Poster group
Details of individual items:
poster
Emotional reactivity in infants acts as a primary mode of communication and an importantmediator of interpersonal relationships in the first year of life. Cocaine has been shown to disruptmonoaminergic neurotransmitters in the mesolimbic region of the fetal brain. This may lead tolongterm problems in the regulation of arousal, anxiety and reactivity. In particular, there is apossibility that cocaine exposure may lead to increased irritability and negative emotionalreactions. This study examined patterns of facial expressions in response to 5 emotion elicitingsituations at 4 months of age. The use of multiple eliciting situations with different emotionalvalences, as well as the examination of 6 different expressions in each situation, results in areliable and valid description of the infant's typical reactions.Responses of 164 subjects, 112 of whom were unexposed to cocaine during pregnancy, and 52 ofwhom were exposed to cocaine, were examined at 4 months of age. Drug exposure wasdetermined by meconium assay and substance use interviews. All families were low SES frominner city neighborhoods, and were predominantly African-American. Subjects were seated in aninfant seat across from the experimenter. There were 6 stimulus situations: tickle, lemon juice,Jack-in-the-Box, arm restraint, and masked stranger approach. The infants' faces were videotapedand later coded second-by-second for expressions of joy, anger, fear, sadness, interest andsurprise using the Maximally Discriminative Facial Coding System (Izard, 1979).Cluster analysis was used to determine whether the infants could be characterized by reactivetendencies across the several different eliciting situations. Similar 3 cluster solutions were foundfor the unexposed and cocaine-exposed infants. In one cluster infants showed relatively highpositive and low negative expression tendencies (56% of the exposed subjects compared to 52%of the unexposed). A second cluster of subjects showed a low positive and high negative pattern(13% of the exposed compared to 14% of the unexposed). Subjects in the third cluster showedrelatively little of any of the negative expressions or joy (31% of the exposed and 34% of theunexposed subjects). Cluster analysis of the total sample described a 3 cluster solution with 46%,16% and 38% of the subjects falling into the clusters described above. There was no exposuregroup difference in the proportion of subjects falling into each cluster (Chi-square(2df).99).This study indicates that it is possible to classify infants at 4 months of age into several distinctand meaningful reaction tendency groups. Infants who were exposed to cocaine in utero do notappear to differ from otherwise similar infants who were not exposed to cocaine in theirtendencies to show specific patterns of facial reactions across different eliciting stimuli. Thisfinding does not confirm a negative reaction tendency in infants prenatally exposed to cocaine inthis context of simple reactivity.
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This study identified behavioral and physiologic responses of infants prenatally exposed to illicitdrugs to a multi-sensory intervention and compared the responses to those of non-drug-exposed infants.Additionally, this study sought to determine whether the infant behavioral state (IBS) of prenatally drug-exposed infants would be positively correlated with pulse rate (PR). The convenience sample was recruited from a large medical center with greater than 2,500 birthsper year. The sample consisted of 45 prenatally drug-exposed and 72 non-drug-exposed infants between36 and 41 weeks gestational age at birth. All infants were clinically stable 24 hours post birth. Based onmaternal report and/or urine toxicology results, infants were categorized into cocaine, opiate (heroinand/or methadone), or poly-drug exposure groups. All infants experiencing active drug withdrawal werenot eligible to participate in the study. The infants were randomly assigned to either a control (Group C)or experimental group (Group E). Group C infants received routine nursery care. Group E infants received fifteen minutes of ATVV(Auditory, Tactile, Visual, and Vestibular) intervention, twice within a 12-hour period starting 24 hourspost-delivery. The first segment of the intervention consisted of a ten-minute head-to-toe body massage(tactile), during which time the researcher attempted to maintain eye-to-eye contact (visual), while talkingsoftly to the infant (auditory). The massage was followed by five minutes of rocking (vestibular). Theinfant's behavioral cues were monitored throughout the intervention, and the ATVV intervention wasmodified accordingly. A one-way ANOVA revealed that drug-exposed infants were significantly different from non-drug-exposed infants on the variable of head circumference (p. 014), but no other significant differences werefound for any of the other demographic variables. Analysis of IBS revealed that both non-drug-exposedand drug-exposed infants in Group E responded to the ATVV with 19% more alertness during theintervention when compared to Group C infants. Although no significant correlations were found for PRand IBS in Group C drug-exposed infants, a strong, significant correlation was identified for Group Edrug-exposed infants (r. 955, p. 003). When correlations were conducted between IBS and PR by drugexposure, a moderate, non-significant, positive correlation was found for opiate exposed infants (r. 664,p. 073), a moderate, positive correlation for polydrug exposed infants (r. 584, p. 046), and a strong,positive correlation for infants exposed to cocaine in Group E (r. 992, p. 000). Results suggest that the ATVV may be effective in integrating and organizing the behavioral stateand autonomic function of drug-exposed infants with the result being that infants who receive the ATVVintervention more closely approximate the behavioral state and autonomic function of non-drug-exposedinfants. Further research is needed to identify whether use of the ATVV intervention will be beneficial toinfants experiencing withdrawal symptoms, to determine whether the ATVV could improveneurobehavioral and autonomic function on a long-term basis, as well to investigate the possibility of adecrease in long term costs that are commonly associated with prenatal drug exposure.
