 801 Massachusetts Avenue, Boston Medical Center, Boston, MA, 02118
| | - Denise Crooks
- Department of Family Medicine, Boston Medical Center, 840 Harrison Avenue, Boston, MA, 02118
| | - Ruth Rose-Jacobs
- Department of Pediatrics, Boston University School of Medicine, Boston, 72 East Concord Street, MA, 02118
| | - Howard J Cabral
- Department of Biostatistics, Boston University School of Public Health, 715 Albany Street, Boston, MA, 02118
| | - Timothy C Heeren
- Data Coordinating Center, Boston University School of Public Health, 715 Albany Street, Boston, MA, 02118
| | - Jessie Gerteis
- Abt Associates, Inc., 55 Wheeler Street, Cambridge, MA, 02138
| | - Danielle P. Appugliese
- Data Coordinating Center, Boston University School of Public Health, 715 Albany Street, Boston, MA, 02118
| | - Orlaith D. Heymann
- Clinical Addiction Research and Education Unit, 801 Massachusetts Avenue, Boston Medical Center, Boston, MA, 02118
| | - Allison V. Lange
- Clinical Addiction Research and Education Unit, 801 Massachusetts Avenue, Boston Medical Center, Boston, MA, 02118
| | - Deborah A. Frank
- Department of Family Medicine, Boston Medical Center, 840 Harrison Avenue, Boston, MA, 02118
- Department of Pediatrics, Boston University School of Medicine, Boston, 72 East Concord Street, MA, 02118
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Richardson GA, Goldschmidt L, Larkby C, Day NL. Effects of prenatal cocaine exposure on adolescent development. Neurotoxicol Teratol 2015; 49:41-8. [PMID: 25778776 DOI: 10.1016/j.ntt.2015.03.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Revised: 02/27/2015] [Accepted: 03/08/2015] [Indexed: 02/06/2023]
Abstract
The associations between prenatal cocaine exposure (PCE) and adolescent behavior, cognitive development, and physical growth were examined in 219 15-year-olds who have participated in a longitudinal study since their fourth gestational month. During the first trimester, 42% of the women used cocaine, with use declining across pregnancy. At the 15-year follow-up, the caregivers were, on average, 43 years old, had 13 years of education, and 50% were African American. First trimester PCE was not associated with global cognitive development or with measures of learning and memory. First trimester PCE was significantly related to adolescent-reported delinquent behavior, poorer problem solving and abstract reasoning, and reduced weight, height, and head circumference at 15 years. These results were significant after other factors that affect these domains were controlled in regression analyses. In addition, exposure to violence partially mediated the effect of PCE on delinquent behavior. These adolescent domains are important because they are predictors of poorer adult functioning.
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Affiliation(s)
- Gale A Richardson
- University of Pittsburgh School of Medicine, Western Psychiatric Institute and Clinic, 3811 O'Hara Street, Pittsburgh, PA 15213, United States.
| | - Lidush Goldschmidt
- University of Pittsburgh Medical Center, Western Psychiatric Institute and Clinic, 3811 O'Hara Street, Pittsburgh, PA 15213, United States
| | - Cynthia Larkby
- University of Pittsburgh School of Medicine, Western Psychiatric Institute and Clinic, 3811 O'Hara Street, Pittsburgh, PA 15213, United States
| | - Nancy L Day
- University of Pittsburgh School of Medicine, Western Psychiatric Institute and Clinic, 3811 O'Hara Street, Pittsburgh, PA 15213, United States
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De Genna N, Goldschmidt L, Richardson GA. Prenatal cocaine exposure and age of sexual initiation: direct and indirect effects. Drug Alcohol Depend 2014; 145:194-200. [PMID: 25456330 PMCID: PMC4254808 DOI: 10.1016/j.drugalcdep.2014.10.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Revised: 10/06/2014] [Accepted: 10/16/2014] [Indexed: 12/16/2022]
Abstract
BACKGROUND Prenatal cocaine exposure (PCE) has been linked to child behavior problems and risky behavior during adolescence such as early substance use. Behavior problems and early substance use are associated with earlier initiation of sexual behavior. The goal of this study was to examine the direct and indirect effects of PCE on sexual initiation in a longitudinal birth cohort, about half of whom were exposed to cocaine in utero. METHODS Women were interviewed twice prenatally, at delivery, and 1, 3, 7, 10, 15, and 21 years postpartum. Offspring (52% female, 54% African American) were assessed at delivery and at each follow-up phase with age-appropriate assessments. At age 21, 225 offspring reported on their substance use and sexual behavior. RESULTS First trimester cocaine exposure was a significant predictor of earlier age of first intercourse in a survival analysis, after controlling for race, sociodemographic characteristics, caregiver pre- and postnatal substance use, parental supervision, and child's pubertal timing. However, the association between PCE and age of first sexual intercourse was mediated by adolescent marijuana and alcohol use prior to age 15. CONCLUSIONS Most of the effect of PCE on age of sexual initiation occurred between the ages of 13-18, when rates of initiation were approximately 10% higher among exposed offspring. This effect was mediated by early adolescent substance use. These results have implications for identification of the exposed offspring at greatest risk of HIV risk behaviors and early, unplanned pregnancy.
