1
|
Singer LT, Powers G, Kim JY, Minnes S, Min MO. Cognitive and functional outcomes at age 21 after prenatal cocaine/polydrug exposure and foster/adoptive care. Neurotoxicol Teratol 2023; 96:107151. [PMID: 36623610 PMCID: PMC9992024 DOI: 10.1016/j.ntt.2023.107151] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 12/28/2022] [Accepted: 12/29/2022] [Indexed: 01/09/2023]
Abstract
OBJECTIVE Prenatal cocaine exposure (PCE) has been linked to specific cognitive deficits and behavioral outcomes through early adolescence but there is little information on adult outcomes nor on the relationship of environmental interventions, such as foster/adoptive care, to outcomes. METHODS At 21 years, data were available on 325 young adults, [163 PCE and 162 non-exposed (NCE)], primarily African-American, with low SES, who were followed from birth in a prospective longitudinal cohort study. Participants were administered the Wechsler Abbreviated Scale of Intelligence (WASI-II) and surveyed regarding high school completion, problematic substance use, and incarceration/probation history. In the PCE group, 32 remained in non-kinship foster/adoptive care (PCE/FA) from early in life (< 4 years) to 17 years. Group differences were examined through t-tests, MANOVA/ MANCOVA with post-hoc analyses, comparing outcomes and environmental correlates of young adults with PCE vs. NCE, as well as outcomes of PCE young adults in non-kinship foster/adoptive care (PCE/ FA) vs. PCE in birth/kinship care and NCE young adults. RESULTS At 21 years, young adults with PCE had lower mean Full Scale (83.7 ± 10.4 vs. 87.3 ± 12.5, p < .01) and Perceptual Reasoning IQs (87.3 ± 11.5 vs. 91.4 ± 13.9, (p < .02), lower high school completion rates (75% vs. 86%, p < .02), and were marginally more likely to have been on probation than NCE young adults, but did not differ in Verbal IQ, self-report of problematic substance use or incarceration. Young adults with PCE in F/A had similar lower IQ scores but had better verbal skills and high school graduation rates that did not differ from NCE young adults (80.6 vs 86.2%, p > .05). They had higher drug exposure at birth and more experiences of maltreatment (p's < 0.05) but their home environment quality was better and lead levels lower (p's < 0.05) than those of young adults with PCE in birth/kinship care. CONCLUSIONS Young adults with PCE had lower Perceptual Reasoning and Full-Scale IQ scores, independent of caregiving placement, compared to non-exposed young adults. Young adults with PCE placed in non-kinship foster/adoptive care had lower lead levels, more stimulating home environments, better vocabulary skills and were more likely to graduate from high school than those in birth/kinship care,but were not different in their self-report of problematic substance use, or experiences of incarceration or probation. Our data suggest that some cognitive deficits observed in young adults with PCE may be biologically based, but that some functional outcomes can be modified through environmental interventions. Our data also reflect the complexity of disentangling the effects of teratologic exposures on long term outcomes across a variety of domains and the need for studies of children in the foster care system.
Collapse
Affiliation(s)
- Lynn T Singer
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, 1090 Euclid Avenue, Cleveland, OH 44106, United States.
| | - Gregory Powers
- Jack, Joseph and Morton Mandel School of Applied Social Sciences, 11235 Bellflower Road, Cleveland, OH, United States.
| | - June-Yung Kim
- Department of Social Work, University of North Dakota, Gillette Hall Room 302, 225 Centennial Dr. Stop 7135, Grand Forks, ND 58202-7135, United States.
| | - Sonia Minnes
- Jack, Joseph and Morton Mandel School of Applied Social Sciences, 11235 Bellflower Road, Cleveland, OH, United States.
| | - Meeyoung O Min
- College of Social Work, University of Utah, 201 Presidents Circle, Salt Lake City, UT 84112, United States.
| |
Collapse
|
2
|
Ikeda AS, Knopik VS, Bidwell LC, Parade SH, Goodman SH, Emory EK, Palmer RHC. A Review of Associations between Externalizing Behaviors and Prenatal Cannabis Exposure: Limitations & Future Directions. TOXICS 2022; 10:toxics10010017. [PMID: 35051059 PMCID: PMC8779620 DOI: 10.3390/toxics10010017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 12/13/2021] [Accepted: 12/28/2021] [Indexed: 02/04/2023]
Abstract
In utero cannabis exposure can disrupt fetal development and increase risk for various behavioral disruptions, including hyperactivity, inattention, delinquent behaviors, and later substance abuse, among others. This review summarizes the findings from contemporary investigations linking prenatal cannabis exposure to the development of psychopathology and identifies the limitations within the literature, which constrain our interpretations and generalizability. These limitations include a lack of genetic/familial control for confounding and limited data examining real world products, the full range of cannabinoids, and motives for use specifically in pregnant women. Taken together, our review reveals the need to continue to improve upon study designs in order to allow researchers to accurately draw conclusions about the development of behavioral consequences of prenatal cannabis exposure. Findings from such studies would inform policy and practices regarding cannabis use during pregnancy and move the field toward developing a comprehensive teratogenic profile of cannabis similar to what is characterized in the prenatal alcohol and tobacco literature.