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We report the mental health outcomes of a large sample of individualsassessed longitudinally from birth to 21 years of age. From apopulation-based screening sample of alcohol use during pregnancy, 500women (half 'heavier' drinkers who typically drank at 'social' drinkinglevels and half infrequent drinkers and abstainers) were selected tocreate the follow-up cohort. The women were primarily white, middle-class,married, in their twenties, and at low risk for adverse pregnancy outcome. Mental health measures reported here were gathered at 4 and 21 years ofage. At 4 years, 452 caregivers completed standardized behaviorquestionnaires (the Conners' Behavior Rating Scales and the Werry-Weisshyperactivity index) and a structured interview about various childhoodproblems developed for this study (the Psychiatric Symptom Checklist,PSC). At 21 years, 429 subjects completed the Achenbach Young AdultSelf-Report (YASR) and the Brief Symptom Inventory (BSI). Caregiverscompleted the Achenbach Young Adult Behavior Checklist (YABC). Bothsubjects and their caregivers were interviewed about various personal,social, and psychiatric issues with a structured questionnaire developedfor this study. For the purpose of this preliminary report, maternalalcohol use during pregnancy was categorized into three patterns:abstainers/infrequent use (LOW, n160), moderate use (MOD, n137), andbinge drinking (BINGE, n132). 375 subjects were seen at 4 and 21 years.Patterns of maternal alcohol use during pregnancy were related toclinically significant levels of psychopathology at 21 years of age (i.e.,scores above clinical cutoffs), as rated by both the young adults andtheir caregivers. On the BSI, a larger proportion of subjects in the BINGEgroup reported an overall level of psychopathology and paranoid ideationabove the clinical cutoff than the LOW or MOD groups. On the YASR, alarger proportion of the BINGE group reported externalizing problems,attention problems, and delinquent behavior above the clinical cutoff thanthe LOW and MOD groups. On the YABC, a larger proportion of the BINGEgroup caregivers reported clinically significant levels of delinquentbehavior than the LOW and MOD group. Larger proportions of the LOW andBINGE groups reported externalizing problems, attention problems,aggressive behavior, and intrusive behavior above the clinical cutoffsthan the MOD group. In the structured interview, a larger proportion ofsubjects in the BINGE group reported that they had received inpatientpsychiatric treatment or any type of mental health treatment at some timein their lives compared to the LOW and MOD groups. See Table 1 fordescriptive statistics.Assessment of mental health problems at 4 years was associated with mentalhealth outcomes at 21 years. In general, the PSC, Conners', andWerry-Weiss composite scores at 4 years were related to the BSI, YASR, andYABC total scores at 21 years. In addition, particular 4-year outcomes(e.g., thought disturbance) were related to similar constructs at 21 years(e.g., psychoticism). We discuss the contribution of prenatal alcohol exposure, early childhoodpsychopathology, and other factors known to influence development as theyrelate to adult mental health status.Table 1. Mental Health Outcomes at 21 Years of Age. 21-Year Outcomes LOW MOD BINGE Above Clinical Cutoff No. % No. % No. % Brief Symptom Inventory (T>63)Global Severity Index* 39/157 25 27/132 21 45/128 35Positive Symptom Total 37/157 24 30/133 23 37/129 29Positive Symptom Distress 26/157 17 18/132 14 25/128 20Hostility 29/157 19 25/132 19 30/128 23Interpersonal Sensitivity 41/157 26 33/133 25 42/129 33Obsessive-Compulsive 47/157 30 45/132 34 48/128 38Paranoid Ideation* 37/157 24 30/133 23 48/129 37Phobic Anxiety 25/157 16 26/132 20 21/128 16Anxiety 24/157 15 21/132 16 24/128 19Depression 34/157 22 34/133 26 37/129 29Somatization 22/157 14 20/132 15 17/128 13Psychoticism 43/157 27 34/132 26 44/128 34Young Adult Self-Report (YASR)Total Problem Scales (T>60) n 129 n 119 n 118Externalizing Total* 20 16 11 9 30 25Internalizing Total 17 13 16 13 16 14Total Problems 17 13 19 16 28 24YASR Subscales (T>67) n 129 n 119 n 118Aggressive Behavior 12 9 6 5 12 10Anxiety 5 4 8 7 11 9Attention