Early adolescent cocaine use as determined by hair analysis in a prenatal cocaine exposure cohort

Pathways from prenatal cocaine exposure to adult substance use and behavior

This is a report from the most recent adult follow-up of the longest running cohort study of prenatal cocaine exposure (PCE), in which women were enrolled prenatally and offspring were assessed in infancy, childhood, adolescence, and young adulthood. In previous studies, PCE was linked to offspring behavior problems such as early substance use and externalizing behavior problems. The current analyses examine pathways from PCE to behavioral outcomes in offspring at the 25-year assessment. Prenatal cocaine exposure was moderate in this cohort; most women decreased or discontinued use after the first trimester. During the first and third trimesters, 38% and 11% used cocaine, respectively. This represents the most common pattern of PCE in non-treatment samples. At this phase, the adult offspring were, on average, 27.3 years old (range = 25-30), had 13.4 years of education, 83% were employed, 55% were Black, and 55% were female. Offspring who were exposed to cocaine during the first trimester were significantly more likely to use marijuana in the past year, report more arrests, and have poorer scores on a decision-making task, controlling for other prenatal substance exposure, demographic, and socioeconomic factors. In mediation analyses, there were indirect pathways from PCE to current marijuana use through early initiation of marijuana use and 21-year marijuana use, and through 15-year status offenses and 21-year marijuana use. There was also an indirect pathway from PCE to lifetime arrests through early initiation of marijuana use and 21-year Conduct Disorder, although the direct pathway from PCE to arrests also remained significant. These findings are consistent with those from previous phases and are an indication that there are detrimental associations with PCE that persist across developmental stages and into adulthood.

Does prenatal cocaine exposure predict adolescent substance use?

Prenatal cocaine exposure (PCE) has rarely been examined as a predictor of substance use during late adolescence, and few studies have examined both the initiation of substance use and current substance use as outcomes. The present longitudinal study examined PCE, other prenatal exposures, and psychosocial risk factors for their association with substance use in mid to late adolescence. Adolescents (n = 150) followed since birth reported on their use of alcohol, cigarette, and cannabis every 6 months from age 15.0 to 17.5 using a computer-assisted self-administration version of the Youth Risk Behavior Survey. PCE did not predict substance use in a series of growth curve analyses. Several psychosocial risk factors were associated with adolescents' substance use. Having friends who use substances predicted past month cigarette and cannabis use as well as initiation of alcohol and cannabis use, while depressive symptoms predicted initiation of alcohol, cigarette, and cannabis use. The current findings suggest that more proximal psychosocial factors may play a greater role in adolescent substance use than prenatal substance exposure.

The association of prenatal cocaine exposure, externalizing behavior and adolescent substance use

Prenatal cocaine exposure (PCE) may increase adolescent substance use through alterations of neurotransmitter systems affecting fetal brain development. The relationship between PCE and substance use at 15 and 17 years was examined. Subjects (365: 186 PCE; 179 non-cocaine exposed (NCE)) supplied biologic and self-report data using the Youth Risk Behavior Surveillance System (YRBSS) and Computerized Diagnostic Interview Schedule for Children (C-DISC 4) at ages 15 and 17. The relationship between PCE and substance use was assessed using General Estimating Equation (GEE) analyses controlling for confounding factors including violence exposure and preschool lead level. Teens with PCE vs. NCE teens were 2 times more likely to use tobacco (OR=2.1; 95% CI 1.21-3.63; p<.001) and marijuana (OR=1.85; CI 1.18-2.91; p<.001) and have a substance use disorder at age 17 (OR=2.51; CI 1.00-6.28; p<.05). Evaluation of PCE status by gender revealed an association between PCE and marijuana use that was more pronounced for boys than girls at 17 years. Violence exposure was also a significant predictor of alcohol (p<.001), tobacco (p<.05), and marijuana (p<.0006) use and substance abuse/dependence (p<.01). Externalizing behavior at age 12 fully mediated the effects of PCE on substance use disorder at age 17 and partially mediated effects of PCE on tobacco use, but did not mediate effects on marijuana use. The percentage of substance use reported increased between 15 and 17 years, with no differences between the PCE and NCE groups. Data suggest specialized drug use prevention measures for children with PCE may benefit this high risk group.