Collapse
Affiliation(s)
- Ami S. Ikeda
- Behavioral Genetics of Addiction Laboratory, Emory University, Atlanta, GA 30322, USA
- Department of Psychology, Emory University, Atlanta, GA 30322, USA; (S.H.G.); (E.K.E.)
- Correspondence: (A.S.I.); (R.H.C.P.)
| | - Valerie S. Knopik
- Department of Human Development and Family Studies, College of Health and Human Sciences, Purdue University, West Lafayette, IN 47907, USA;
| | - L. Cinnamon Bidwell
- Institute of Cognitive Science, University of Colorado Boulder, Boulder, CO 80309, USA;
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, CO 80309, USA
| | - Stephanie H. Parade
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI 02903, USA;
- Bradley/Hasbro Children’s Research Center, E.P. Bradley Hospital, East Providence, RI 02915, USA
| | - Sherryl H. Goodman
- Department of Psychology, Emory University, Atlanta, GA 30322, USA; (S.H.G.); (E.K.E.)
| | - Eugene K. Emory
- Department of Psychology, Emory University, Atlanta, GA 30322, USA; (S.H.G.); (E.K.E.)
| | - Rohan H. C. Palmer
- Behavioral Genetics of Addiction Laboratory, Emory University, Atlanta, GA 30322, USA
- Department of Psychology, Emory University, Atlanta, GA 30322, USA; (S.H.G.); (E.K.E.)
- Correspondence: (A.S.I.); (R.H.C.P.)
| |
Collapse
|
3
|
Wong RS, Tung KTS, Cheng AWF, Shiu YK, Wong WHS, Tso WWY, Ho MSP, Chan KL, Ho FKW, Lo CKM, Chow CB, Ip P. Disentangling the Effects of Exposure to Maternal Substance Misuse and Physical Abuse and Neglect on Child Behavioral Problems. JOURNAL OF INTERPERSONAL VIOLENCE 2021; 36:8435-8455. [PMID: 31130045 DOI: 10.1177/0886260519849661] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
There is inconsistent evidence on the association between prenatal substance exposure and child behavioral problems. Children affected by maternal substance misuse are vulnerable to physical abuse and neglect. Few studies have examined factors contributing to internalizing and externalizing problems in these children. This study, with a focus on children with prenatal substance exposure, investigated whether family characteristics (the duration of maternal substance misuse postpartum or the existence of a sibling) moderated the association between adverse exposure (physical abuse or neglect) and behavior (internalizing or externalizing problems). We recruited 54 Hong Kong Chinese mothers with registered records of substance misuse during pregnancy and their children (2-9 years). Mothers completed questionnaires on drug use patterns during pregnancy and postpartum, abusive and neglectful parenting behaviors in the preceding year, and children's current behavioral problems. Moderated regression analyses tested whether abusive and neglectful parenting behavior interacted with family characteristics to affect child behavioral problems. The existence of a sibling moderated the relationship between neglect experience and internalizing problems, with a positive relationship observed only among single children (adjusted B [95% confidence interval] = 3.70 [0.98, 6.41], p = .012). The duration of maternal substance misuse postpartum moderated the relationship between physical abuse experience and externalizing problems, with a positive relationship observed only among children of mothers abusing substances beyond the child's infancy period (adjusted B [95% confidence interval] = 6.86 [2.34, 11.38], p = .008). The results show that the impact of physical abuse and neglect experiences depend on the type of behavior assessed and family and child characteristics. Positive sibling relationship and early detoxification in the mother can foster healthy behavioral development for children exposed prenatally to maternal substance misuse.
Collapse
Affiliation(s)
- Rosa S Wong
- The University of Hong Kong, Pokfulam, Hong Kong
| | | | | | | | | | | | | | - Ko Ling Chan
- The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | | | - Camilla K M Lo
- The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | | | - Patrick Ip
- The University of Hong Kong, Pokfulam, Hong Kong
| |
Collapse
|
4
|
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: 21] [Impact Index Per Article: 4.2] [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.
Collapse
|
5
|
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.
Collapse
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.
| |
Collapse
|
6
|
Richardson MA, Grant-Knight W, Beeghly M, Rose-Jacobs R, Chen CA, Appugliese DP, Cabral HJ, Liebschutz JM, Frank DA. Psychological Distress Among School-Aged Children with and Without Intrauterine Cocaine Exposure: Perinatal Versus Contextual Effects. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2016; 44:547-60. [PMID: 26194603 PMCID: PMC4854523 DOI: 10.1007/s10802-015-0052-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Whether intrauterine cocaine exposure (IUCE) explains unique variance in psychiatric functioning among school age children, even after controlling for other biological and social risk factors, has not been fully delineated. As part of a longitudinal birth cohort study of children with and without IUCE, we conducted and analyzed data based on structured clinical interviews with 105 children (57% male) and their caregivers when the child was approximately 8.5 years old; 47% of the children had experienced IUCE. Interviews included past and current major psychological disorders and sub-threshold mental health symptoms. Potential covariates were ascertained by interviews of birth mothers and other caregivers from shortly after the child's birth until the 8.5-year visit. More than one-third of children met DSM-IV criteria for one or more mood, anxiety, attention deficit, or disruptive behavior disorders. IUCE was not significantly associated with children's history of psychological distress, in either bivariate or multiple logistic regressions. In contrast, birth mothers' acknowledgement of greater psychiatric distress at baseline and higher levels of alcohol consumption during pregnancy, and at 8.5 years caregivers' reports of their own psychological distress, and children's lower IQ were predictors of higher rates of psychological morbidity. Findings are consistent with prior reports suggesting that, regardless of IUCE status, children from low-income, urban backgrounds are at heightened risk for psychological distress. Results underscore the need for closer monitoring of the mental health of children living in low-income households, with or without intrauterine substance exposures, to facilitate access to appropriate services.