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Affiliation(s)
- Natacha De Genna
- University of Pittsburgh School of Medicine, Western Psychiatric Institute and Clinic, 3811 O'Hara Street, Pittsburgh, PA 15213
| | - Lidush Goldschmidt
- University of Pittsburgh Medical Center, Program in Epidemiology, 3811 O'Hara Street, Pittsburgh, PA 15213
| | - Gale A. Richardson
- University of Pittsburgh School of Medicine, Western Psychiatric Institute and Clinic, 3811 O'Hara Street, Pittsburgh, PA 15213
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Zhao T, Li Y, Wei W, Savage S, Zhou L, Ma D. Ketamine administered to pregnant rats in the second trimester causes long-lasting behavioral disorders in offspring. Neurobiol Dis 2014; 68:145-55. [DOI: 10.1016/j.nbd.2014.02.009] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2013] [Revised: 02/21/2014] [Accepted: 02/25/2014] [Indexed: 12/29/2022] Open
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Yolton K, Cornelius M, Ornoy A, McGough J, Makris S, Schantz S. Exposure to neurotoxicants and the development of attention deficit hyperactivity disorder and its related behaviors in childhood. Neurotoxicol Teratol 2014; 44:30-45. [PMID: 24846602 DOI: 10.1016/j.ntt.2014.05.003] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2012] [Revised: 05/08/2014] [Accepted: 05/13/2014] [Indexed: 01/28/2023]
Abstract
The purpose of this manuscript is to review the literature to determine evidence of associations between exposure to prenatal and postnatal environmental agents and the development of attention deficit hyperactivity disorder (ADHD) and related behaviors. A review of published research literature was conducted on associations between exposures to prenatal and postnatal cigarette smoke, prenatal exposure to alcohol, cocaine, and heroin, childhood exposure to lead, and prenatal exposure to organophosphate pesticides and outcomes of ADHD or behaviors related to ADHD. Review of the literature in these areas provides some evidence of associations between each of the exposures and ADHD-related behaviors, with the strongest evidence from prenatal cigarette and alcohol exposure and postnatal lead exposure. However, research on each exposure also produced evidence of weaknesses in these hypothesized links due to imprecise research methodologies and issues of confounding and inaccurate covariate adjustment. More rigorous studies are needed to provide definitive evidence of associations between each of these prenatal or postnatal exposures and the development of ADHD or symptoms of ADHD. Future studies need to clarify the underlying mechanisms between these exposures and the increased risk for ADHD and associated behaviors. More research is also needed utilizing study designs that include genetic information, as ADHD is highly heritable and there appear to be some protective mechanisms offered by certain genetic characteristics as evidenced in gene by environmental studies. Finally, while studies focusing on individual drugs and chemicals are an important first step, we cannot ignore the fact that children are exposed to combinations of drugs and chemicals, which can interact in complex ways with each other, as well as with the child's genetic makeup and psychosocial environment to influence ADHD risk.
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Affiliation(s)
- Kimberly Yolton
- Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, ML 7035, Cincinnati, OH 45229-3039, United States.
