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Powers G, Lewis B, Min MO, Minnes S, Kim JY, Kim SK, Singer L. The association of prenatal cocaine exposure with expressive and receptive language skills, phonological processing and reading ability at age 17. Neurotoxicol Teratol 2023; 95:107135. [PMID: 36395974 DOI: 10.1016/j.ntt.2022.107135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 11/04/2022] [Accepted: 11/10/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Prenatal cocaine exposure (PCE) has been associated with small but significant effects on language development in childhood and early adolescence. This study examined whether this association persists into later adolescence and what relationship language skills may have with reading proficiency in this population. METHODS Enrolled were 338 (167 with PCE, 171 with NCE or no cocaine exposure) 17-year-olds recruited at birth who, together with their current caregiver, were seen as part of a 17-year follow-up. Participants were given assessments of reading achievement (WIAT-III), receptive and expressive language (CELF-IV), and phonological processing (CTOPP). Relationships between PCE status and language outcomes were modeled using multiple linear regression controlling for environmental and caregiver factors, and other prenatal substance exposures. RESULTS Adolescents with PCE scored lower in areas of phonological processing and reading related skills compared to adolescents with NCE. PCE by sex interactions were identified on language, memory and spoken language comprehension, with lower scores for girls with PCE compared to girls with NCE. CONCLUSION These findings suggest the persistence of PCE's relationship with phonological awareness well into adolescence. PCE was also associated with lower scores on measures of skills related to reading ability, which may be a manifestation of the observed deficits in phonological processing.
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Affiliation(s)
- Gregory Powers
- Jack, Joseph and Morton Mandel School of Applied Social Sciences, Case Western Reserve University, 11235 Bellflower Road, Cleveland,OH, United States.
| | - Barbara Lewis
- Department of Psychological Sciences, Case Western Reserve University, Cleveland, OH 44106, United States.
| | - Meeyoung O Min
- College of Social Work, University of Utah, 201 Presidents Circle, Salt Lake City, UT 84112, United States.
| | - Sonia Minnes
- Jack, Joseph and Morton Mandel School of Applied Social Sciences, Case Western Reserve University, 11235 Bellflower Road, Cleveland,OH, United States.
| | - June-Yung Kim
- Department of Social Work, University of North Dakota, Gillette Hall Room 302, 225 Centennial, Dr. Stop 7135, Grand Forks, ND 58202-7135, United States.
| | - Sun Kyung Kim
- Jack, Joseph and Morton Mandel School of Applied Social Sciences, Case Western Reserve University, 11235 Bellflower Road, Cleveland,OH, United States.
| | - Lynn Singer
- Department of Population and Quantitative Health Sciences, Case Western Reserve, University, 1090 Euclid Avenue, Cleveland, OH, 44106, United States.
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Martin MM, Graham DL, McCarthy DM, Bhide PG, Stanwood GD. Cocaine-induced neurodevelopmental deficits and underlying mechanisms. ACTA ACUST UNITED AC 2017; 108:147-73. [PMID: 27345015 DOI: 10.1002/bdrc.21132] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Accepted: 06/06/2016] [Indexed: 11/06/2022]
Abstract
Exposure to drugs early in life has complex and long-lasting implications for brain structure and function. This review summarizes work to date on the immediate and long-term effects of prenatal exposure to cocaine. In utero cocaine exposure produces disruptions in brain monoamines, particularly dopamine, during sensitive periods of brain development, and leads to permanent changes in specific brain circuits, molecules, and behavior. Here, we integrate clinical studies and significance with mechanistic preclinical studies, to define our current knowledge base and identify gaps for future investigation. Birth Defects Research (Part C) 108:147-173, 2016. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Melissa M Martin
- Department of Biomedical Sciences and Center for Brain Repair, Florida State University College of Medicine, Tallahassee, Florida
| | - Devon L Graham
- Department of Biomedical Sciences and Center for Brain Repair, Florida State University College of Medicine, Tallahassee, Florida
| | - Deirdre M McCarthy
- Department of Biomedical Sciences and Center for Brain Repair, Florida State University College of Medicine, Tallahassee, Florida