Problems* 9 7 13 11 21 18Delinquent Behavior* 12 9 19 16 26 22Somatization 11 9 20 17 19 16Thought Problems 13 10 13 11 20 17Intrusive Behavior 15 12 10 8 17 14Withdrawn 19 15 16 13 13 11Young Adult Behavior Checklist (YABC)Total Problem Scales (T>60) n 126 n 119 n 114Externalizing Total* 19 15 7 6 19 17Internalizing Total 19 15 12 10 20 18Total Problems 20 16 13 11 22 19YABC Subscales (T>67) n 126 n 119 n 114Aggressive Behavior* 14 11 3 3 9 8Anxiety 7 6 9 8 11 10Attention Problems* 16 13 4 3 10 9Delinquent Behavior* 15 12 6 5 12 20Somatization 10 8 6 5 10 9Thought Problems 6 5 12 10 9 8Intrusive Behavior* 11 9 2 2 9 8Withdrawn 15 12 11 9 8 7Structured Interview n 160 n 137 n 132Inpatient Mental Health* 4 3 7 5 13 10Any Mental Health* 62 39 67 49 70 53Attention Deficit Disorder 15 9 20 15 22 17Conduct Disorder 5 3 4 1 7 5Serious Depression 30 19 33 24 30 23Hallucinations 2 1 1 1 5 4Substance Abuse 14 9 17 12 20 15Suicide Attempt 6 4 7 5 9 7Suicide Threat 8 5 7 5 14 11Abuse Victim 19 12 13 10 25 19Family Counseling 35 22 38 28 43 33 * p < .05 for the hypothesis for no difference by category.
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Objective: To investigate the relationship between the dose of methadone mothers received during their pregnancy and the developmental outcomes of their infants. Method: A sample of 32 infants born to mothers on methadone maintenance was compared to a group of 42 control infants born to non-opioid using mothers. All infants were delivered at National Women's Hospital in Auckland, New Zealand between 1996 and 1999. Data collected during the perinatal period included birth weight, length and head circumference, gestation, postnatal stay in hospital, incidence and severity of Neonatal Abstinence Syndrome (NAS). During the third trimester of the mother's pregnancy, maternal and paternal demographics and measures of psychological well- being, drug use and criminal history were obtained. Results: There was a significant relationship between maternal methadone dose at birth and infant developmental outcomes. Birth weight, length, head circumference and gestation were all negatively correlated with maternal methadone dose at birth, r -.687, r -.651, r -.631, and r -.617, p<.0001, respectively. Infant stay in hospital postnatally was positively correlated with dose r .749, p<.0001. There was also a significant relationship between maternal methadone dose at birth and a number of maternal factors. A negative correlation was found between maternal years of education and methadone dose r .-.573 p<.0001. Mothers on higher doses of methadone were more likely to have a history of miscarriage and growth retardation, and less likely to have attended more than 5 antenatal visits prior to their babies birth, r .551 p<.0001, r .320 p<.01, and r -.507 p<.0001, respectively. There was also a positive correlation between maternal methadone dose and other drug use. Mothers on higher doses of methadone smoked more cigarettes per day r .678 p<.0001, and were more likely to be dependent on other illicit drugs r .625 p<.0001. Finally, there was a relationship between maternal methadone dose and depression prenatally r .493 p<.0001. To examine the extent to which associations between maternal methadone dose and infant outcomes could be explained by the confounding effects of the maternal factors associated with dose, a series of multiple regression models were fitted. Infant outcomes at birth were largely and consistently explained by methadone dose. The only other factors that contributed significantly to the prediction of infant outcomes were maternal history of miscarriage, and attending less than 5 antenatal visits, and number of cigarettes smoked per day. For example, methadone dose and these maternal factors explained 61% (59% adjusted) of the variability in birth weight F (4, 68) 26.62 p<.0001, standardized coefficients for these factors were methadone dose -.49, maternal history of miscarriage .27, less than 5 antenatal visits -.26, and cigarettes smoked per day -.31. Conclusion: Preliminary results of this study suggest higher doses of methadone during pregnancy may put infants at higher risk of growth retardation, preterm birth and longer stays in hospital postnatally.