| | - Marie Cornelius
- University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, United States
| | - Asher Ornoy
- Hebrew University Hadassah Medical School, Jerusalem, Israel
| | - James McGough
- Semel Institute for Neuroscience & Human Behavior, 300 UCLA Medical Plaza, Suite 1524C, Los Angeles, CA 90095, United States; David Geffen School of Medicine at the University of California, Los Angeles, 300 UCLA Medical Plaza, Suite 1524C, 300 UCLA Medical Plaza, Suite 1524C, Los Angeles, CA 90095, United States
| | - Susan Makris
- United States Environmental Protection Agency, National Center for Environmental Assessment, 1200 Pennsylvania Avenue, NW, Mailcode 8623P, Washington, DC 20460, United States
| | - Susan Schantz
- College of Veterinary Medicine, University of Illinois at Urbana-Champaign, Urbana, IL 61802, United States
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Min MO, Minnes S, Lang A, Weishampel P, Short EJ, Yoon S, Singer LT. Externalizing behavior and substance use related problems at 15 years in prenatally cocaine exposed adolescents. J Adolesc 2014; 37:269-79. [PMID: 24636687 PMCID: PMC3980446 DOI: 10.1016/j.adolescence.2014.01.004] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2013] [Revised: 10/30/2013] [Accepted: 01/15/2014] [Indexed: 11/17/2022]
Abstract
The effect of prenatal cocaine exposure (PCE) on externalizing behavior and substance use related problems at 15 years of age was examined. Participants consisted of 358 adolescents (183 PCE, 175 non-cocaine exposed (NCE)), primarily African-American and of low socioeconomic status, prospectively enrolled in a longitudinal study from birth. Regression analyses indicated that the amount of PCE was associated with higher externalizing behavioral problems (β = .15, p = .02). Adolescents with PCE were also 2.8 times (95% CI = 1.38-5.56) more likely to have substance use related problems than their NCE counterparts. No differences between PCE adolescents in non-kinship adoptive/foster care (n = 44) and PCE adolescents in maternal/relative care (n = 139) were found in externalizing behavior or in the likelihood of substance use related problems. Findings demonstrate teratologic effects of PCE persisting into adolescence. PCE is a reliable marker for the potential development of problem behaviors in adolescence, including substance use related problems.
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Affiliation(s)
- Meeyoung O Min
- Case Western Reserve University, Jack, Joseph and Morton Mandel School of Applied Social Sciences, USA.
| | - Sonia Minnes
- Case Western Reserve University, Jack, Joseph and Morton Mandel School of Applied Social Sciences, USA
| | - Adelaide Lang
- Case Western Reserve University, Jack, Joseph and Morton Mandel School of Applied Social Sciences, USA
| | - Paul Weishampel
- Case Western Reserve University, Jack, Joseph and Morton Mandel School of Applied Social Sciences, USA
| | | | - Susan Yoon
- Case Western Reserve University, Jack, Joseph and Morton Mandel School of Applied Social Sciences, USA
| | - Lynn T Singer
- School of Medicine, Department of Pediatrics, USA; School of Medicine, Department of Psychiatry, USA; School of Medicine, Department of Environmental Health Sciences, USA
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Minnes S, Singer LT, Min MO, Lang AM, Ben-Harush A, Short E, Wu M. Comparison of 12-year-old children with prenatal exposure to cocaine and non-exposed controls on caregiver ratings of executive function. J Youth Adolesc 2014; 43:53-69. [PMID: 23423839 PMCID: PMC3715590 DOI: 10.1007/s10964-013-9927-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2012] [Accepted: 02/08/2013] [Indexed: 11/28/2022]
Abstract
Differences in caregiver reported executive function in 12-year-old children who were prenatally exposed to cocaine (PCE) compared to children who were not prenatally exposed to cocaine (NCE) were assessed. One hundred and sixty-nine PCE and 169 NCE, primarily African-American, low socioeconomic status children participated in a prospective longitudinal study. The Behavior Rating Inventory of Executive Function (BRIEF) Parent Form was administered. Two broadband BRIEF scores (Behavioral Regulation Index (BRI) and Metacognition Index (MI)) and a summary Global Executive Composite (GEC) were computed. Multiple and logistic regression analyses were used to assess the effects of amount of PCE on executive function, controlling for covariates including caregiver (rater) psychological distress, child's gender and other prenatal drug exposure variables. After adjustment for covariates, amount of PCE was associated with the GEC and two MI subscales, Plan/Organize and Monitor, with heavier exposure associated with more problems of executive function. An amount of PCE by gender interaction revealed amount of PCE effects in other remaining subscales of the MI (Initiate, Working Memory, and Organization of Materials) only among girls. Head circumference did not mediate the effects of cocaine on outcomes. Higher current caregiver psychological distress levels were independently associated with poorer ratings on the executive function scales. Assessment and targeted interventions to improve metacognitive processes are recommended for girls who were prenatally exposed to cocaine.