| | - Pradeep G Bhide
- Department of Biomedical Sciences and Center for Brain Repair, Florida State University College of Medicine, Tallahassee, Florida
| | - Gregg D Stanwood
- Department of Biomedical Sciences and Center for Brain Repair, Florida State University College of Medicine, Tallahassee, Florida
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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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Skogerbø Å, Kesmodel US, Denny CH, Kjaersgaard MIS, Wimberley T, Landrø NI, Mortensen EL. The effects of low to moderate alcohol consumption and binge drinking in early pregnancy on behaviour in 5-year-old children: a prospective cohort study on 1628 children. BJOG 2013; 120:1042-50. [PMID: 23837773 DOI: 10.1111/1471-0528.12208] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2012] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To examine the effects of low to moderate maternal alcohol consumption and binge drinking in early pregnancy on behaviour in children at the age of 5 years. DESIGN Prospective cohort study. SETTING Neuropsychological testing in four Danish cities, 2003-2008. POPULATION A total of 1628 women and their children sampled from the Danish National Birth Cohort. METHODS Participants were sampled based on maternal alcohol drinking patterns during early pregnancy. When the children were 5 years of age the parent and teacher versions of the Strengths and Difficulties Questionnaire (SDQ) were completed by the mothers and a preschool teacher, respectively. The full statistical model included the following potential confounding factors: maternal binge drinking or low to moderate alcohol consumption, respectively; parental education; maternal IQ; prenatal maternal smoking; the child's age at testing; the child's gender; maternal age; parity; maternal marital status; family home environment; postnatal parental smoking; prepregnancy maternal body mass index (BMI); and the child's health status. MAIN OUTCOME MEASURE Behaviour among children assessed by the SDQ parent and teacher forms. RESULTS Adjusted for all potential confounding factors, no statistically significant associations were observed between maternal low to moderate average weekly alcohol consumption and SDQ behavioural scores (OR 1.1, 95% CI 0.5-2.3; OR 1.1, 95% CI 0.6-2.1 for the total difficulties scores) or between binge drinking and SDQ behavioural scores (OR 1.2, 95% CI 0.8-1.7; OR 0.8, 95% CI 0.6-1.2). CONCLUSION This study observed no consistent effects of low to moderate alcohol consumption or binge drinking in early pregnancy on offspring behaviour at the age of 5 years.
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Affiliation(s)
- Å Skogerbø
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
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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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Lewis MW, Phillips G, Bowser M, DeLuca S, Johnson HL, Rosen TS. Cocaine-exposed infant behavior during Still-Face: risk factor analyses. THE AMERICAN JOURNAL OF ORTHOPSYCHIATRY 2009; 79:60-70. [PMID: 19290726 DOI: 10.1037/a0014931] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Prenatal cocaine exposure and the role of gender were evaluated using risk factor analyses to determine whether 6-month-old cocaine-exposed male infants demonstrated greater disruptions in infant-caregiver socioemotional interactions during a Still-Face test. Overall, non-cocaine-exposed infants spent more time looking at toys, compared with cocaine-exposed infants; nonexposed female infants spent more time scanning the environment, compared with nonexposed male infants. When caregiver behavior during the Still-Face was evaluated, differences emerged in amount of time the caregiver spent vocalizing to the infant. She vocalized more to a cocaine-exposed infant compared with a nonexposed one; she reduced vocalizing more during the test if the cocaine-exposed infant was female. An exposure by gender interaction emerged in the amount of change in caregiver vocalizations; however, the overarching hypothesis that male cocaine-exposed infants are at higher risk than nonexposed male, nonexposed female, and cocaine-exposed female infants was not supported. Because this interaction was evident in this cohort at 24 months, future research is needed to determine at what age an interaction begins to emerge in this cohort.
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Affiliation(s)
- Marilyn W Lewis
- College of Social Work, Ohio State University, Columbus, OH 43210, USA.