Collapse
Affiliation(s)
- Mark A Richardson
- Division of Psychiatry, Boston University School of Medicine, Boston, MA, USA.
- Department of Psychological and Brain Sciences, Boston University, 648 Beacon Street, 2nd floor, Boston, MA, 02215, USA.
| | | | - Marjorie Beeghly
- Department of Psychology, Wayne State University, Detroit, MI, USA
- Division of Developmental Medicine, Boston Children's Hospital, Boston, MA, USA
| | - Ruth Rose-Jacobs
- Division of Developmental and Behavioral Medicine, Boston Medical Center, Boston, MA, USA
- Department of Pediatrics, Boston University School of Medicine, Boston, MA, USA
| | - Clara A Chen
- Data Coordinating Center, Boston University School of Public Health, Boston, MA, USA
| | - Danielle P Appugliese
- Data Coordinating Center, Boston University School of Public Health, Boston, MA, USA
| | - Howard J Cabral
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Jane M Liebschutz
- General Internal Medicine, Department of Medicine, Boston Medical Center, Boston, MA, USA
| | - Deborah A Frank
- Division of Developmental and Behavioral Medicine, Boston Medical Center, Boston, MA, USA
- Department of Pediatrics, Boston University School of Medicine, Boston, MA, USA
| |
Collapse
|
7
|
Abstract
This was a prospective longitudinal multisite study of the effects of prenatal cocaine and/or opiate exposure on temperament in 4-month-olds of the Maternal Lifestyle Study (N = 958: 366 cocaine exposed, 37 opiate exposed, 33 exposed to both drugs, 522 matched comparison). The study evaluated positivity and negativity during The Behavior Assessment of Infant Temperament (Garcia Coll et al., 1988). Parents rated temperament (Infant Behavior Questionnaire; Rothbart, 1981). Cocaine-exposed infants showed less positivity overall, mainly during activity and threshold items, more negativity during sociability items, and less negativity during irritability and threshold items. Latent profile analysis indicated individual temperament patterns were best described by three groups: low/moderate overall reactivity, high social negative reactivity, and high nonsocial negative reactivity. Infants with heavy cocaine exposure were more likely in high social negative reactivity profile, were less negative during threshold items, and required longer soothing intervention. Cocaine- and opiate-exposed infants scored lower on Infant Behavior Questionnaire smiling and laughter and duration of orienting scales. Opiate-exposed infants were rated as less respondent to soothing. By including a multitask measure of temperament we were able to show context-specific behavioral dysregulation in prenatally cocaine-exposed infants. The findings indicate flatter temperament may be specific to nonsocial contexts, whereas social interactions may be more distressing for cocaine-exposed infants.
Collapse
|
8
|
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: 37] [Impact Index Per Article: 4.1] [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.
Collapse
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
| |
Collapse
|
9
|
Prenatal cocaine exposure: the role of cumulative environmental risk and maternal harshness in the development of child internalizing behavior problems in kindergarten. Neurotoxicol Teratol 2014; 44:1-10. [PMID: 24803425 DOI: 10.1016/j.ntt.2014.04.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Revised: 04/21/2014] [Accepted: 04/23/2014] [Indexed: 12/16/2022]
Abstract
This study examined the associations between prenatal exposure to cocaine and other substances and child internalizing behavior problems at kindergarten. We investigated whether maternal harshness or cumulative environmental risk mediated or moderated this association. Participants consisted of 216 (116 cocaine exposed, 100 non-cocaine exposed) mother-infant dyads participating in an ongoing longitudinal study of prenatal cocaine exposure. Results indicated that, as hypothesized, maternal harshness moderated the association between prenatal cocaine exposure to child internalizing in kindergarten such that prenatal cocaine exposure increased risk for internalizing problems at high levels of maternal harshness from 7 to 36months and decreased risk at low levels of harshness. Contrary to hypothesis, the association between prenatal cocaine exposure and child internalizing in kindergarten was not mediated by maternal harshness or cumulative environmental risk. However, cumulative environmental risk (from 1month of child age to kindergarten) was predictive of child internalizing behavior problems at kindergarten. Results have implications for parenting interventions that may be targeted toward reducing maternal harshness in high risk samples characterized by maternal substance use in pregnancy.
Collapse
|
10
|
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: 36] [Impact Index Per Article: 3.6] [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.