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Affiliation(s)
- Sonia Minnes
- Mandel School of Applied Social Sciences, Case Western Reserve University, Cleveland, OH, USA,
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Allen JWP, Bennett DS, Carmody DP, Wang Y, Lewis M. Adolescent risk-taking as a function of prenatal cocaine exposure and biological sex. Neurotoxicol Teratol 2013; 41:65-70. [PMID: 24334262 DOI: 10.1016/j.ntt.2013.12.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2013] [Revised: 11/27/2013] [Accepted: 12/06/2013] [Indexed: 01/17/2023]
Abstract
OBJECTIVE To examine the effects of prenatal cocaine exposure and biological sex on adolescent risk-taking while controlling for early environmental risk. METHODS Adolescents (n=114, mean age=16) were grouped according to high and low risk-taking propensity as measured by the Balloon Analogue Risk Task (BART). Prenatal cocaine exposure was assessed at birth, while environmental risk was assessed at three points during early childhood. RESULTS A binary regression analysis indicated that males were 3.5 times more likely than females to be high risk-takers. Biological sex and prenatal cocaine exposure interacted such that exposed males were most likely to be high risk-takers while exposed females were the least likely to be high risk-takers. This pattern held after controlling for prenatal alcohol exposure and early environmental risk. Early environmental risk did not predict adolescent risk-taking. CONCLUSIONS These findings complement and extend earlier research demonstrating that prenatal cocaine exposure interacts with biological sex in domains related to inhibitory control, emotion regulation, antisocial behavior, and health risk behaviors during preadolescence.
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Affiliation(s)
| | - David S Bennett
- Department of Psychiatry, Drexel University College of Medicine, Philadelphia, PA, USA
| | | | - Yiping Wang
- Institute for the Study of Child Development, Department of Pediatrics, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Michael Lewis
- Institute for the Study of Child Development, Department of Pediatrics, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA.
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Richardson GA, Goldschmidt L, Larkby C, Day NL. Effects of prenatal cocaine exposure on child behavior and growth at 10 years of age. Neurotoxicol Teratol 2013; 40:1-8. [PMID: 23981277 DOI: 10.1016/j.ntt.2013.08.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2013] [Revised: 08/12/2013] [Accepted: 08/13/2013] [Indexed: 10/26/2022]
Abstract
We examined physical growth and behavioral outcomes in 226 10-year-old children who were participants in a longitudinal study of prenatal cocaine exposure (PCE), while controlling for other factors that affect development. During the first trimester, 42% of the women used cocaine, with use declining across pregnancy. At the 10-year follow-up, the caregivers were 37years old, had 12.8years of education, and 50% were African American. First trimester cocaine exposure predicted decreased weight, height, and head circumference at 10years. First trimester cocaine use also predicted maternal ratings of less sociability on the EAS Temperament Survey and more withdrawn behavior problems on the Child Behavior Checklist, more anxious/depressed behaviors on the Teacher Report Form, and more self-reported depressive symptoms on the Children's Depression Inventory. In addition, exposure to violence mediated the effect of PCE on child and teacher reports of depressive symptoms, but not of maternal reports of sociability and withdrawn behaviors. These behaviors may be precursors of later psychiatric problems.
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Affiliation(s)
- Gale A Richardson
- University of Pittsburgh School of Medicine, Western Psychiatric Institute and Clinic, 3811 O'Hara Street, Pittsburgh, PA 15213, United States.
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Richardson GA, Larkby C, Goldschmidt L, Day NL. Adolescent initiation of drug use: effects of prenatal cocaine exposure. J Am Acad Child Adolesc Psychiatry 2013; 52:37-46. [PMID: 23265632 PMCID: PMC3530145 DOI: 10.1016/j.jaac.2012.10.011] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2012] [Revised: 10/10/2012] [Accepted: 10/18/2012] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To investigate the direct effects of prenatal cocaine exposure (PCE) on adolescent drug use, while controlling for other predictors of adolescent use. METHOD Data are from a longitudinal study of PCE in which women and their offspring were assessed throughout childhood. Adolescents were interviewed at 15 years about their age at initiation of alcohol, marijuana, and tobacco. The sample consisted of 214 adolescents and their caregivers: 50% was of white ethnicity, and 50% African American. RESULTS First trimester cocaine exposure significantly predicted earlier adolescent marijuana and alcohol initiation. The hazard of marijuana and alcohol initiation among exposed adolescents was almost two times greater than among nonexposed adolescents, adjusting for other significant factors. There were no differences in tobacco initiation. Other significant predictors of adolescent drug use were family history of alcohol problems, exposure to violence, and childhood maltreatment. CONCLUSIONS Cocaine exposure during early pregnancy was associated with initiation of marijuana and alcohol use. Exposure to violence, childhood maltreatment, and familial factors also predicted adolescent initiation, but did not mitigate the effects of PCE. The combination of these risk factors has significant implications for the development of later substance use, social, and psychiatric problems.