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CHURCH MICHAELW, CROSSLAND WILLIAMJ, HOLMES PAMELAA, OVERBECK GEORGEW, TILAK JACQUELINEP. Effects of Prenatal Cocaine on Hearing, Vision, Growth, and Behaviora. Ann N Y Acad Sci 2006; 846:12-28. [DOI: 10.1111/j.1749-6632.1998.tb09723.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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MAYES LINDAC, GRILLON CHRISTIAN, GRANGER RICHARD, SCHOTTENFELD RICHARD. Regulation of Arousal and Attention in Preschool Children Exposed to Cocaine Prenatally. Ann N Y Acad Sci 2006; 846:126-143. [DOI: 10.1111/j.1749-6632.1998.tb09731.x] [Citation(s) in RCA: 109] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Lewis MW, Misra S, Johnson HL, Rosen TS. Neurological and developmental outcomes of prenatally cocaine-exposed offspring from 12 to 36 months. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2004; 30:299-320. [PMID: 15230078 DOI: 10.1081/ada-120037380] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Second generation studies of prenatal cocaine exposure failed to find gross deficits after controlling for confounders. Concern remained that exposure could cause subtle deficits. This prospective, cohort study evaluated effects of cocaine on development at 12, 18, 24, and 36 months. From 1991-1993, 361 mother-infant pairs were recruited from the Children's Hospital of New York, Presbyterian Medical Center's prenatal clinic or delivery room suite. Mothers were assigned to the cocaine group based on report of prenatal cocaine use or positive urine toxicology. Control mothers were enrolled from the same clinic and matched for age and socioeconomic status (SES). Women with serious medical problems were excluded from either group. Of the retained cohort, at 12 months, 147 infants were exposed and 89 were unexposed case controls. Both groups were raised in impoverished environments with few supports. Developmental evaluations were conducted blinded to group. Cross-sectional analysis revealed cocaine-related deficits in neurological exams and speech across all time periods, in spite of catch up in weight, length, and head circumference. Overall analysis of development was evaluated using Generalized Estimating Equations regression analysis. Bayley Mental [Badj = -6.5 (CI--9.4, -3.5, p < or = 0.001)] and Psychomotor [Badj = -3.9 (CI--7.4, -0.5, p = 0.02)] Developmental Indices showed deficits after controlling for confounders. Males were more vulnerable to cocaine exposure for height, motor development, and emotional regulation. Dose-response relationships existed for abnormal neurological exams (Ptrends < 0.08), Mental Development Index (MDI) (Ptrend < 0.001), and Psychomotor Development Index (PDI) (Ptrend < 0.001) deficits. Although nonexposed children performed poorly, cocaine-exposed children showed worse performance. Both groups showed declines at 18 months in mental and psychomotor development from which only nonexposed children rebounded. Overall, cocaine exposure adds an additional risk to disadvantaged children's development. Cocaine-exposed children are less resilient to effects of these multiple risks.
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Affiliation(s)
- Marilyn W Lewis
- Alcohol Research Center, University of Connecticut School of Medicine, Farmington, Connecticut, 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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Abstract
PURPOSE To identify what women recovering from cocaine addiction think is needed of them to be good parents. DESIGN An exploratory descriptive design using in-depth, semistructured interviews, conducted in the woman's home or in a treatment center. Demographics and pregnancy history were collected during the interview. A convenience sample of 11 mothers recovering from cocaine addiction participated. RESULTS Content analysis was used to analyze the interview data. Five themes emerged from the interviews: lack of structure, abandonment, impatience/anger, lack of parenting knowledge, and repeating dysfunctional patterns from family of origin. CLINICAL IMPLICATIONS Women addicted to cocaine who are parenting children need strong encouragement from the healthcare system to begin a recovery program and also to gain parenting skills. Discussions of child development and parenting stresses should be included during the recovery process from addiction because lack of parenting knowledge might be a major barrier for them. This study can help nurses to provide improved care for women who are parenting children while using cocaine or other drugs.
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Gendle MH. Increases, Reductions, or No Effect? The Puzzle of Neural Findings from Animal Models of Prenatal Cocaine Exposure. JOURNAL OF DRUG ISSUES 2002. [DOI: 10.1177/002204260203200101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In the past 10 years, behavioral neuroscience research has revealed that prenatal exposure to cocaine results in a specific constellation of cognitive impairments, primarily within the domains of selective attention, sustained attention, and emotional reactivity. In this time, numerous animal models have been developed in an attempt to understand the biological basis of these cognitive and affective changes. However, several inconsistencies in key methodologies and experimental procedures utilized by these models have hindered the formulation of conclusions from this animal data. In this commentary, these procedural differences are discussed, and numerous criteria are proposed for evaluating the validity of animal models of prenatal cocaine exposure.
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Singer LT, Arendt R, Minnes S, Salvator A, Siegel AC, Lewis BA. Developing language skills of cocaine-exposed infants. Pediatrics 2001; 107:1057-64. [PMID: 11331686 DOI: 10.1542/peds.107.5.1057] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To assess whether there is an association of level of fetal cocaine exposure to developmental precursors of speech-language skills at 1 year of age, after controlling for confounding factors. DESIGN In a prospective, longitudinal, quasi-experimental, matched cohort design, 3 cocaine exposure groups were defined by maternal self-report and infant meconium assay: nonexposure (n = 131), heavier exposure (n = 66), >the 75th percentile for maternal self-report and >the 70th percentile of benzoylecgonine concentration, and all others as lighter exposure (n = 68). At 1 year of age, the Preschool Language Scale-3 was administered by examiners unaware of infant drug status. RESULTS Independent of confounding drug, medical, and environmental factors, more heavily exposed infants had lower auditory comprehension scores than nonexposed infants and lower total language scores than lighter and nonexposed infants. More heavily exposed infants were also more likely to be classified as mildly delayed by total language score than nonexposed infants. There were positive linear relationships between the concentration of benzoylecgonine in meconium and all outcomes and between maternal report of severity of prenatal cocaine use with poorer auditory comprehension indicating a relationship between amount of exposure and poorer outcomes. CONCLUSIONS This study documents significant behavioral teratogenic effects of fetal cocaine exposure on attentional abilities underlying auditory comprehension skills considered to be precursors of receptive language. Pediatricians are in a unique position to monitor early development of cocaine-exposed infants and make timely referrals for intervention.
