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Lewis BA, Minnes S, Short EJ, Min MO, Wu M, Lang A, Weishampel P, Singer LT. Language outcomes at 12 years for children exposed prenatally to cocaine. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2013; 56:1662-76. [PMID: 24149136 PMCID: PMC4131682 DOI: 10.1044/1092-4388(2013/12-0119)] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
PURPOSE 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. METHOD 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 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. CONCLUSIONS 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.
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Lewis BA, Minnes S, Short EJ, Weishampel P, Satayathum S, Min MO, Nelson S, Singer LT. The effects of prenatal cocaine on language development at 10 years of age. Neurotoxicol Teratol 2010; 33:17-24. [PMID: 20600843 DOI: 10.1016/j.ntt.2010.06.006] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2009] [Revised: 06/21/2010] [Accepted: 06/21/2010] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To examine the long term effects of prenatal cocaine exposure (PCE) on the language development of 10-year-old children utilizing a prospective design, controlling for confounding drug and environmental factors. PARTICIPANTS Children exposed to cocaine in utero (PCE; n=175) and non-exposed children (NCE; n=175) were followed prospectively to 10years of age and were compared on language subscales of the Test of Language Development-Intermediate 3rd Edition (TOLD-I:3) and phonological processing as measured by the Comprehensive Test of Phonological Processing (CTOPP). METHODS Multivariate analysis of covariance (MANCOVA), linear regression, and logistic regressions were used to evaluate the relationship of prenatal cocaine exposure to language development, while controlling for confounders. RESULTS After controlling for confounding variables, prenatal cocaine effects were observed for specific aspects of language including syntax (Sentence Combining subtest of the TOLD-I:3, p=0.001), semantics (Malopropism subtest of the TOLD-I:3, p=0.05) and phonological processing (Phonological Awareness subscale, p=0.01). The caregiver factors of vocabulary, HOME, and psychological symptoms also had consistent effects on language subtests and phonological processing scores. Children with PCE who experienced foster or adoptive care had enhanced language development compared to those living with birth mothers or in relative care. Cocaine exposed girls had lower scores on the phonological awareness subscale of the CTOPP than non-exposed girls. CONCLUSIONS PCE has subtle effects on specific aspects of language development and phonological processing at age 10, even after controlling for confounding variables. Environmental factors (i.e., postnatal lead exposure, home environment, and caregiver vocabulary and psychological symptoms) also impact language skills at 10years. Adoptive or foster care appears to enrich PCE children's linguistic environment and protects children against language delay in the PCE sample.
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Affiliation(s)
- Barbara A Lewis
- Department of Communication Sciences, Case Western Reserve University, Cleveland, OH 44106, USA.
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Cone-Wesson B. Prenatal alcohol and cocaine exposure: influences on cognition, speech, language, and hearing. JOURNAL OF COMMUNICATION DISORDERS 2005; 38:279-302. [PMID: 15862811 DOI: 10.1016/j.jcomdis.2005.02.004] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2004] [Revised: 02/11/2005] [Accepted: 02/11/2005] [Indexed: 05/24/2023]
Abstract
UNLABELLED This paper reviews research on the consequences of prenatal exposure to alcohol and cocaine on children's speech, language, hearing, and cognitive development. The review shows that cognitive impairment, learning disabilities, and behavioral disorders are the central nervous system manifestations of fetal alcohol syndrome (FAS), and cranio-facial abnormalities are also present. Delays in language acquisition, as well as receptive and expressive language deficits, are commonly reported. The cranio-facial abnormalities of FAS, which sometimes include cleft palate, make the child prone to otitis media with effusion and conductive hearing loss. The family environment in which one or both parents is a heavy alcohol user presents challenges to a child with normal intelligence, but may be especially deleterious to the child with mental retardation. Prenatal exposure to cocaine results in subtle cognitive disabilities when measured at 4 years of age. The cognitive effects may be ameliorated by a stimulating and sensitive care-giving environment. A small, deleterious "cocaine-effect" is also seen in speech and language development. The child with prenatal exposure to cocaine may be considered at increased risk for language delay or disorder. There is no evidence that prenatal cocaine exposure by itself is a risk factor for sensorineural hearing impairment, although auditory evoked potentials from the brainstem and cortex suggest some abnormalities in central auditory processing, at least during the newborn period. The strong effect of the home environment for ameliorating the effects of prenatal cocaine-exposure suggests that a family-focused approach for cognitive, language, and social-emotional habilitation would be beneficial to all. LEARNING OUTCOMES The learner will be able to describe the major features of fetal alcohol syndrome and how they relate to speech, language, hearing, and cognitive disorders. The learner will review the literature and determine research needs with respect to language, speech, and hearing among infants and children with fetal alcohol syndrome. Similarly, the learner will distinguish the outcomes of prenatal alcohol-exposure from those of prenatal cocaine-exposure. The learner will summarize the controversy regarding the possible stigmatization of cocaine-exposed infants. The learner will summarize the speech, language, and hearing effects of prenatal cocaine-exposure.