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Bennett DS, Marini VA, Berzenski SR, Carmody DP, Lewis M. Externalizing problems in late childhood as a function of prenatal cocaine exposure and environmental risk. J Pediatr Psychol 2012; 38:296-308. [PMID: 23248347 DOI: 10.1093/jpepsy/jss117] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To examine whether prenatal cocaine exposure (PCE) predicts externalizing problems in late childhood. METHODS Externalizing problems were assessed using caregiver, teacher, and child ratings and a laboratory task when children (N = 179; 74 cocaine exposed) were aged 8-10 years. PCE, environmental risk, sex, neonatal health, other prenatal exposures, and foster care history were examined as predictors of externalizing problems. RESULTS Multiple regression analyses indicated that PCE, environmental risk, and male sex explained significant variance in externalizing problems in late childhood. Models varied by source of information. PCE predicted externalizing problems for child laboratory behavior and interacted with sex because males with PCE reported more externalizing problems. PCE did not predict caregiver or teacher ratings of externalizing problems. CONCLUSIONS The effect of PCE on externalizing problems may persist into late childhood. The findings highlight the potential importance of including child-based measures of externalizing problems in studies of prenatal exposure.
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Affiliation(s)
- David S Bennett
- Drexel University College of Medicine, Philadelphia, PA 19144, USA.
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Bada HS, Bann CM, Whitaker TM, Bauer CR, Shankaran S, LaGasse L, Lester BM, Hammond J, Higgins R. Protective factors can mitigate behavior problems after prenatal cocaine and other drug exposures. Pediatrics 2012; 130. [PMID: 23184114 PMCID: PMC3507246 DOI: 10.1542/peds.2011-3306] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND We determined the role of risk and protective factors on the trajectories of behavior problems associated with high prenatal cocaine exposure (PCE)/polydrug exposure. METHODS The Maternal Lifestyle Study enrolled 1388 children with or without PCE, assessed through age 15 years. Because most women using cocaine during pregnancy also used other substances, we analyzed for the effects of 4 categories of prenatal drug exposure: high PCE/other drugs (OD), some PCE/OD, OD/no PCE, and no PCE/no OD. Risks and protective factors at individual, family, and community levels that may be associated with behavior outcomes were entered stepwise into latent growth curve models, then replaced by cumulative risk and protective indexes, and finally by a combination of levels of risk and protective indexes. Main outcome measures were the trajectories of externalizing, internalizing, total behavior, and attention problems scores from the Child Behavior Checklist (parent). RESULTS A total of 1022 (73.6%) children had known outcomes. High PCE/OD significantly predicted externalizing, total, and attention problems when considering the balance between risk and protective indexes. Some PCE/OD predicted externalizing and attention problems. OD/no PCE also predicted behavior outcomes except for internalizing behavior. High level of protective factors was associated with declining trajectories of problem behavior scores over time, independent of drug exposure and risk index scores. CONCLUSIONS High PCE/OD is a significant risk for behavior problems in adolescence; protective factors may attenuate its detrimental effects. Clinical practice and public health policies should consider enhancing protective factors while minimizing risks to improve outcomes of drug-exposed children.
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Affiliation(s)
- Henrietta S. Bada
- Department of Pediatrics, College of Medicine, University of Kentucky, Lexington, Kentucky
| | - Carla M. Bann
- RTI International, Research Triangle Park, North Carolina
| | - Toni M. Whitaker
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Charles R. Bauer
- Department of Pediatrics, University of Miami School of Medicine, Miami, Florida
| | - Seetha Shankaran
- Department of Pediatrics, Wayne State University School of Medicine, Detroit, Michigan
| | - Linda LaGasse
- Department of Pediatrics, Brown University Medical School, Providence, Rhode Island; and
| | - Barry M. Lester
- Department of Pediatrics, Brown University Medical School, Providence, Rhode Island; and
| | - Jane Hammond
- RTI International, Research Triangle Park, North Carolina
| | - Rosemary Higgins
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Rockville, Maryland
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Abstract
Substance use among pregnant women continues to be a major public health concern, posing potential risk to their drug-exposed children as well as burdens on society. This review is intended to discuss the most recent literature regarding the association between in utero cocaine exposure and developmental and behavioral outcomes from birth through adolescence across various domains of functioning (growth, neurobiology, intelligence, academic achievement, language, executive functioning, behavioral regulation and psychopathology). In addition, methodological limitations, associated biological, sociodemographic and environmental risk factors and future directions in this area of research are discussed. Given the large number of exposed children in the child welfare system and the increased need for medical, mental health and special education services within this population, more definitively documenting associations between prenatal cocaine exposure and later child outcomes is essential in order to be able to prospectively address the many significant public health, economic and public policy implications.