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Affiliation(s)
- L T Singer
- Department of Pediatrics, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA.
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Abstract
In North America, an increasing number of babies are prenatally exposed to cocaine, yet the implications of cocaine use during pregnancy are not fully understood. The effects of cocaine are exerted primarily by its influence on aminergic receptors in the central and peripheral nervous systems. Developmental, physiological, and behavioral problems in infants and children are likely outcomes of maternal cocaine abuse, but these findings are confounded by concomitant use of other drugs such as marijuana and cocaine and by factors such as time, dosage, and route of cocaine intake. Different screening options exist for cocaine and its metabolites, including sampling of neonatal urine, hair and meconium need to be considered, as do the sensitivity and the ethical implications of such testing. Clinical management of cocaine-exposed infants requires attention to several issues, including: central nervous system irritation, cardiac anomalies, apnea, and feeding difficulties, as well as infant safety and follow-up postdischarge. Early detection and intervention remain the primary objectives of caring for cocaine-exposed infants.
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Affiliation(s)
- D F Askin
- Faculty of Nursing, University of Manitoba, Winnipeg, Manitoba
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Delaney-Black V, Covington C, Templin T, Kershaw T, Nordstrom-Klee B, Ager J, Clark N, Surendran A, Martier S, Sokol RJ. Expressive language development of children exposed to cocaine prenatally: literature review and report of a prospective cohort study. JOURNAL OF COMMUNICATION DISORDERS 2000; 33:463-481. [PMID: 11141028 DOI: 10.1016/s0021-9924(00)00033-2] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
It was hypothesized that prenatal exposure to cocaine and other substances would be related to delayed expressive language development. Speech and language data were available for 458 6-year olds (204 were exposed to cocaine). No significant univariate or multivariate differences by cocaine exposure group were observed. Classification and regression tree modeling was then used to identify language variable composites predictive of cocaine exposure status. Meaningful cut points for two language measures were identified and validated. Children with a type token ratio of less than 0.42 and with fewer than 97 word types were classified into a low language group. Low language children (n = 57) were more likely to be cocaine exposed (63.1%), with cocaine-exposed children 2.4 times more likely to be in the low language group compared with control children after adjustment for covariates. Prenatal cigarette, but not alcohol exposure, was also significantly related to expressive language delays.
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Affiliation(s)
- V Delaney-Black
- Department of Pediatrics, School of Medicine, Wayne State University, Detroit, Michigan, USA.
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Inman-Wood SL, Williams MT, Morford LL, Vorhees CV. Effects of prenatal cocaine on Morris and Barnes maze tests of spatial learning and memory in the offspring of C57BL/6J mice. Neurotoxicol Teratol 2000; 22:547-57. [PMID: 10974593 DOI: 10.1016/s0892-0362(00)00084-2] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Cocaine was administered to gravid C57BL/6J mice on embryonic days E8-18 at doses of either 17.5 or 20 mg/kg x 2 per day; controls received equal volumes of vehicle. The two cocaine dose groups were indistinguishable in their effects on maternal weight gain, offspring survival or body weight; therefore, the two groups were combined. Offspring were assessed as adults in straight channel swimming, cued and spatial reference-memory and working memory versions of the Morris water maze (MWM), and in the Barnes spatial maze to escape from a light, tone and fan. Cocaine offspring had shorter latencies in the straight channel and increased cumulative distance from the platform and path length in the spatial version of the Morris maze, but only when the platform size was reduced, not under standard platform conditions. In the working memory test, cocaine offspring showed deficits in acquisition and, following random trials, on relearning during a final test phase. In the Barnes maze, cocaine offspring were delayed in utilizing more efficient search strategies and took longer to find the goal. Taken together, the data suggest that prenatal cocaine induces modest but significant long-term alterations in both reference and working memory-based spatial learning and memory.