Collapse
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
| |
Collapse
|
11
|
Finger B, Schuetze P, Eiden RD. Behavior problems among cocaine exposed children: role of physiological regulation and parenting. Neurotoxicol Teratol 2014; 42:51-9. [PMID: 24480789 PMCID: PMC4163043 DOI: 10.1016/j.ntt.2014.01.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2012] [Revised: 12/03/2013] [Accepted: 01/02/2014] [Indexed: 11/27/2022]
Abstract
This study examined interrelations between prenatal cocaine exposure, child autonomic regulation, parenting behavior and child sex on parent-reported behavior problems at 36 months of age. We hypothesized that respiratory sinus arrhythmia (RSA) at 13 months of age would mediate the relation between cocaine exposure and behavior problems. We also hypothesized that child sex, maternal negative affect, and maternal sensitivity observed at 13 months of age would moderate the relation between RSA and behavior problems. Results revealed that cocaine exposure predicted low baseline RSA and low RSA withdrawal during a negative affect task. Low baseline RSA, in turn, predicted fewer behavior problems offering support for an indirect association between cocaine exposure and behavior problems. The association between baseline RSA and behavior problems was further moderated by maternal negative affect such that high baseline RSA was more strongly related to behavior problems under conditions of high compared to low maternal negative affect. Results also revealed a near significant trend for baseline RSA to be more strongly related to behavior problems among boys than girls. These findings highlight several possible pathways toward behavior problems among cocaine exposed children.
Collapse
Affiliation(s)
- Brent Finger
- Montana State University Billings, 1500 University Drive, Billings, MT 59101, United States.
| | - Pamela Schuetze
- Psychology Department, Buffalo State College, 1300 Elmwood Avenue, Buffalo, NY 14222, United States
| | - Rina D Eiden
- Montana State University Billings, 1500 University Drive, Billings, MT 59101, United States; Research Institute on Addictions, State University of New York at Buffalo, 1021 Main Street, Buffalo, NY 14203, United States
| |
Collapse
|
12
|
Child behavior problems among cocaine-exposed toddlers: indirect and interactive effects. Dev Psychopathol 2014; 23:539-50. [PMID: 23786694 DOI: 10.1017/s0954579411000058] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
This study examined the role of maternal psychopathology and maternal warmth as mediators of the association between prenatal cocaine and other substance exposure and toddler behavior problems. It was also hypothesized that infant cortisol reactivity and environmental risk may moderate these associations. Participants were 220 caregiver-infant dyads (119 cocaine exposed, 101 not cocaine exposed; 49% boys). Mother-infant dyads were recruited at delivery with assessments at 4-8 weeks and 7, 13, and 18 months of child ages. Results yielded no direct associations between prenatal cocaine/other substance exposure and toddler behavior problems, but significant indirect associations between prenatal cigarette/alcohol exposure and toddler behavior problems at 18 months. With regard to moderation, results indicated an indirect association between prenatal cocaine exposure and toddler behavior problems via lower maternal warmth for children with higher, but not lower, cortisol reactivity at 7 months. Results suggest potential pathways to toddler behavior problems among children at high biological risk.
Collapse
|
13
|
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: 28] [Impact Index Per Article: 2.5] [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.
Collapse
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.
| | | | | | | |
Collapse
|
14
|
Abstract
Prenatal substance abuse continues to be a significant problem in this country and poses important health risks for the developing fetus. The primary care pediatrician's role in addressing prenatal substance exposure includes prevention, identification of exposure, recognition of medical issues for the exposed newborn infant, protection of the infant, and follow-up of the exposed infant. This report will provide information for the most common drugs involved in prenatal exposure: nicotine, alcohol, marijuana, opiates, cocaine, and methamphetamine.
Collapse
|
15
|
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: 21] [Impact Index Per Article: 1.8] [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.
Collapse
Affiliation(s)
- David S Bennett
- Drexel University College of Medicine, Philadelphia, PA 19144, USA.
| | | | | | | | | |
Collapse
|
16
|
Liles BD, Newman E, LaGasse LL, Derauf C, Shah R, Smith LM, Arria AM, Huestis MA, Haning W, Strauss A, DellaGrotta S, Dansereau LM, Neal C, Lester BM. Perceived child behavior problems, parenting stress, and maternal depressive symptoms among prenatal methamphetamine users. Child Psychiatry Hum Dev 2012; 43:943-57. [PMID: 22552952 PMCID: PMC3717339 DOI: 10.1007/s10578-012-0305-2] [Citation(s) in RCA: 27] [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] [Indexed: 10/28/2022]
Abstract
The present study was designed to examine parenting stress, maternal depressive symptoms, and perceived child behavior problems among mothers who used methamphetamine (MA) during pregnancy. Participants were a subsample (n = 212; 75 exposed, 137 comparison) of biological mothers who had continuous custody of their child from birth to 36 months. The subsample was drawn from a larger, ongoing longitudinal study on the effects of prenatal methamphetamine exposure (n = 412; 204 exposed, 208 comparison) (Arria et al in Matern Child Health J 10:293-302 2006). Mothers who used MA during pregnancy reported more parenting stress and more depressive symptoms than a matched comparison group. There were no differences between groups on perceived child behavior problems. In a hierarchical linear model, depressive symptoms, and perceived child behavior problems, but not MA exposure, were statistically significant predictors of parenting stress. Screening for potential parenting problems among mothers with a history of substance abuse is warranted. Parenting interventions targeting depressive symptoms, parenting stress, and child behavior problems are needed for this population.