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no abstract
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The purpose of this study was to determine the role of the neighborhood environment in mediating the effects of prenatal drug exposure on child outcome. The Neighborhood Scales (NS; Furstenberg, Cook, Eccles, Elder & Sameroff, 1999) were administered to the caregivers of 501 cocaine/opiate exposed and 584 comparison infants when the infants were 10 months of age as part of the NIH multisite longitudinal Maternal Lifestyle Study of prenatal drug exposure and child outcome. The sample was approximately 77% African American, 16% Caucasian, 6% Hispanic (race varies) and 1% other race or ethnicity. The NS consist of 26-items that evaluate the perceived quality of the neighborhood environment on a 5-point Likert scale and yield 3 subscale scores. Subscale scores assess social cohesion, neighborhood problems and access to social services. Child outcome measures included the Bayley II Scales at 12 months of age, and the Peabody Motor Scales and the Ainsworth Strange Situation at 18 months of age. As shown in Table 1, the cocaine/opiate exposed group showed higher neighborhood cohesion scores and more years of neighborhood residence than the comparison group. These effects were observed with SES (modified Hollingshead) controlled. Neighborhood measures were dichotomized into high and low categories based on a mean split. MANOVA's were conducted for each continuous outcome measure with NS and exposure status as predictors and family SES as a covariate. Results indicated that cocaine exposure was associated with lower Bayley MDI scores when neighborhood environment was controlled. Family SES and an interaction between neighborhood cohesion and exposure status were found to significantly predict Peabody fine motor scores (Table 2). Specifically, higher neighborhood cohesion in the exposed group was associated with lower fine motor scores. Using logistic regression, attachment status was not predicted by neighborhood cohesion, exposure status or family SES. This is the first study to measure the perceived quality of the neighborhood in drug exposed children. The finding that cocaine-exposed children are more likely to live in a high cohesion neighborhood and reside longer in a neighborhood, regardless of family SES, does not support the stereotypic view that drug exposed children are reared in environments characterized by high turnover and low cohesion neighborhoods. The fact that these effects were observed with SES controlled suggests that the NS measures different aspects of the environment than SES. Results on the Bayley MDI expand previous findings by showing that prenatal cocaine-exposure is associated with subtle but measurable effects when both SES and neighborhood quality are controlled. Findings on the Peabody Scales showed neighborhood environment effects on and fine motor behavior at 18 months on age. The poorer fine motor scores in exposed children from high cohesion neighborhoods could suggest that high cohesion in these families is a marker for negative caregiving that affects fine motor development. Neighborhood effects have not been previously reported in children as early as 18 months. Continued follow-up of these children will enable us to determine the role of the neighborhood in better understanding how the caregiving environment affects developmental outcome in drug exposed children. References Furstenberg, F. F., Cook, T. D., Eccles, J., Elder, G. H., & Sameroff, A. (1999). Managing to Make It: Urban Families and Adolescent Success. Chicago: The University of Chicago Press.