Parental Substance Abuse As an Early Traumatic Event. Preliminary Findings on Neuropsychological and Personality Functioning in Young Drug Addicts Exposed to Drugs Early

Parental substance use is a major risk factor for child development, heightening the risk of drug problems in adolescence and young adulthood, and exposing offspring to several types of traumatic events. First, prenatal drug exposure can be considered a form of trauma itself, with subtle but long-lasting sequelae at the neuro-behavioral level. Second, parents' addiction often entails a childrearing environment characterized by poor parenting skills, disadvantaged contexts and adverse childhood experiences (ACEs), leading to dysfunctional outcomes. Young adults born from/raised by parents with drug problems and diagnosed with a Substance Used Disorder (SUD) themselves might display a particularly severe condition in terms of cognitive deficits and impaired personality function. This preliminary study aims to investigate the role of early exposure to drugs as a traumatic event, capable of affecting the psychological status of young drug addicts. In particular, it intends to examine the neuropsychological functioning and personality profile of young adults with severe SUDs who were exposed to drugs early in their family context. The research involved three groups, each consisting of 15 young adults (aged 18–24): a group of inpatients diagnosed with SUDs and exposed to drugs early, a comparison group of non-exposed inpatients and a group of non-exposed youth without SUDs. A neuropsychological battery (Esame Neuropsicologico Breve-2), an assessment procedure for personality disorders (Shedler-Westen Assessment Procedure-200) and the Symptom CheckList-90-Revised were administered. According to present preliminary results, young drug addicts exposed to drugs during their developmental age were characterized by elevated rates of neuropsychological impairments, especially at the expense of attentive and executive functions (EF); personality disorders were also common but did not differentiate them from non-exposed youth with SUDs. Alternative multi-focused prevention and intervention programs are needed for children of drug-misusing parents, addressing EF and adopting a trauma-focused approach.

Defining and distinguishing promotive and protective effects for childhood externalizing psychopathology: a systematic review

PURPOSE

We examine evidence for whether decreases in externalizing behaviors are driven by the absence of risk (e.g., lack of poor housing quality) or the presence of something positive (e.g., good housing quality). We also review evidence for whether variables have promotive (main) effects or protective (buffering) effects within contexts of risks.

METHODS

We conducted a systematic review of longitudinal studies. First, we review studies (n = 7) that trichotomized continuous predictor variables. Trichotomization tests whether the positive end of a variable (e.g., good housing quality) is associated with lower delinquency compared with the mid-range, and whether mid-range scores are associated with fewer problems than the "risky" end (e.g., poor housing quality). We do not review dichotomous variables, because the interpretation of results is the same regardless of which value is the reference group. To address our second aim, we review studies (n = 53) that tested an interaction between a risk and positive factor.

RESULTS

Both the absence of risk and the presence of positive characteristics were associated with low externalizing problems for IQ, temperament, and some family variables. For other variables, associations with low delinquency involved only the presence of something positive (e.g., good housing quality), or the absence of a risk factor (e.g., community crime). The majority of studies that tested interactions among individual and family characteristics supported protective, rather than promotive, effects. Few studies tested interactions among peer, school, and neighborhood characteristics.

CONCLUSIONS

We discuss implications for conceptual understanding of promotive and protective factors and for intervention and prevention strategies.

Violence Exposure and Early Substance Use in High-Risk Adolescents

This study examines the relationship between violence exposure and early substance use as mediated by trauma symptoms. The Assessment of Liability and Exposure to Substance Use and Antisocial Behavior Scale was used to assess violence exposure at age 10 and substance use by age 12. Mediation analysis indicated direct relationships between violence exposure and tobacco/illegal drug use and indirect relationships between violence exposure and girls' substance use through trauma symptoms. Practitioners should consider violence exposure as a risk factor for early substance use in high-risk youths and potential gender differences in trauma symptom pathways to early substance use.

Pathways to adolescent sexual risk behaviors: Effects of prenatal cocaine exposure

BACKGROUND

To assess the impact of prenatal cocaine exposure (PCE) on adolescent sexual risk behaviors. Externalizing behavior, teen substance use, and early sexual intercourse were examined as pathways mediating the effects of PCE on sexual risk behaviors.