Collapse
Affiliation(s)
- Brandi D. Liles
- Department of Psychology, University of Tulsa, 800 South Tucker Drive, Tulsa, OK 74104-3189, USA
| | - Elana Newman
- Department of Psychology, University of Tulsa, 800 South Tucker Drive, Tulsa, OK 74104-3189, USA
| | - Linda L. LaGasse
- Center for the Study of Children at Risk, Women and Infant’s Hospital, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Chris Derauf
- Department of Pediatric & Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
| | - Rizwan Shah
- Blank Hospital, Regional Child Protection Center-Children-Iowa Health, Des Moines, IA, USA
| | - Lynne M. Smith
- LABioMed Institute at Harbor-UCLA Medical Center, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Amelia M. Arria
- Center on Young Adult Health and Development, University of Maryland School of Public Health, College Park, MD, USA
| | - Marilyn A. Huestis
- Intramural Research Program, National Institute on Drug Abuse, National Institutes of Health, Baltimore, MD, USA
| | - William Haning
- John A. Burns School of Medicine, University of Hawaii, Honolulu, HI, USA
| | - Arthur Strauss
- Miller Children’s Hospital at Long Beach (MCHLB), Long Beach, CA, USA
| | - Sheri DellaGrotta
- Center for the Study of Children at Risk, Women and Infant’s Hospital, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Lynne M. Dansereau
- Center for the Study of Children at Risk, Women and Infant’s Hospital, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Charles Neal
- John A. Burns School of Medicine, University of Hawaii, Honolulu, HI, USA
| | - Barry M. Lester
- Center for the Study of Children at Risk, Women and Infant’s Hospital, Warren Alpert Medical School of Brown University, Providence, RI, USA
| |
Collapse
|
17
|
Accornero VH, Anthony JC, Morrow CE, Xue L, Mansoor E, Johnson AL, McCoy CB, Bandstra ES. Estimated effect of prenatal cocaine exposure on examiner-rated behavior at age 7 years. Neurotoxicol Teratol 2011; 33:370-8. [PMID: 21640292 DOI: 10.1016/j.ntt.2011.02.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2009] [Revised: 02/21/2011] [Accepted: 02/24/2011] [Indexed: 01/24/2023]
Abstract
UNLABELLED Prenatal cocaine exposure has been linked to increased child behavior difficulties in some studies but not others. OBJECTIVE The primary aim was to estimate the relationship between in utero cocaine exposure and child behavioral functioning at age 7 years with ratings made by blinded examiners during a structured testing session. A second aim was to examine whether caregiver drug use and psychological problems might mediate suspected relationships between prenatal cocaine exposure and aspects of examiner-rated behavior. METHODS 407 children (212 cocaine-exposed, 195 non-exposed) participating in the longitudinal Miami Prenatal Cocaine Study (MPCS) were rated with regard to their behavior during a neuropsychological assessment conducted at age 7 years. Raters were trained research psychometricians blinded to drug exposure status. Individual behavioral items were summarized and the cocaine-behavior relationship was estimated within the context of latent variable modeling, using Mplus software. RESULTS Two latent variables, Behavioral Regulation and Sociability, were derived via exploratory latent structure analysis with promax rotation. Prenatal cocaine exposure, statistically controlling for child sex, test age, and prenatal exposure to alcohol, tobacco, and marijuana, was associated with Behavioral Regulation (estimated slope ß=-0.25; 95% CI=-0.48, -0.02; p=0.04) but not Sociability (estimated slope ß=-0.03; 95% CI=-0.26, 0.20; p=0.79). Neither postnatal drug use by caregivers nor the severity of their psychological problems at age 5 follow-up predicted levels of child Behavioral Regulation or Sociability at age 7 years (p>0.10). CONCLUSIONS Examiner ratings of child behavior at age 7 revealed less optimal behavioral regulation for prenatally cocaine-exposed compared to non-exposed children, in contrast with what had been previously found from parent-report data. This evidence highlights the potential value of trained observers in assessing behavioral outcomes of children exposed in utero to drugs and other toxicants.
