Cognitive Outcomes of Preschool Children With Prenatal Cocaine Exposure

Department of Pediatrics, The Ohio State University, Columbus, Ohio, United States
JAMA The Journal of the American Medical Association (Impact Factor: 35.29). 06/2004; 291(20):2448-56. DOI: 10.1001/jama.291.20.2448
Source: PubMed


placental and fetal brain barriers1-3 and has a direct effect on the developing fetal brain through alterations in the central monoamine systems and an indirect effect through maternal vascular disruptions. 4 Brain glucose metabolism is decreased in animal studies of cocaineexposed offspring, also potentially affecting neurodevelopment5 and raising concerns about long-term cognitive outcomes. 6 A number of methodologically sound studies have found a relationship between fetal cocaine exposure and negative child developmental outcomes in the first years of life, 7-15 although others have not. 16,17 A few studies have documented outcomes in the later preschool or early school years. 17-20 Longterm studies are important because cocaine may have “sleeper ” effects that are not detectable until complex functional abilities are measurable. 21,22 Compensatory mechanisms may ameliorate negative effects, 23 while environmental circumstances may exacerbate or minimize the sequelae of early brain insults. 18,24 Findings in studies with Context Because of methodological limitations, the results of the few prospective studies assessing long-term cognitive effects of prenatal cocaine exposure are inconsistent. Objective To assess effects of prenatal cocaine exposure and quality of caregiving environment on 4-year cognitive outcomes. Design Longitudinal, prospective, masked comparison cohort study from birth (September 1994-June 1996) to 4 years. Setting Research laboratory of a US urban county teaching hospital. Participants A total of 415 consecutively enrolled infants identified from a highrisk population screened for drug use through clinical interview, urine, and meconium screens. Ninety-three percent retention for surviving participants at 4 years of age resulted in 376 children (190 cocaine-exposed and 186 nonexposed).

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    • "The prefrontal cortex is functionally associated with higher cognitive functions such as attention, executive function, and inhibitory control (Marsh, Gerber, & Peterson, 2008; Mueller et al., 2010). The current literature has reported a number of developmental delays and deficits in children prenatally exposed to illicit drugs (Ackerman, Riggins, & Black, 2010; Fetherston & Lenton, 2014; Goldschmidt, Richardson, Willford, & Day, 2008; Schölmerich & Pinnow, 2008; Singer et al., 2004). In this study, we focus on attention regulation on different levels to investigate the concordance of basic neuronal function, different aspects of attention, and the incidence of clinical behavioral manifestations, as in attention deficit disorder. "
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    ABSTRACT: Children born to drug abusers are exposed to teratogenic influences on intrauterine brain development and undergo postnatal withdrawal. We investigated the interplay of different domains and levels of attention functioning in 24 prenatally exposed and 25 nonexposed children who were 5 to 6 years old. Assessment included parent ratings and neuropsychological and electrophysiological methods. Exposed children had a higher prevalence of attention deficit hyperactivity symptoms, tended to have poorer performance in an attention test battery, and showed EEG alterations in P3 and N2c. Findings suggest long-term effects of prenatal drug exposure on specific domains and on different levels of attention functioning. © 2015 Michigan Association for Infant Mental Health.
    Full-text · Article · Aug 2015 · Infant Mental Health Journal
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    • "Environmental factors associated with prenatal drug use, such as poor quality of the home environment, caregiver ongoing substance use and psychological distress, violence exposure (Bada et al., 2007, 2011; Frank et al., 2011), non-kinship adoptive/foster care placement (Linares et al., 2006), negative attachment to caregiver (Warner et al., 2011) and low levels of parental monitoring (Bohnert, Anthony, & Breslau, 2012; Laird, Criss, Pettit, Dodge, & Bates, 2008) may heighten the drug exposed child's vulnerability to maladaptive behavioral development and obscure the long-term effects of PCE. In contrast, positive environmental factors may be protective or compensate for earlier biologic risk factors (Bada et al., 2012; Singer, 2004, 2008). "
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    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.
    Full-text · Article · Apr 2014 · Journal of Adolescence
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    • "In some cases, placement in foster or adoptive care has been found to improve language outcomes for children with PCE compared with children who remained in the care of their biological mothers (Lewis et al., 2004). Children in foster or adoptive care had caregivers with higher vocabulary scores than those of the biological caregivers and attained IQ scores similar to those of children with no cocaine exposure (NCE; Singer et al., 2004). These results suggest that a cocaine-specific effect on language skills may be modified with an enriched environment. "
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    ABSTRACT: In this study, the authors aimed to examine the long-term effects of prenatal cocaine exposure (PCE) on the language development of 12-year-old children using a prospective design, controlling for confounding prenatal drug exposure and environmental factors. Children who were exposed to cocaine in utero (PCE; n = 183) and children who were not exposed to cocaine (i.e., no cocaine exposure [NCE]; n = 181) were followed prospectively from birth to 12 years of age and were compared on language subtests of the Test of Language Development-Intermediate, Third Edition ( Hammill & Newcomer, 1997b), and phonological processing as measured by the Comprehensive Test of Phonological Processing ( Wagner & Torgesen, 1999). The authors evaluated the relationship of PCE to language development through a multivariate analysis of covariance and regression analyses while controlling for confounders. Results show that PCE has small effects on specific aspects of language, including syntax and phonological processing. The caregiver variables of lower maternal vocabulary, more psychological symptoms, and a poorer home environment also had consistent effects on language and phonological processing scores. These findings suggest that PCE continues to have small, subtle effects on specific aspects of language at age 12 years. Phonological processing skills were significantly related to the reading outcomes of letter-word identification, reading fluency, and reading comprehension, indicating that PCE also has small but lasting effects on the language skills that are related to later literacy skills.
    Full-text · Article · Oct 2013 · Journal of Speech Language and Hearing Research
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