METHODS

Adolescents (N=364; 185 PCE, 179 non-cocaine exposure (NCE); 205 girls, 159 boys), primarily African-American and of low socioeconomic status, were prospectively enrolled in a longitudinal study at birth. Risky sexual behaviors were assessed at ages 15 and 17. Externalizing behavior at 12 years was assessed with the Youth Self-Report. Substance use, via self-report and biologic assays, and early (before age 15) sexual intercourse were assessed at age 15. Path analyses with the weighted least squares estimator with mean and variance adjustments were performed.

RESULTS

The final structural equation model-based path model, χ(2)=31.97 (df=27), p=.23, CFI=.99, TLI=.99, RMSEA=.021, WRMR=.695, indicated a direct effect of PCE on sexual risk behavior (β=.16, p=.02). Although PCE was related to greater externalizing behavior (β=.14, p=.009), which in turn, predicted early sexual intercourse (β=.16, p=.03), leading to sexual risk behavior (β=.44, p<.001), bootstrapping indicated a non-significant indirect effect (β=.01, p>.10). Substance use was correlated with early sexual intercourse (r=.60, p<.001) and predicted sexual risk behavior by age 17 (β=.31, p=.01).

CONCLUSIONS

Prenatal cocaine exposure was related to more engagement in sexual risk behaviors, suggesting the importance of reducing substance use among pregnant women as a means of prevention of offspring substance use and sexual risk behavior.

Constructing and Adapting Causal and Formative Measures of Family Settings: The HOME Inventory as Illustration

Measures of the home environment are frequently used in studies of children's development. This review provides information on indices composed of causal and formative indicators (the kind of indicators often used to capture salient aspects of family environments) and to suggest approaches that may be useful in constructing such measures for diverse populations. The HOME Inventory is used to illustrate challenges scholars face in determining what to include in useful measures of family settings. To that end, a cross-cultural review of research on relations among HOME, family context, and child outcomes is presented. The end of the review offers a plan for how best to further research on relations between the home environment and child development for diverse populations.

Executive function and cortical thickness in youths prenatally exposed to cocaine, alcohol and tobacco

Small and detrimental, albeit inconsistent, effects of prenatal cocaine exposure (PCE) during early childhood have been reported. The teratogenic effects of prenatal alcohol (PAE) and tobacco exposure (PTE) on neurobehavior are more firmly established than PCE. We tested if co-exposure to all three drugs could be related to greater differences in brain structure than exposure to cocaine alone. Participants (n=42, PCE=27; age range=14-16 years) received an executive function battery prior to a T1-weighted 3T structural MRI scan. Cortical thickness was measured using FreeSurfer (v5.1). Fetal drug exposure was quantified through maternal self-reports usage during pregnancy. Using general linear modeling, we found no main effects of PCE on cortical thickness, but significant main effects of PAE and PTE in superior and medial frontal regions, after co-varying for the effects of age, sex, and each drug of exposure. Significant alcohol-by-tobacco interactions, and significant cocaine-by-alcohol interactions on cortical thickness in medial parietal and temporal regions were also observed. Poly-drug exposure and cognitive function also showed significant interactions with cortical thickness: lower cortical thickness was associated with better performance in PCE-exposed adolescents. Results suggest that although children with PCE have subtle but persistent brain cortical differences until mid-to-late adolescence.

Effects of prenatal cocaine exposure on early sexual behavior: Gender difference in externalizing behavior as a mediator

BACKGROUND

Prenatal cocaine exposure (PCE) is associated with increased risk for externalizing behavior problems; childhood externalizing behavior problems are linked with subsequent early sexual behavior. The present study examined the effects of PCE on early sexual initiation (sexual intercourse prior to age 15) and whether externalizing behavior in preadolescence mediated the relationship.

METHODS

Three hundred fifty-four (180 PCE and 174 non-cocaine exposed; 192 girls, 142 boys), primarily African-American, low socioeconomic status, 15-year-old adolescents participated in a prospective longitudinal study. Adolescents' sexual behavior was assessed at 15 years using the Youth Risk Behavior Surveillance System. Externalizing behavior was assessed at 12 years using the Youth Self-Report.