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LaGasse LL, Derauf C, Smith LM, Newman E, Shah R, Neal C, Arria A, Huestis MA, DellaGrotta S, Lin H, Dansereau LM, Lester BM. Prenatal methamphetamine exposure and childhood behavior problems at 3 and 5 years of age. Pediatrics 2012; 129:681-8. [PMID: 22430455 PMCID: PMC3313637 DOI: 10.1542/peds.2011-2209] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE We evaluated behavior problems in children who were prenatally exposed to methamphetamine (MA) at ages 3 and 5 years. METHODS The Infant Development, Environment, and Lifestyle study, a prospective, longitudinal study of prenatal MA exposure and child outcome, enrolled subjects postpartum in Los Angeles, California; Honolulu, Hawaii; Des Moines, Iowa; and Tulsa, Oklahoma. Prenatal exposure was determined by maternal self-report and/or meconium results. Exposed and comparison groups were matched on race, birth weight, public health insurance, and education. Mothers in the comparison group denied use and had a negative meconium screen for amphetamines. Prenatal exposures to tobacco, alcohol, or marijuana occurred in both groups. At ages 3 and 5 years, 330 children (166 exposed and 164 comparison) were assessed for behavior problems by using the caregiver report on the Child Behavior Checklist. General linear mixed models were used to determine the effects of prenatal MA exposure, including heavy exposure (≥3 days per week), age, and the interaction of exposure and age on behavior problems with adjustment for other drugs of abuse and environmental risk factors. RESULTS MA exposure was associated with increased emotional reactivity and anxious/depressed problems at both ages and externalizing and attention-deficit/hyperactivity disorder problems by age 5 years. Heavy exposure was related to attention problems and withdrawn behavior at both ages. There were no effects of MA on the internalizing or total behavior problems scales. CONCLUSIONS This first report of behavior problems in patients as young as 3 years associated with MA exposure identifies an important public health problem. Continued follow-up can inform the development of preventive intervention programs.
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Affiliation(s)
- Linda L. LaGasse
- Brown Center for the Study of Children at Risk, Warren Alpert Medical School at Brown University and Women & Infants Hospital, Providence, Rhode Island
| | - Chris Derauf
- Department of Pediatrics, University of Hawaii, Honolulu, Hawaii
| | - Lynne M. Smith
- Department of Pediatrics, Los Angeles Biomedical Research Institute at Harbor–UCLA Medical Center and David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Elana Newman
- Department of Psychology, The University of Tulsa, Tulsa, Oklahoma
| | - Rizwan Shah
- Blank Children’s Hospital Regional Child Protection Center, Iowa Health, Des Moines, Iowa
| | - Charles Neal
- Department of Pediatrics, University of Hawaii, Honolulu, Hawaii
| | - Amelia Arria
- Family Science Department, Center on Young Adult Health and Development, University of Maryland School of Public Health, College Park, Maryland; and
| | - Marilyn A. Huestis
- Intramural Research Program, National Institute on Drug Abuse, National Institutes of Health, Baltimore, Maryland
| | - Sheri DellaGrotta
- Brown Center for the Study of Children at Risk, Warren Alpert Medical School at Brown University and Women & Infants Hospital, Providence, Rhode Island
| | - Hai Lin
- Brown Center for the Study of Children at Risk, Warren Alpert Medical School at Brown University and Women & Infants Hospital, Providence, Rhode Island
| | - Lynne M. Dansereau
- Brown Center for the Study of Children at Risk, Warren Alpert Medical School at Brown University and Women & Infants Hospital, Providence, Rhode Island
| | - Barry M. Lester
- Brown Center for the Study of Children at Risk, Warren Alpert Medical School at Brown University and Women & Infants Hospital, Providence, Rhode Island
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