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Affiliation(s)
- Barbara Cone-Wesson
- Speech Language and Hearing Sciences, University of Arizona, P.O. Box 210071, 1131 E. Second Street, Tucson, AZ 85718, USA.
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Morrow CE, Vogel AL, Anthony JC, Ofir AY, Dausa AT, Bandstra ES. Expressive and receptive language functioning in preschool children with prenatal cocaine exposure. J Pediatr Psychol 2004; 29:543-54. [PMID: 15347702 PMCID: PMC2653083 DOI: 10.1093/jpepsy/jsh056] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To estimate the relationship between severity of prenatal cocaine exposure and expressive and receptive language skills in full-term, African American children at age 3 years. METHODS Language was assessed at age 3 using the Clinical Evaluation of Language Fundamentals-Preschool (CELF-P). The sample included 424 children (226 cocaine exposed, 198 non-cocaine exposed) who received preschool language assessments at age 3, drawn from a cohort of 476 children enrolled prospectively at birth. RESULTS Structural equation modeling was used to regress expressive and receptive language as intercorrelated response variables on level of prenatal cocaine exposure, measured by a latent construct including maternal self-report of cocaine use and maternal/infant urine toxicology assays and infant meconium. Results indicated a.168 SD decrease in expressive language functioning for every unit increase in exposure level (95% CI = -.320, -.015; p =.031) after consideration for fetal growth and gestational age as correlated response variables. Receptive language was more modestly related to prenatal cocaine exposure and was not statistically significant. Results for expressive language remained stable with inclusion of the McCarthy general cognitive index as a response variable (expressive language beta = -.173, 95% CI = -.330, -.016; p =.031), and with adjustment for maternal age and prenatal exposures to alcohol, tobacco, and marijuana (expressive language beta = -.175, 95% CI = -.347, -.003; p =.046). Additional child and caregiver environmental variables assessed at age 3 were also evaluated in varying statistical models with similar results. CONCLUSION The evidence from this study supports a gradient relationship between increased level of prenatal cocaine exposure and decreased expressive language functioning in preschool-aged cocaine-exposed children.
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Affiliation(s)
- Connie E Morrow
- Department of Pediatrics, University of Miami School of Medicine, Miami, Florida 33101, USA.
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Lewis BA, Singer LT, Short EJ, Minnes S, Arendt R, Weishampel P, Klein N, Min MO. Four-year language outcomes of children exposed to cocaine in utero. Neurotoxicol Teratol 2004; 26:617-27. [PMID: 15315811 DOI: 10.1016/j.ntt.2004.06.007] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2003] [Revised: 06/09/2004] [Accepted: 06/14/2004] [Indexed: 11/23/2022]
Abstract
A large cohort of children exposed to cocaine in utero (n=189) were followed prospectively from birth to 4 years of age and compared to nonexposed children (n=185) on the Clinical Evaluation of Language Fundamentals-Preschool (CELF-P), a measure of receptive and expressive language abilities. Children exposed to cocaine in utero performed more poorly on the expressive and total language measures than nonexposed children after controlling for confounding variables, including prenatal exposure to alcohol, marijuana, and tobacco, as well as medical and sociodemographic variables. Children exposed to cocaine had more mild receptive language delays than nonexposed children and were less likely to have higher expressive abilities. Also, maternal factors such as language ability, performance IQ, race, and education correlated with child language abilities. Prenatal cigarette and marijuana exposure were related to deficits in specific language skills. Children placed in adoptive or foster care who were cocaine exposed demonstrated superior language skills compared to children exposed to cocaine who remained in biological relative or mother's care. These findings support a cocaine-specific effect on language skills in early childhood that may be modified with an enriched environment.