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Affiliation(s)
- S L Inman-Wood
- Division of Developmental Biology, Children's Hospital Research Foundation, Cincinnati, OH 45229-3039, USA
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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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Prenatal cocaine exposure impairs selective attention: Evidence from serial reversal and extradimensional shift tasks. Behav Neurosci 2000. [DOI: 10.1037/0735-7044.114.4.725] [Citation(s) in RCA: 62] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Malakoff ME, Mayes LC, Schottenfeld R, Howell S. Language production in 24-month-old inner-city children of cocaine-and-other-drug-using mothers. JOURNAL OF APPLIED DEVELOPMENTAL PSYCHOLOGY 1999. [DOI: 10.1016/s0193-3973(99)80009-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Madison CL, Johnson JM, Seikel JA, Arnold M, Schultheis L. Comparative study of the phonology of preschool children prenatally exposed to cocaine and multiple drugs and non-exposed children. JOURNAL OF COMMUNICATION DISORDERS 1998; 31:231-244. [PMID: 9621905 DOI: 10.1016/s0021-9924(97)00091-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Cocaine and multiple drug abuse among young adults has spawned research interest in fetal exposure and the sequela of that exposure during the formative developmental years. Previous study of the language development of exposed children has not specifically addressed phonological acquisition. In the present study, the speech of 25 children prenatally exposed to cocaine and multiple drugs was analyzed and compared to that of 25 children who were not prenatally exposed to determine if differences were evident in their phonological patterns. The children ranged in age from 22 months to 51 months. The number and type of phonological processes produced, number of utterances needed to produce a 50-word sample, number of unintelligible words produced, and Home Observation for Measurement of the Environment (HOME) scores were recorded and analyzed. The use of cocaine and multiple drugs during pregnancy was associated with an increase in the use of phonological processes.
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Affiliation(s)
- C L Madison
- Washington State University, Spokane 99204-0399, USA.
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Wagner CL, Katikaneni LD, Cox TH, Ryan RM. The impact of prenatal drug exposure on the neonate. Obstet Gynecol Clin North Am 1998; 25:169-94. [PMID: 9547766 DOI: 10.1016/s0889-8545(05)70364-8] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Several social or recreational drugs singly or together have demonstrated effects on the fetus and neonate, with those effects extending into adulthood. The use of recreational drugs during pregnancy remains a major health problem, with adverse effects including higher rates of fetal distress and demise, lower Apgar scores, growth retardation, and adverse neurodevelopmental outcome. Ethanol has the most profound effects, with physical stigmata of the drug seen in one third of exposed infants. In children without the affected physical appearance, profound neurodevelopmental sequelae have been demonstrated. Other drugs, such as cocaine, heroin, amphetamines, and nicotine, have been associated with impaired fetal growth and acute withdrawal during the neonatal period. Subsequently, these infants and children have an increased risk for altered neurodevelopment and long-term health status. Long-term follow-up and assessment are essential. The risk of neonatal withdrawal or abstinence syndrome is greatest with narcotic drugs but has been found to occur in neonates following exposure to cocaine, nicotine, and amphetamines. Early treatment with tincture of opium, paregoric, or phenobarbital is crucial. Assessment of the overall health status of the infant should include growth parameters, signs and symptoms of infection (especially hepatitis, syphilis, and immunodeficiency viruses), and neurobehavioral function. Such assessments should not be limited to the newborn period, as neurodevelopmental sequelae may not be manifest until later in infancy and childhood. In addition, evaluation of the social milieu is warranted because of the increased risk for neglect and abuse of drug-exposed infants and children. Early intervention, maternal drug rehabilitation treatment, and parenting classes are frequently prescribed, but their efficacy is variable. Further investigations should study the potential benefits of these recommendations.
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Affiliation(s)
- C L Wagner
- Department of Pediatrics, Children's Hospital, Medical University of South Carolina, Charleston, USA
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Hurt H, Malmud E, Betancourt L, Brodsky NL, Giannetta J. A prospective evaluation of early language development in children with in utero cocaine exposure and in control subjects. J Pediatr 1997; 130:310-2. [PMID: 9042138 DOI: 10.1016/s0022-3476(97)70361-5] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
A cohort of children of low socioeconomic status, 76 with in utero cocaine exposure and 81 control subjects, was assessed for early language development at 2 1/2 years of age by a masked examiner using the Preschool Language Scale. There were no differences between groups in expressive, receptive, or total language score (all p > or = 0.57). Physicians caring for cocaine-exposed children with early language delay should not automatically ascribe the delay to cocaine exposure but should initiate a standard evaluation for language delay.
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Affiliation(s)
- H Hurt
- Division of Neonatology, Albert Einstein Medical Center, Philadelphia, Pennsylvania 19141, USA
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