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Responding to joint attention (RJA) skill refers to infants' capacity tofollow the gaze shift, head turn, and/or pointing gesture of a socialpartner. A small, but growing research literature suggests that earlymeasures of RJA (assessed at 18 months and younger) are significantlyassociated with later cognitive and language outcomes innormally-developing and high-risk populations; however, the predictivevalidity of RJA skill as measured at 24 months of age remains to beexplored. The purpose of this study was to evaluate the incrementalvalidity of a battery of infant predictors, including RJA at 24 months, tomeasures of cognitive development at 24 months in a sample of high-risktoddlers. Fifty-one toddlers, prenatally expose to cocaine, participated in thisstudy. All toddlers were assessed at approximately 12, 18, and 24 monthsof age. Birthweight was used to provide an indicator of biological risk.RJA skill was assessed at 12, 18, and 24 months using the EarlySocial-Communication Scales (ESCS). During the ESCS, RJA is assessed viasix trials where the tester orients to a distal target to the left, right,and behind the child while pointing and calling the child's name threetimes. The RJA score reflects the percent of trials on which the childlooks in the direction indicated by the tester. Cognitive ability wasmeasured at 12 and 24 months using the Bayley Scales of Infant Development- Second Edition (Bayley-II). A hierarchical regression was used to predict 24 month Bayley-II MDI frombirthweight, Bayley-II MDI at 12 months and RJA at 12, 18, and 24 months.It is notable that all of our predictor variables, with the exclusion ofbirthweight, were significantly correlated with Bayley-II MDI at 24 months(see Table 1). The hierarchical regression model using birthweight,Bayley-II MDI at 12 months, and RJA at 12, 18, and 24 months combined tosignificantly predict Bayley-II MDI scores at 24 months of age (R2 .721,F(3,45) 9.75, p < .001); however, only Bayley-II MDI at 12 months and RJAat 18 months displayed significant standardized coefficients andbirthweight approached significance (see Table 2). The data in this studyprovide evidence for the incremental validity of measures of RJA in theprediction of cognitive outcome. The results of this study also suggestthat the utility of RJA as a predictor may be most evident when RJA isassessed at approximately 18 months of age in high-risk population. Table 1One-Tailed Pearson Product Moment Correlational Data______________________________________________________________________________ 24 month MDI p-valueBirthweight .10 .1812 month MDI .35** .0012 month RJA .24* .0318 month RJA .50** .0024 month RJA .23* .04______________________________________________________________________________*p < .05, **p < .01 Table 2Hierarchical Regression Analysis of Birthweight, Bayley-II MDI at 12months, and RJA skill at 12, 18, and 24 months to Bayley-II MDI at 24 months R Adj. R2 Beta p-valueStep 1: .54** .27** .00 Birthweight .09 .49 12 month MDI .56** .00Step 2: .72** .47** .00Birthweight .19 .0812 month MDI .28* .0312 month RJA .002 .9918 month RJA .57** .00 24 month RJA .01 .96*p < .05, **p < .01
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To investigate the effects of prenatal cocaine exposure, 154 cocaine using women and 154matched controls living in a southern rural region were recruited to participate in a prospective,longitudinal maternal-infant health and development study either at the time they entered thepublic health care system for prenatal care or at delivery if they had limited or no prenatal care. Experienced interviewers obtained consent and completed confidential interviews with allpotential subjects about substance usage in each prior trimester. A structured interviewinstrument was used to collect information on pattern, amount, and frequency of use forcocaine, alcohol, tobacco, and marijuana from the study participants. Pregnancy was brokendown into periods of use punctuated by behaviorally and medically meaningful events(conception, realization and confirmation of pregnancy, ends of trimesters, celebrations andspecial events). These data were then transferred to a week by week calendar which spanned theperiod from 12 weeks before conception to birth. The database structure for each woman consistsof 12 weeks pre-conception substance use data plus 40 weeks (approximately) gestationalsubstance use data. For each week and for each of the four substances, the amount and frequencyused during the week is coded to give a final dimensionality of 416 to the substance use data set.Among the 154 prenatal cocaine users: 32% reported using cocaine, alcohol, and tobacco; 30%reported using cocaine, alcohol, marijuana and tobacco; 14% reported using cocaine and tobacco;9% reported using cocaine and no other substance; and 15% reported using cocaine inmiscellaneous combinations. Among the controls: 71% reported using no substances; 13%reported using tobacco; 8% reported using alcohol and tobacco; and 8% reported miscellaneoussubstance combinations. To better understand the effects of prenatal cocaine exposure (presence/absence, timing, anddose) in the presence of other substance use (alcohol, tobacco, and marijuana), data reductionmethods which are more sophisticated than rudimentary summary statistics (mean, median,standard deviation) are needed. Interesting structures in low dimension data are readilydiscerned using familiar graphing techniques such as histograms or scatter plots. Data which isof high dimension cannot be similarly viewed. Projection pursuit is a multivariate data analysistechnique which seeks interesting structures of high dimension data for the ultimate purpose ofdata reduction and application to outcome analysis. The goal of this poster will be a step by stepillustration of Projection Pursuit methodology applied to the 416-dimension substance use dataset.