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Affiliation(s)
- Barbara A Lewis
- Department of Pediatrics, Case Western Reserve University School of Medicine, 10900 Euclid Avenue, Cleveland, OH 44106, USA.
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Bandstra ES, Vogel AL, Morrow CE, Xue L, Anthony JC. Severity of prenatal cocaine exposure and child language functioning through age seven years: a longitudinal latent growth curve analysis. Subst Use Misuse 2004; 39:25-59. [PMID: 15002943 PMCID: PMC2634602 DOI: 10.1081/ja-120027765] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
The current study estimates the longitudinal effects of severity of prenatal cocaine exposure on language functioning in an urban sample of full-term African-American children (200 cocaine-exposed, 176 noncocaine-exposed) through age 7 years. The Miami Prenatal Cocaine Study sample was enrolled prospectively at birth, with documentation of prenatal drug exposure status through maternal interview and toxicology assays of maternal and infant urine and infant meconium. Language functioning was measured at ages 3 and 5 years using the Clinical Evaluation of Language Fundamentals--Preschool (CELF-P) and at age 7 years using the Core Language Domain of the NEPSY: A Developmental Neuropsychological Assessment. Longitudinal latent growth curve analyses were used to examine two components of language functioning, a more stable aptitude for language performance and a time-varying trajectory of language development, across the three time points and their relationship to varying levels of prenatal cocaine exposure. Severity of prenatal cocaine exposure was characterized using a latent construct combining maternal self-report of cocaine use during pregnancy by trimesters and maternal and infant bioassays, allowing all available information to be taken into account. The association between severity of exposure and language functioning was examined within a model including factors for fetal growth, gestational age, and IQ as intercorrelated response variables and child's age, gender, and prenatal alcohol, tobacco, and marijuana exposure as covariates. Results indicated that greater severity of prenatal cocaine exposure was associated with greater deficits within the more stable aptitude for language performance (D = -0.071, 95% CI = -0.133, -0.009; p = 0.026). There was no relationship between severity of prenatal cocaine exposure and the time-varying trajectory of language development. The observed cocaine-associated deficit was independent of multiple alternative suspected sources of variation in language performance, including other potential responses to prenatal cocaine exposure, such as child's intellectual functioning, and other birth and postnatal influences, including language stimulation in the home environment.
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Affiliation(s)
- Emmalee S Bandstra
- Department of Pediatrics, University of Miami School of Medicine, Miami, Florida 33101, USA.
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Morrow CE, Bandstra ES, Anthony JC, Ofir AY, Xue L, Reyes MB. Influence of prenatal cocaine exposure on early language development: longitudinal findings from four months to three years of age. J Dev Behav Pediatr 2003; 24:39-50. [PMID: 12584484 PMCID: PMC2641033 DOI: 10.1097/00004703-200302000-00009] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The influence of prenatal cocaine exposure on children's language functioning was evaluated longitudinally at six time points from 4 months to 3 years of age. The Miami Prenatal Cocaine Study prospectively enrolled 476 full-term African-American infants at birth, categorized as cocaine-exposed (n = 253) or non-cocaine-exposed (n = 223) by maternal self-report and bioassays (maternal/infant urine, meconium). The Bayley Scales of Infant Development, scored using the Kent Scoring Adaptation for language, was administered at 4, 8, 12, 18, and 24 months. The Clinical Evaluation of Language Fundamentals-Preschool was administered at 3 years. In longitudinal analyses using Generalized Estimating Equations, cocaine-exposed children had lower overall language skills than non-cocaine-exposed children (D = -0.151; 95% CI = -0.269, -0.033; p =.012). Longitudinal findings remained stable after evaluation of potential confounding influences including other prenatal substance exposures and sociodemographic factors. Preliminary evidence also indicated possible mediation through an intermediary effect involving cocaine-associated deficits in fetal growth.
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Affiliation(s)
- Connie E Morrow
- University of Miami School of Medicine, Department of Pediatrics, P.O. Box 016960 (M-808), Miami, FL 33101, USA.