Collapse
Affiliation(s)
- Veronica H Accornero
- University of Miami Miller School of Medicine, Department of Pediatrics, Miami, FL 33101, United States.
| | | | | | | | | | | | | | | |
Collapse
|
18
|
Are there effects of intrauterine cocaine exposure on delinquency during early adolescence? A preliminary report. J Dev Behav Pediatr 2011; 32:393-401. [PMID: 21558951 PMCID: PMC3129616 DOI: 10.1097/dbp.0b013e318218d9f2] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To ascertain whether level of intrauterine cocaine exposure (IUCE) is associated with early adolescent delinquent behavior, after accounting for prenatal exposures to other psychoactive substances and relevant psychosocial factors. METHODS Ninety-three early adolescents (12.5-14.5 years old) participating since birth in a longitudinal study of IUCE reported delinquent acts via an audio computer-assisted self-interview. Level of IUCE and exposure to cigarettes, alcohol, and marijuana were determined by maternal report, maternal and infant urine assays, and infant meconium assays at birth. Participants reported their exposure to violence on the Violence Exposure Scale for Children-Revised at ages 8.5, 9.5, and 11 years and during early adolescence, and the strictness of supervision by their caregivers during early adolescence. RESULTS Of the 93 participants, 24 (26%) reported ≥ 3 delinquent behaviors during early adolescence. In the final multivariate model (including level of IUCE and cigarette exposure, childhood exposure to violence, and caregiver strictness/supervision) ≥ 3 delinquent behaviors were not significantly associated with level of IUCE but were significantly associated with intrauterine exposure to half a pack or more of cigarettes per day and higher levels of childhood exposure to violence, effects substantially unchanged after control for early adolescent violence exposure. CONCLUSIONS In this cohort, prospectively ascertained prenatal exposure to cigarettes and childhood exposure to violence are associated with self-reported delinquent behaviors during early adolescence. Contrary to initial popular predictions, intrauterine cocaine is not a strong predictor of adolescent delinquent behaviors in this cohort.
Collapse
|
19
|
Whitaker TM, Bada HS, Bann CM, Shankaran S, LaGasse L, Lester BM, Bauer CR, Hammond J, Higgins R. Serial pediatric symptom checklist screening in children with prenatal drug exposure. J Dev Behav Pediatr 2011; 32:206-15. [PMID: 21200328 PMCID: PMC3069136 DOI: 10.1097/dbp.0b013e318208ee3c] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To examine screening results obtained by serial annual behavioral assessment of children with prenatal drug exposure. METHOD The Maternal Lifestyle Study enrolled children with prenatal cocaine exposure (PCE) at birth for longitudinal assessments of developmental, behavioral, and health outcomes. At 8, 9, 10, 11, and 12 years of age, caregivers rated participants on the Pediatric Symptom Checklist (PSC). Serial PSC results were compared with an established broad-based behavioral measure at 9, 11, and 13 years. PSC results were analyzed for 1081 children who had at least 2 annual screens during the 5-year time span. Most subjects (87%) had 4 or more annual screens rated by the same caregiver (80%). PSC scores (and Positive screens) over time were compared at different time points for those with and without PCE. Covariates, including demographic factors and exposures to certain other substances, were controlled. RESULTS Children with PCE had significantly higher scores overall, with more Positive screens for behavior problems than children without PCE. Children with PCE had more externalizing behavior problems. Children exposed to tobacco prenatally and postnatally also showed higher PSC scores. Over time, PSC scores differed slightly from the 8-year scores, without clear directional trend. Earlier PSC results predicted later behavioral outcomes. CONCLUSION Findings of increased total PSC scores and Positive PSC screens for behavioral concerns in this group of children with prenatal substance exposure support the growing body of evidence that additional attention to identification of mental health problems may be warranted in this high-risk group.
Collapse
Affiliation(s)
- Toni M Whitaker
- Department of Pediatrics, Boling Center for Developmental Disabilities, University of Tennessee College of Medicine, Memphis, TN 38105, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|
20
|
Greenwald MK, Chiodo LM, Hannigan JH, Sokol RJ, Janisse J, Delaney-Black V. Teens with heavy prenatal cocaine exposure respond to experimental social provocation with escape not aggression. Neurotoxicol Teratol 2010; 33:198-204. [PMID: 20600841 DOI: 10.1016/j.ntt.2010.06.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2009] [Revised: 02/19/2010] [Accepted: 06/20/2010] [Indexed: 10/19/2022]
Abstract
Preclinical data show that, compared to no exposure, prenatal cocaine exposure (PCE) has age-dependent effects on social interaction and aggression. The aim of this clinical study was to determine how heavy/persistent PCE--after controlling for other prenatal drug exposures, sex and postnatal factors--predicts behavioral sensitivity to provocation (i.e., reactive aggression) using a well-validated human laboratory model of aggression. African American teens (mean=14.2 years old) with histories of heavy/persistent PCE (maternal cocaine use ≥ 2 times/week during pregnancy, or positive maternal or infant urine/meconium test at delivery; n=86) or none/some exposure (NON: maternal cocaine use < 2 times/week during pregnancy; n=330) completed the Point Subtraction Aggression Paradigm. In this task, teens competed in a computer game against a fictitious opponent. There were three possible responses: (a) earn points, to exchange for money later; or (b) "aggress" against the fictitious opponent by subtracting their points; or (c) escape temporarily from point subtraction perpetrated by the fictitious opponent. The PCE group responded significantly more frequently on the escape option than the NON group, but did not differ in aggressive or money-earning responses. These data indicate that PCE-teens provoked with a social stressor exhibit a behavioral preference for escape (negative reinforcement) than for aggressive (retaliatory) or appetitive (point- or money-reinforced) responses. These findings are consistent with preclinical data showing that social provocation of adolescent or young adult offspring after PCE is associated with greater escape behavior, inferring greater submission, social withdrawal, or anxiety, as opposed to aggressive behavior.