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Longitudinal research designed to follow high-risk infants into their school years and examinethe social/environmental contribution to their development presents tracking problems when thesample consists of an economically marginal population. For many infants, especially those thatare drug-exposed and at risk for removal from their biological mother, their caregiver andresidence may change numerous times. Research staff must develop communication and trust,foster subjects' interest, and develop contact strategies that overcome the burdens of a chaoticliving environment. In this study, 154 women using cocaine prenatally and 154 matches were enrolled in alongitudinal, developmental research project to examine the medical/developmental outcomes of in utero cocaine exposure. Mother/infant and/or caregiver/infant dyads would participate in 12evaluation time points including five home visits during a five year period. The geographicalarea of subject residence initially embraced two large rural counties in Florida. The project team used various strategies to track where children were living: newsletters, thankyou cards, drive-bys, searches of the Internet and all public records, and the use of money, toysand incentives. Deciding who to interview was often complicated; decision making wasenhanced by establishing protocols, contacting relatives and county family services and regularteam meetings to share information. Additional considerations included how to account forchanges in caregiver status, and establish the validity of what was being measured. Challengesincluded how to simplify data for statistical analyses yet maintain data integrity and how toidentify and quantify the hidden issues in the environmental feedback loop. Findings at five years showed a residential spread that expanded to the entire state plus eightothers. Eighty eight children had been in out-of -home care at some time point during their firstfive years. Six were lost to follow-up. The remaining 82 had 178 different caregivers and 129changes in caregivers. Fifty two (63%) were living in a kinship network, of these, 7 wereformally adopted; 16 (20%) were in foster care of whom 11 were formally adopted; 13 (16%)had returned to their biological mother; 1 child died in foster care. Reasons for a child living inout-of-home care included drug use (n 72), incarceration of the mother (n 43 ), neglect (n6),relinquishment (n6), or other (n 6), often in combination. Biological mothers were on average19 years younger than out-of-home caregivers (m49 years); mean educational levels for theentire sample were less than high school equivalency. To better understand the mechanism of environmental contribution to childhood development,every effort must be made to locate and identify the correct caregiver and householdcomposition, to track the demographic changes, and construct the statistical equations thatconsider the numerous changes and vicissitudes of children in out-of-home placement. Thispresentation will include the strategies developed for the project that have enabled us to maintaina subject follow-up rate of 90% over five years. Potential solutions to the problems ofappropriately identifying and assessing caregivers will be discussed.
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The recent convergence of developmental neuropsychology and cognitivedevelopmental psychology has resulted in infant measures of abilitiessupported by specific brain systems. Executive Functioning (EF) tasks allowfor the early assessment of the constellation of planning and inhibitorycontrol abilities that research suggests rely on the prefrontal cortex(PFC). Current research indicates that development of these abilities isparticularly at-risk in cocaine-exposed children. Animal studies havereported persistent alteration in dopamine (DA) neurons after gestationalcocaine exposure and the PFC depends selectively on this transmitter system.Outcome studies with children exposed during gestation to drugs complementthe animal studies in their implication of the PFC. Infant EF measures have only recently been used in research with clinicalpopulations and no study has explored the relation between prenataldrug-exposure and EF in the first year of life. Disabilities in a specificcognitive system may only be identifiable in infancy. Early assessment maylimit the confounding of impoverished rearing environments and drug-exposurestatus. Because of accumulated loss of opportunities to learn that may beexperienced by drug-exposed children, a specific disability may, with age,manifest as a generalized cognitive dysfunction. For this reason it iscrucial to look for specific effects of drug-exposure early in development. We compared the delay tolerance of a cocaine-exposed group of 11-month-oldinfants and a matched no-cocaine control group on a modified version of theA-not-B task. On the A-not-B task, an infant is challenged to find a toythey have seen hidden in a new location and resist the tendency to search inthe previously correct location (the A-not-B error). Delay tolerance on theA-not-B task is sensitive to PFC dysfunction and the disruption of DA.Prefrontal development, as measured by EEG, corresponds to increased delaytolerance on the A-not-B task. We used a measure of delay tolerancepublished by Matthews, Ellis, & Nelson in 1996. At this point in datacollection (n 13), the mean delay that produces the A-not-B error in thecocaine-exposed group is 2.24 seconds. The mean delay that produces theA-not-B error in the control group is 3.5 seconds. The higher delaytolerance in the control group is consistent with the decreased frequency ofperseverative runs of responses seen in that group. Only 33% of controlinfants had episodes in which they reached to the same incorrect hiding wellon 4 or more consecutive trials, as compared to 86% of the cocaine-exposedinfants. (Although these differences do not approach statisticalsignificance, data collection is on-going and we anticipate testing a totalof 50 infants.)