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Hyter YD, Atchison B, Henry J, Sloane M, Black-Pond C. A response to traumatized children: developing a best practices model. Occup Ther Health Care 2002; 15:113-40. [PMID: 23952026 DOI: 10.1080/j003v15n03_07] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
SUMMARY This manuscript describes the key components for establishing collaborative partnerships in the delivery of services to children who have been traumatized by abuse, neglect, and prenatal exposure to alcohol. Specifically, the manuscript addresses: the national need for such collaborative partnerships; the effects of abuse, neglect, and prenatal exposure to alcohol on developmental and educational outcomes; the process used to develop the children's trauma assessment center (CTAC) including discussion on the family centered and transdisciplinary nature of the center; and the accomplishment and future goals of CTAC. The members of the CTAC team currently include the disciplines of counseling, occupational therapy, pediatric medicine, social work, and speech-language pathology. Future goals include expanding the core team to include the nursing and educational psychology disciplines.
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Affiliation(s)
- Yvette D Hyter
- Western Michigan University, Southwestern Michigan Children's Trauma Assessment Center, 1000 Oakland Drive, 3rd floor, Kalamazoo, MI, 49008
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Potter SM, Zelazo PR, Stack DM, Papageorgiou AN. Adverse effects of fetal cocaine exposure on neonatal auditory information processing. Pediatrics 2000; 105:E40. [PMID: 10699142 DOI: 10.1542/peds.105.3.e40] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Studies with animals have shown that in utero exposure to cocaine interferes with fetal brain development by disrupting the processes of neuronal proliferation, differentiation, and migration, often leading to subsequent neurobehavioral deficits. However, studies with humans have produced inconsistent findings. Although neurobehavioral abnormalities have been observed among cocaine-exposed infants in several studies and in some cases dose-response effects have been found, the specific neurobehaviors affected vary from one study to the next. Researchers studying the effects of fetal cocaine-exposure are faced with many difficult challenges. For example, women who use cocaine typically use other substances in addition to cocaine, many of the methods available for identifying cocaine-exposed neonates are not reliable, and the available methods for assessing cocaine-exposed newborns may not be sufficiently sensitive to detect the subtle effects of cocaine on the developing central nervous system. Despite these difficulties, there is a growing body of research that suggests that fetal cocaine exposure is associated with subsequent language deficits among children exposed in utero. However, it is virtually impossible to disentangle the effects of the impoverished environments in which these children are often raised from the effect, if any, of fetal cocaine exposure. To determine the effects of fetal cocaine exposure independent of postnatal environmental effects, cocaine-exposed neonates would ideally be tested within the first few weeks of birth, and to identify early risks for subsequent language delay, well-researched auditory information processing measures could be used. OBJECTIVE The purpose of the present study was to assess the effects of fetal cocaine exposure on neonatal auditory information processing ability. To overcome limitations of some previous studies on the neuroteratogenic effects of cocaine, such as unreliable subject identification techniques, inadequate control over confounding variables, and questionable measures of central nervous system integrity, a valid measure of auditory information processing was used in a rigorous, case-control design. METHOD Newborn information processing was assessed using habituation and recovery of head-turning toward an auditory stimulus across the 3 phases of the procedure: familiarization, novelty, and dishabituation. During the familiarization phase, the infant orients and habituates to a repeated word; during the novelty phase, the infant recovers head-turning to a novel word and subsequently habituates to this word; and during the dishabituation phase the infant displays renewed head-turning to the return of the original stimulus. Testing takes approximately 20 minutes. This procedure has been shown previously to discriminate among infants at high-, moderate-, and low-risk for subsequent developmental delay. Twenty-five cocaine-exposed and 25 nonexposed control neonates, identified by meconium analysis, urine analysis, and/or maternal self-report, were tested on the auditory information processing procedure. The majority of infants were tested within the first few days of birth. Cocaine-exposed and control neonates were matched on birth weight, gestational age, Apgar scores, age at testing, and socioeconomic status as reflected by household income. Mothers were matched on age, weight gain, cigarette smoking, and alcohol consumption. RESULTS Fetal cocaine exposure was associated with impaired auditory information processing. Both cocaine-exposed and nonexposed control neonates oriented to the familiarization stimulus, but cocaine-exposed neonates displayed impaired habituation. Moreover, cocaine-exposed neonates did not recover or habituate to the novel stimulus or dishabituate to the return of the familiarization stimulus. (ABSTRACT TRUNCATED)
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Affiliation(s)
- S M Potter
- Department of Psychology and Research Institute, McGill University and Montreal Children's Hospital, Montreal, Canada.
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