RESULTS

Logistic regression models indicated that adolescents with PCE (n=69, 38%) were 2.2 times more likely (95% CI=1.2-4.1, p<.01) to engage in early sexual intercourse than non-exposed peers (n=49, 28%) controlling for covariates. This relationship was fully mediated by self-reported externalizing behavior in girls but not in boys, suggesting childhood externalizing behavior as a gender moderated mediator. Blood lead level during preschool years was also related to a greater likelihood of early sexual intercourse (OR=2.6, 95% CI=1.4-4.7, p<.002). Greater parental monitoring decreased the likelihood of early sexual intercourse, while violence exposure increased the risk.

CONCLUSIONS

PCE is related to early sexual intercourse, and externalizing behavior problems mediate PCE effects in female adolescents. Interventions targeting externalizing behavior may reduce early sexual initiation and thereby reduce HIV risk behaviors and early, unplanned pregnancy in girls with PCE.

Prenatal drug exposure, behavioral problems, and drug experimentation among African-American urban adolescents

PURPOSE

To examine how prenatal drug exposure (PDE) to heroin/cocaine and behavioral problems relate to adolescent drug experimentation.

METHODS

The sample included African-American adolescents (mean age = 14.2 years, SD = 1.2) with PDE (n = 73) and a nonexposed community comparison (n = 61). PDE status was determined at delivery through toxicology analysis and maternal report. Internalizing/externalizing problems were assessed during adolescence with the Behavior Assessment System for Children, Second Edition. Drug experimentation was assessed by adolescent report and urine analysis. Logistic regression evaluated the likelihood of drug experimentation related to PDE and behavioral problems, adjusting for age, gender, PDE, perceived peer drug use, and caregiver drug use. Interaction terms examined gender modification.

RESULTS

Sixty-seven subjects (50%) used drugs: 25 (19%) used tobacco/alcohol only and 42 (31%) used marijuana/illegal drugs. Ninety-four subjects (70%) perceived peer drug use. PDE significantly increased the risk of tobacco/alcohol experimentation (odds ratio = 3.07, 95% confidence interval [CI] 1.09-8.66, p = .034) but not after covariate adjustment (adjusted odds ratio [aOR] = 1.16, 95% CI .31-4.33, p > .05). PDE was not related to the overall or marijuana/illegal drug experimentation. The likelihood of overall drug experimentation was doubled per SD increase in externalizing problems (aOR = 2.28, 95% CI 1.33-3.91, p = .003) and, among girls, 2.82 times greater (aOR = 2.82, 95% CI 1.34-5.94, p = .006) per SD increase in internalizing problems. Age and perceived peer drug use were significant covariates.

CONCLUSIONS

Drug experimentation was relatively common (50%), especially in the context of externalizing problems, internalizing problems (girls only), older age, and perceived peer drug use. Findings support the Problem Behavior Theory and suggest that adolescent drug prevention addresses behavioral problems and promotes prosocial peer groups.

Problematic substance use in urban adolescents: role of intrauterine exposures to cocaine and marijuana and post-natal environment

BACKGROUND

Linkages between intrauterine exposures to cocaine and marijuana and adolescents' problematic substance use have not been fully delineated.

METHODS

Prospective longitudinal study with assessors unaware of intrauterine exposure history followed 157 urban participants from birth until late adolescence. Level of intrauterine exposures was identified by mother's report and infant's meconium. Problematic substance use, identified by the Voice Diagnostic Interview Schedule for Children (V-DISC) or the Audio Computer Assisted Self-Interview (ACASI) and urine assay, was a composite encompassing DSM-IV indication of tolerance, abuse, and dependence on alcohol, marijuana, and tobacco and any use of cocaine, glue, or opiates.

RESULTS

Twenty percent (32/157) of the sample experienced problematic substance use by age 18 years, of whom the majority (22/157) acknowledged abuse, tolerance or dependence on marijuana with or without other substances. Structural equation models examining direct and indirect pathways linking a Cox survival model for early substance initiation to a logistic regression models found effects of post-natal factors including childhood exposure to violence and household substance use, early youth substance initiation, and ongoing youth violence exposure contributing to adolescent problematic substance use.

CONCLUSION

We did not identify direct relationships between intrauterine cocaine or marijuana exposure and problematic substance use, but did find potentially modifiable post-natal risk factors also noted to be associated with problematic substance use in the general population including earlier substance initiation, exposure to violence and to household substance use.