Collapse
Affiliation(s)
- M K Greenwald
- Department of Psychiatry & Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, MI, USA.
| | | | | | | | | | | |
Collapse
|
21
|
Minnes S, Singer LT, Kirchner HL, Short E, Lewis B, Satayathum S, Queh D. The effects of prenatal cocaine exposure on problem behavior in children 4-10 years. Neurotoxicol Teratol 2010; 32:443-51. [PMID: 20227491 DOI: 10.1016/j.ntt.2010.03.005] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2010] [Accepted: 03/05/2010] [Indexed: 11/25/2022]
Abstract
BACKGROUND Children prenatally exposed to cocaine may be at increased risk for behavioral problems due to disruptions of monaminergically regulated arousal systems and/or environmental conditions. OBJECTIVE To assess behavioral outcomes of cocaine (CE) and non-cocaine-exposed (NCE) children, 4 through 10 years old, controlling for other prenatal drug exposures and environmental factors. METHODS Low socioeconomic status (SES), primarily African American children (n=381 (193 (CE), 188 (NCE)) were recruited from birth. Generalized Estimating Equation (GEE) analyses were used to assess the predictive relationship of prenatal cocaine exposure to odds of caregiver reported clinically elevated behavioral problems at 4, 6, 9 and 10y ears of age, controlling for confounders. RESULTS Prenatal cocaine exposure was associated with increased rates of caregiver reported delinquency (OR=1.93, CI: 1.09-3.42, p<0.02). A significant prenatal cocaine exposure by sex interaction was found for delinquency indicating that only females were affected (OR=3.57, CI: 1.67-7.60, p<0.001). There was no effect of cocaine on increased odds of other CBCL subscales. Higher prenatal tobacco exposure was associated with increased odds of externalizing symptoms at 4, 9 and 10 years of age. For CE children, those in foster or adoptive care were rated as having more behavior problems than those in biologic mother or relative care. Greater caregiver psychological distress was associated with increased behavioral problems. There were no independent effects of elevated blood lead level on increased behavior problems after control for prenatal drug exposure and other environmental conditions. CONCLUSION Prenatal cocaine and tobacco exposure were associated with greater externalizing behavior after control for multiple prenatal drug exposures, other environmental and caregiving factors and lead exposure from 4 through 10 years of age. Greater caregiver psychological distress negatively affected caregiver ratings of all CBCL domains. Since cocaine and tobacco use during pregnancy and maternal psychological distress have the potential to be altered through prenatal educational, drug treatment and mental health interventions, they warrant attention in efforts to reduce rates of problem behaviors in children.
Collapse
Affiliation(s)
- Sonia Minnes
- Case Western Reserve University, The Mandel School of Applied Social Science, Cleveland, Ohio 44106, USA.
| | | | | | | | | | | | | |
Collapse
|
22
|
Morrow CE, Xue L, Manjunath S, Culbertson JC, Accornero VH, Anthony JC, Bandstra ES. Estimated Risk of Developing Selected DSM-IV Disorders Among 5-Year-Old Children with Prenatal Cocaine Exposure. JOURNAL OF CHILD AND FAMILY STUDIES 2009; 18:356-364. [PMID: 27761099 PMCID: PMC5067100 DOI: 10.1007/s10826-008-9238-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
This study estimated childhood risk of developing selected DSM-IV Disorders, including Attention-Deficit Hyperactivity Disorder (ADHD), Oppositional Defiant Disorder (ODD), and Separation Anxiety Disorder (SAD), in children with prenatal cocaine exposure (PCE). Children were enrolled prospectively at birth (n=476) with prenatal drug exposures documented by maternal interview, urine and meconium assays. Study participants included 400 African-American children from the birth cohort, 208 cocaine-exposed (CE) and 192 non-cocaine-exposed (NCE) who attended a 5-year follow-up assessment and whose caregiver completed the Computerized Diagnostic Interview Schedule for Children. Under a generalized linear model (logistic link), Fisher's exact methods were used to estimate the CE-associated relative risk (RR) of these disorders. Results indicated a modest but statistically robust elevation of ADHD risk associated with increasing levels of PCE (p<0.05). Binary comparison of CE versus NCE children indicated no CE-associated RR. Estimated cumulative incidence proportions among CE children were 2.9% for ADHD (vs 3.1% NCE); 1.4% for SAD (vs 1.6% NCE); and 4.3% for ODD (vs 6.8% NCE). Findings offer suggestive evidence of increased risk of ADHD (but not ODD or SAD) in relation to an increasing gradient of PCE during gestation.