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Introduction: As part of an on-going longitudinal study of prenatal cocaine exposure, one hundred and seventy-three 3-year-olds (73 cocaine exposed, 100 unexposed) were assessed on the McCarthy Scales of Children's Abilities. The McCarthy Scales, which were administered by qualified examiners blinded to drug exposure status, consists of six subscales: Verbal, Perceptual-Performance, Qualitative, General Cognitive, Memory, and Motor. Subjects: Participants were recruited from either a newborn nursery at delivery or at a well baby visit. Drug exposure was determined by a combination of medical chart review, maternal and/or infant urine toxicology results, and/or brief clinical interviews. Data Analysis: Possible confounders examined included number of prenatal visits, age at delivery, parity, and income. Gestational age, birth weight, length, head circumference, and 5 minute APGAR score were examined as potential mediators. Relationships between possible confounding and outcome variables was examined, using a p <0.1 significance level. Variables that correlated with outcomes were subsequently entered into hierarchical multiple regression analyses to determine whether drug effects remained after controlling for confounders. Demographic and prenatal confounding variables were entered first. Next, cocaine exposure and, finally, birth outcomes were entered as potential mediators. Results: Mothers who used cocaine were older, and had higher parity and less prenatal care. Cocaine-exposed children were more likely to have a lower gestational age, and lower birth length, weight, and head circumference, even after adjustment for gestational age. There was a significant difference between cocaine-exposed and unexposed children on mean Verbal (42.1 vs. 45.0, t 3D 2.12, p <.05), Perceptual-Performance (45.4 vs. 47.2, t 3D 1.94, p < .05), and General Cognitive (86.9 vs. 91.0, t 3D 2.23, p< .05) Index scores. Although the mean scores of both groups were below average, the cocaine exposed group performed less well on all three subscales. There were no significant differences on the Quantitative, Memory, or Motor subscales. Number of prenatal visits correlated with Verbal, Perceptual-Performance, and General Cognitive Index scores (r 3D 0.24, r 3D .015, and r 3D 0.27, respectively). Head circumference correlated with the Verbal, Perceptual-Performance, and General Cognitive Index scores (r 3D 0.14, r 3D 0.13, and r 3D 0.15, respectively). Hierarchical regression analyses indicated that the number of prenatal visits, but not cocaine exposure, accounted for a significant amount of variance in the Verbal and the General Cognitive scores, which was not mediated by head circumference. Further analyses to account for possible confounding effects of exposure to other drugs, particularly alcohol, nicotine, and marijuana, are planned. Conclusions: The present suggests that inadequate health care during pregnancy, which may be influenced by cocaine use, puts children at risk for cognitive delays beyond the neonatal period.
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Introduction: Chronic cocaine use may directly affect the psychologicalfunctioning and behavior of those who use it. These symptoms are ofparticular concern among post-partum women as their psychological status andbehavioral interactions with their infants may adversely influence infantbehavioral and developmental outcome. The present study investigated therelationships between level of cocaine use, psychological distress symptomsand quality of maternal infant interaction. Subjects: In a prospectivestudy of 289 post partum women and their infants, 132 cocaine using and 157non cocaine using women were assessed within the first month after infantbirth. Women were primarily African American and low socio-economic status.Maternal subjects were classified further as either non (N), light (L), orheavy (H) users of cocaine based on a post partum interview and/or infantmeconium analyses. Method: All mothers were interviewed concerning theirfrequency and amount of substance use, completed the Brief Symptom Inventory(BSI) to assess severity of psychological symptoms, and were video tapedfeeding their infants. The quality of feeding interactions was rated byindividuals unaware of maternal drug use history with the Nursing ChildAssessment Feeding Scale (NCAFS). Mothers were rated for sensitivity tocues, response to distress, socioemotional growth fostering and cognitivegrowth fostering. Infants were rated for their responsivity and clarity ofcues. Data Analyses: ANOVA with Duncan post hoc tests were used for 3group and t-tests for 2 group comparisons. Correlational analysesinvestigated the relationships between maternal-infant interaction andpsychological distress. Results: Total child score on the NCAFS was lowerfor cocaine exposed infants than for non exposed infants (t 1.98, p<.05)while none of the maternal scores were significantly different. When NCAFSoutcomes were compared based on severity of cocaine use there were nodifferences. There was a significant correlation between total parentrating and total child rating r .46, p<.0001). NCAFS subscales and totalscores were correlated with summary scores of the BSI. There was a trendfor parental cognitive growth fostering to negatively correlate with theGlobal Severity Index (GSI ) score of the BSI and the interpersonalsensitivity and phobic anxiety subscales (p's<.1). Child responsiveness wasnegatively correlated with GSI r -.14, p<.03), somatization ( r -.12,p<.05), anxiety ( r -.12, p<.05) and psychoticism ( r .-11, p<.08).Total child score was also negatively correlated with maternal anxiety r -.12, p<.05) and there were trends for negative correlations with GSI(p<.11) and psychoticism (p<.10). Hierarchical linear regression analysiswas used to assess the relative effects of cocaine use and anxiety on totalchild score. Anxiety predicted total child score ( -.55, p<.05), and metthe criterion as a mediator of cocaine's effect on child feeding interactionbehavior. Conclusions: Maternal-infant interaction during feeding may benegatively affected by maternal cocaine use. Maternal psychologicalsymptoms, particularly anxiety, may mediate drug effects on maternal-infantbehavior.