Self-reported adolescent behavioral adjustment: effects of prenatal cocaine exposure

PURPOSE

To assess the direct effects of prenatal cocaine exposure (PCE) on adolescent internalizing, externalizing, and attention problems, controlling for confounding drug and environmental factors.

METHOD

At 12 and 15 years of age, 371 adolescents (189 PCE and 182 noncocaine exposed), primarily African-American and of low socioeconomic status, participating in a longitudinal, prospective study from birth were assessed for behavioral adjustment using the Youth Self-Report.

RESULTS

Longitudinal mixed model analyses indicated that PCE was associated with greater externalizing behavioral problems at ages 12 and 15 years and more attention problems at age 15, after controlling for confounders. PCE effects were not found for internalizing behaviors. PCE adolescents in adoptive/foster care reported more externalizing and attention problems than PCE adolescents in biological mother/relative care at age 12 or noncocaine-exposed adolescents at both ages. No PCE by gender interaction was found. Prenatal marijuana exposure, home environment, parental attachment and monitoring, family conflict, and violence exposure were also significant predictors of adolescent behavioral adjustment.

CONCLUSIONS

PCE is a risk factor for poor behavioral adjustment in adolescence.

Externalizing behavior and substance use related problems at 15 years in prenatally cocaine exposed adolescents

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.

Effects of prenatal cocaine exposure on child behavior and growth at 10 years of age

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.

Systematic review of prenatal cocaine exposure and adolescent development

BACKGROUND AND OBJECTIVE

Previous research found that prenatal cocaine exposure (PCE) may increase children's vulnerability to behavior and cognition problems. Maturational changes in brain and social development make adolescence an ideal time to reexamine associations. The objective was to conduct a systematic review of published studies examining associations between PCE and adolescent development (behavior, cognition/school outcomes, physiologic responses, and brain morphology/functioning).

METHODS

Articles were obtained from PubMed, PsycInfo, Web of Science, and CINAHL databases through July 2012 with search terms: prenatal drug, substance, or cocaine exposure; adolescence/adolescent; and in utero substance/drug exposure. Criteria for inclusion were nonexposed comparison group, human adolescents aged 11 to 19, peer-reviewed, English-language, and adolescent outcomes.

RESULTS

Twenty-seven studies representing 9 cohorts met the criteria. Four outcome categories were identified: behavior, cognition/school performance, brain structure/function, and physiologic responses. Eleven examined behavior; 7 found small but significant differences favoring nonexposed adolescents, with small effect sizes. Eight examined cognition/school performance; 6 reported significantly lower scores on language and memory tasks among adolescents with PCE, with varying effect sizes varied. Eight examined brain structure/function and reported morphologic differences with few functional differences. Three examined physiologic responses with discordant findings. Most studies controlled for other prenatal exposures, caregiving environment, and violence exposure; few examined mechanisms.

CONCLUSIONS

Consistent with findings among younger children, PCE increases the risk for small but significantly less favorable adolescent functioning. Although the clinical importance of differences is often unknown, the caregiving environment and violence exposure pose additional threats. Future research should investigate mechanisms linking PCE with adolescent functioning.

Risk-taking behavior among adolescents with prenatal drug exposure and extrauterine environmental adversity

OBJECTIVE

High-risk environments characterized by familial substance use, poverty, inadequate parental monitoring, and violence exposure are associated with an increased propensity for adolescents to engage in risk-taking behaviors (e.g., substance use, sexual behavior, and delinquency). However, additional factors such as drug exposure in utero and deficits in inhibitory control among drug-exposed youth may further influence the likelihood that adolescents in high-risk environments will engage in risk-taking behavior. This study examined the influence of prenatal substance exposure, inhibitory control, and sociodemographic/environmental risk factors on risk-taking behaviors in a large cohort of adolescents with and without prenatal cocaine exposure (PCE).

METHOD

Risk-taking behavior (delinquency, substance use, and sexual activity) was assessed in 963 adolescents (433 cocaine-exposed, 530 nonexposed) at 15 years of age.

RESULTS

Prenatal cocaine exposure predicted later arrests and early onset of sexual behavior in controlled analyses. Associations were partially mediated, however, by adolescent inhibitory control problems. PCE was not associated with substance use at this age. In addition, male gender, low parental involvement, and violence exposure were associated with greater odds of engaging in risk-taking behavior across the observed domains.