Collapse
Affiliation(s)
- Connie E. Morrow
- Department of Pediatrics, Miller School of Medicine, University of Miami, Miami, Florida
| | - Lihua Xue
- Department of Pediatrics, Miller School of Medicine, University of Miami, Miami, Florida
| | - Sudha Manjunath
- Department of Psychiatry and Behavioral Sciences, Miller School of Medicine, University of Miami, Miami, Florida
| | - Jan C. Culbertson
- University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Veronica H. Accornero
- Department of Pediatrics, Miller School of Medicine, University of Miami, Miami, Florida
| | - James C. Anthony
- Department of Epidemiology, Michigan State University College of Human Medicine, East Lansing, Michigan
| | - Emmalee S. Bandstra
- Department of Pediatrics, Miller School of Medicine, University of Miami, Miami, Florida
| |
Collapse
|
23
|
Kurtz PF, Chin MD, Rush KS, Dixon DR. Treatment of challenging behavior exhibited by children with prenatal drug exposure. RESEARCH IN DEVELOPMENTAL DISABILITIES 2008; 29:582-594. [PMID: 18037269 DOI: 10.1016/j.ridd.2007.05.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2007] [Revised: 05/25/2007] [Accepted: 05/30/2007] [Indexed: 05/25/2023]
Abstract
A large body of literature exists describing the harmful effects of prenatal drug exposure on infant and child development. However, there is a paucity of research examining strategies to ameliorate sequelae such as externalizing behavior problems. In the present study, functional analysis procedures were used to assess challenging behavior exhibited by two children who were prenatally exposed to drugs of abuse. Results for both children indicated that challenging behavior was maintained by access to positive reinforcement (adult attention and tangible items). For one child, challenging behavior was also maintained by negative reinforcement (escape from activities of daily living). Function-based interventions were effective in reducing challenging behavior for both children. Implications for utilizing methods of applied behavior analysis in research with children with prenatal drug exposure are discussed.
Collapse
Affiliation(s)
- Patricia F Kurtz
- Kennedy Krieger Institute, The Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA.
| | | | | | | |
Collapse
|
24
|
Dixon DR, Kurtz PF, Chin MD. A systematic review of challenging behaviors in children exposed prenatally to substances of abuse. RESEARCH IN DEVELOPMENTAL DISABILITIES 2008; 29:483-502. [PMID: 18037268 DOI: 10.1016/j.ridd.2007.05.006] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2007] [Revised: 05/25/2007] [Accepted: 05/30/2007] [Indexed: 05/25/2023]
Abstract
A review of the existing literature on the occurrence of challenging behavior among children with prenatal drug exposure was conducted. While a large number of studies were identified that evaluated various outcomes of prenatal drug exposure, only 37 were found that directly evaluated challenging behaviors. Of the 37 studies, 23 focused on prenatal cocaine exposure, and 14 focused on prenatal alcohol exposure; most studies relied on broadband measures such as the CBCL for the assessment of challenging behavior. Among the 37 studies, a clear role for the postnatal environment on developing challenging behaviors was evident; however, prenatal alcohol exposure showed a much clearer independent effect upon challenging behaviors than was noted in the prenatal cocaine studies. Additionally, only 3 of the 37 studies addressed interventions for challenging behaviors, each of which showed an improvement in child behavior or parent-child interactions. As researchers have continued to show the importance of the postnatal environment, it is likely that interventions addressing specific environmental risk factors will be helpful to reduce or prevent challenging behaviors among this population.
Collapse
Affiliation(s)
- Dennis R Dixon
- Kennedy Krieger Institute, The Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | | | | |
Collapse
|
25
|
Bada HS, Das A, Bauer CR, Shankaran S, Lester B, LaGasse L, Hammond J, Wright LL, Higgins R. Impact of prenatal cocaine exposure on child behavior problems through school age. Pediatrics 2007; 119:e348-59. [PMID: 17272597 DOI: 10.1542/peds.2006-1404] [Citation(s) in RCA: 117] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE We examined the trajectory of childhood behavior problems after prenatal cocaine exposure. METHODS The Maternal Lifestyle Study, a longitudinal cohort study, enrolled children between 1993 and 1995 at 4 centers. Prenatal cocaine exposure was determined from mothers who admitted use and/or meconium results. Exposed children were matched with a group of nonexposed children within site and by gestational age, gender, race, and ethnicity. The study began at the 1-month corrected age with a total of 1388 children enrolled. A total of 1056 were assessed for internalizing, externalizing, and total behavior problems at ages 3, 5, and 7 years using the Child Behavior Checklist. Longitudinal hierarchical linear models were used to determine the effect of prenatal cocaine exposure on behavior problem trajectories while controlling for other prenatal exposures; time-varying covariates, including ongoing caregiver use of legal and illegal substances; demographic factors; family violence; and caregiver psychological distress. RESULTS High prenatal cocaine exposure was associated with the trajectory of internalizing, externalizing, and total behavior problems; these effects were independent of and less than the significant combined effect of prenatal and postnatal tobacco and alcohol exposures. Caregiver depression and family violence had independent negative influence on all behavior outcomes. CONCLUSIONS Prenatal cocaine exposure has a negative impact on the trajectories of childhood behavior outcomes. When they co-occur with prenatal cocaine exposure, prenatal and postnatal tobacco and alcohol exposures have added negative effects on behavior outcomes.
Collapse
Affiliation(s)
- Henrietta S Bada
- Department of Pediatrics, University of Kentucky College of Medicine, Lexington, Kentucky, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|