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Introduction: Prenatal cocaine exposure may have specific effects on brain mechanisms affecting arousal and attention regulation in infants, thus compromising learning and development. Postnatal influences in the caregiving environment, particularly stressful experiences, such as violence, may also influence attentional and emotional regulation. The present study longitudinally assessed behavioral regulation of cocaine-exposed and non-exposed infants to 2 years of age, relating behaviors to level of concurrent maternal use and experience of violent behaviors. Method: We followed 415 infants [(218 cocaine-exposed (CE), 197 non-exposed (NCE)] from birth to 6.5, 12, and 24 months of age. Infants were recruited from a high risk clinic and were primarily African-American, urban, and poor. Cocaine status was determined by a combination of clinical interview and biologic assessments. Over 90% of subjects were seen at each visit. Mothers were administered the Conflict Tactics Scale (CTS) at each follow-up visit. The CTS is a standardized interview which rates intrafamily conflict on a 7-point scale and provides a measure of maternal engagement in or witness to ordinary and severe physicality and violence during disagreements with a partner or other family member. At each age, infants were rated by the examiner on their behaviors during developmental testing using the Behavior Rating Scale (BRS). The BRS is a standardized, normative measure which yields classifications of within normal limits, questionable or non-optimal on factors re!lating to dimensions of infant test-taking behavior, including Orientation/Engagement, Emotional/Regulation, Motor Quality, and a Total score. Raters were blinded to infants drug exposure status.Data Analysis: Mantel-Haenszel Chi Square was used to compare the CE and NCE groups on their classification on the BRS factors at each age (See Table 1). Correlation analyses were used to examine the relationship of severity of maternal violence exposure to BRS factor scores at each age for the sub-group of infants who resided with their biologic mothers. Results: By two years, cocaine-exposed infants were significantly less likely to be rated as within normal limits on all factors including Emotional Regulation (56% vs 86%, p < .010); Orientation/Engagement (55% vs. 68%, p < .012); Motor quality (82% vs. 90%, p < .031); and Total score (53% vs. 70%, p < .002). Cocaine using women were more likely to experience severe violence at all ages. Maternal report of greater self-use of severe violence (e.g., kicked, bit, beat up) was related to poorer infant orientation/engagement behaviors (r -.14, p < .05), motor quality (r -.13, p < .06), and lower total BRS score (r -.14, p < .06) at 6 months. Her report of greater partner use of both ordinary and severe violence was related to poorer infant motor quality at 12 months (r's -.13, -.15, p's < .06), but there were no significant relationships at two years. Conclusions: Cocaine-exposed infants displayed poorer attention, task orientation, and behavioral adaptation in comparison to non-exposed infants, and their mothers reported higher levels of experience of violent behaviors in family interactions. Thus both biologic exposure to cocaine/polydrugs prenatally and family violence exposure were related to infant behavioral regulation during the first year of life. Table 1 PERCENTAGE OF INFANTS WITHIN NORMAL LIMITS VERSUS QUESTIONABLE OR NON-OPTIMAL ON THE BEHAVIOR RATING SCALE BY AGE AND COCAINE STATUSEmotional RegulationAgeCocaine PositiveCocaine NegativeM-H 2p6 months113 (65%)110 (71%)3.3< .07012 months 86 (47%) 94 (53%)2.2< .1432 years105 (56%)123 (68%)6.6< .010Motor Quality6 months155 (90%)147 (94%) .7< .38912 months161 (89%)165 (94%)1.8< .1752 years154 (82%)163 (90%)4.6< .031Orientation/Engagement6 months 93 (54%)102 (65%)2.6< .10612 months 95 (53%)107 (61%)1.7< .1892 years102 (55%)122 (68%)6.2< .012Total Score6 months107 (65%)117 (77%)5.0< .02512 months104 (61%)113 (66%)1.0< .3062 years 91 (53%)120 (70%)9.4<.002