CONCLUSIONS

Study findings substantiate concern regarding the association between prenatal substance exposure and related risk factors and the long-term outcomes of exposed youth. Access to the appropriate social, educational, and medical services is essential in preventing and intervening with risk-taking behaviors and the potential consequences (e.g., adverse health outcomes and incarceration), especially among high-risk adolescent youth and their families.

Adolescent initiation of drug use: effects of prenatal cocaine exposure

OBJECTIVE

To investigate the direct effects of prenatal cocaine exposure (PCE) on adolescent drug use, while controlling for other predictors of adolescent use.

METHOD

Data are from a longitudinal study of PCE in which women and their offspring were assessed throughout childhood. Adolescents were interviewed at 15 years about their age at initiation of alcohol, marijuana, and tobacco. The sample consisted of 214 adolescents and their caregivers: 50% was of white ethnicity, and 50% African American.

RESULTS

First trimester cocaine exposure significantly predicted earlier adolescent marijuana and alcohol initiation. The hazard of marijuana and alcohol initiation among exposed adolescents was almost two times greater than among nonexposed adolescents, adjusting for other significant factors. There were no differences in tobacco initiation. Other significant predictors of adolescent drug use were family history of alcohol problems, exposure to violence, and childhood maltreatment.

CONCLUSIONS

Cocaine exposure during early pregnancy was associated with initiation of marijuana and alcohol use. Exposure to violence, childhood maltreatment, and familial factors also predicted adolescent initiation, but did not mitigate the effects of PCE. The combination of these risk factors has significant implications for the development of later substance use, social, and psychiatric problems.

Protective factors can mitigate behavior problems after prenatal cocaine and other drug exposures

BACKGROUND

We determined the role of risk and protective factors on the trajectories of behavior problems associated with high prenatal cocaine exposure (PCE)/polydrug exposure.

METHODS

The Maternal Lifestyle Study enrolled 1388 children with or without PCE, assessed through age 15 years. Because most women using cocaine during pregnancy also used other substances, we analyzed for the effects of 4 categories of prenatal drug exposure: high PCE/other drugs (OD), some PCE/OD, OD/no PCE, and no PCE/no OD. Risks and protective factors at individual, family, and community levels that may be associated with behavior outcomes were entered stepwise into latent growth curve models, then replaced by cumulative risk and protective indexes, and finally by a combination of levels of risk and protective indexes. Main outcome measures were the trajectories of externalizing, internalizing, total behavior, and attention problems scores from the Child Behavior Checklist (parent).

RESULTS

A total of 1022 (73.6%) children had known outcomes. High PCE/OD significantly predicted externalizing, total, and attention problems when considering the balance between risk and protective indexes. Some PCE/OD predicted externalizing and attention problems. OD/no PCE also predicted behavior outcomes except for internalizing behavior. High level of protective factors was associated with declining trajectories of problem behavior scores over time, independent of drug exposure and risk index scores.

CONCLUSIONS

High PCE/OD is a significant risk for behavior problems in adolescence; protective factors may attenuate its detrimental effects. Clinical practice and public health policies should consider enhancing protective factors while minimizing risks to improve outcomes of drug-exposed children.

Memory ability and hippocampal volume in adolescents with prenatal drug exposure

The objective of the present study was to examine the influence of prenatal drug exposure (PDE) on memory performance and supporting brain structures (i.e., hippocampus) during adolescence. To achieve this goal, declarative memory ability and hippocampal volume were examined in a well-characterized sample of 138 adolescents (76 with a history of PDE and 62 from a non-exposed comparison group recruited from the same community, mean age=14 years). Analyses were adjusted for: age at time of the assessments, gender, IQ, prenatal exposure to alcohol and tobacco, and indices of early childhood environment (i.e., caregiver depression, potential for child abuse, and number of caregiver changes through 7 years of age). Results revealed that adolescents with a history of PDE performed worse on the California Verbal Learning Test-Child Version (CVLT-C), and story recall from the Children's Memory Scale (CMS), and had larger hippocampal volumes, even after covariate adjustment. Hippocampal volume was negatively correlated with memory performance on the CVLT-C, with lower memory scores associated with larger volumes. These findings provide support for long-term effects of PDE on memory function and point to neural mechanisms that may underlie these outcomes.