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CORK Bibliography: Child Development after Prenatal Drug Exposure71 Citations, 2000-presentPrepared: September 2002Accornero VH; Morrow CE; Bandstra ES; Johnson AL; Anthony JC. Behavioral outcome of preschoolers exposed prenatally to cocaine: Role of maternal behavioral health. Journal of Pediatric Psychology 27(3): 259-269, 2002. (40 refs.)Objective: To examine the impact of prenatal cocaine exposure and maternal behavioral health (recent drug use and psychological functioning) on child behavior at age 5 years. Method. In this longitudinal investigation, maternal report of child behavior was assessed using the Achenbach Child Behavior Checklist (CBCL) in 140 cocaine-exposed and 181 noncocaine-exposed (61 alcohol, tobacco, and/or marijuana-exposed, and 120 nondrug-exposed) low- income, African American children. Structural equation modeling was used to estimate suspected causal relationships between indicators of maternal behavioral health at 5-year follow-up, according to self- report on a modified Addiction Severity Index (ASI) and CBCL scores. Results: Prenatal cocaine exposure was not related to child behavior at age 5. Recent maternal drug use and psychological functioning had relationships with CBCL Internalizing and Externalizing scores. However, when considered within a combined model, only maternal psychological functioning remained significant. Conclusions: Findings highlight the importance of maternal functioning in the behavioral outcome of children exposed prenatally to cocaine. Copyright 2002, Plenum Publishing CorporationAdnams CM; Kodituwakku PW; Hay A; Molteno CD; Viljoen D; May PA. Patterns of cognitive-motor development in children with fetal alcohol syndrome from a community in South Africa. Alcoholism: Clinical and Experimental Research 25(4): 557-562, 2001. (55 refs.)Background: Even though fetal alcohol syndrome (FAS) has been reported in nonwestern nations, there is a paucity of information on neurodevelopment in the affected children from those nations. This article reports on a study of cognitive-motor development in a group of children with FAS from a community in the Western Cape Province in South Africa. Methods: Thirty-four children with FAS and 34 controls from grade 1 (school entry level) classes participated. The two groups comprised Afrikaans-speaking children of mixed ancestry (South African Colored) and were matched for age, sex, and family income. The Griffiths Mental Development Scares were used to assess cognitive motor development of the participants. Results: A multivariate analysis of covariance was performed to test the group effect on the combined Griffiths subscales adjusting for maternal education. The results showed a significant group effect. Follow-up analyses revealed that a combination of four subscales (Speech and Hearing, Performance, Practical Reasoning, and Eye and Hand Coordination) primarily contributed to the overall effect. Although there was a marginal effect on the Personal-Social subscale, no significant effect on the Locomotor (gross motor) subscale was found. Conclusions: The results showed that the FAS group was markedly deficient only in higher-order cognitive-motor competencies. Copyright 2001, Research Society on Alcoholism. Used with permission.Anonymous. Prenatal exposure to alcohol. Alcohol Research & Health 24(1): 32-41, 2000. (19 refs.)Maternal alcohol consumption during pregnancy can cause serious birth defects, of which fetal alcohol syndrome (FAS) is the most devastating. Recognizable by characteristic craniofacial abnormalities and growth deficiency, this condition includes severe alcohol-induced damage to the developing brain. FAS children experience deficits in intellectual functioning; difficulties in learning, memory, problem-solving, and attention; and difficulties with mental health and social interactions. An FAS diagnosis, however, fails to identify prenatal-alcohol-exposed children who lack the characteristic facial defects and growth deficiency of FAS. Nonetheless, these often undiagnosed children may still experience serious fetal alcohol effects (FAE) including alcohol-induced mental impairments (i.e, alcohol-related neurodevelopment disorder) or alcohol-related abnormalities of the skeleton and certain organ systems (i.e., alcohol-related birth defects). Neuroimaging techniques can assist researchers in identifying FAE through precise pictures of brain abnormalities in persons prenatally exposed to alcohol. By understanding the mechanisms underlying FAE and the behavioral manifestations of the resulting structural brain damage, researchers can ultimately develop effective FAS prevention strategies that identify and assist high-risk women at varying levels of pregnancy. Public DomainArchibald SL; Fennema-Notestine C; Gamst A; Riley EP; Mattson SN; Jernigan TL. Brain dysmorphology in individuals with severe prenatal alcohol exposure. Developmental Medicine and Child Neurology 43(3): 148-154, 2001. (30 refs.)Our previous studies revealed abnormalities on structural MRI (sMRI) in small groups of children exposed to alcohol prenatally, Microcephaly, disproportionately reduced basal ganglia volume, and abnormalities of the cerebellar vermis and corpus callosum were demonstrated. The present study used sMRI to examine in detail the regional pattern of brain hypoplasia resulting from prenatal exposure to alcohol using a higher resolution imaging protocol and larger sample sixes than reported previously. Fourteen participants (mean 11.4 years; eight females, six males) with fetal alcohol syndrome (FAS) and 12 participants (mean 14.8 years; four females, eight males) with prenatal exposure to alcohol (PEA) but without the facial features of FAS were compared to a group of 41 control participants (mean 12.8 years, 20 females, 21 males), Findings of significant microcephaly and disproportionately reduced basal ganglia volumes in the FAS group were confirmed. Novel findings were that in FAS participants, white matter volumes were more affected than gray matter volumes in the cerebrum, and parietal lobes were more affected than temporal and occipital lobes, Among subcortical structures, in contrast to the disproportionate effects on caudate nucleus, the hippocampus was relatively preserved in FAS participants. Differences between the PEA group and controls were generally non-significant; however, among a few of the structures most affected in FAS participants, there was some evidence for volume reduction in PEA participants as well, specifically in basal ganglia and the parietal lobe, There were no group differences in cerebral volume asymmetries. Severe prenatal alcohol exposure appears to produce a specific pattern of brain hypoplasia. Copyright 2001, Cambridge University PressAutti-Ramo I. Foetal alcohol syndrome: A multifaceted condition. Developmental Medicine & Child Neurology 44(2): 141-144, 2002. (42 refs.)Foetal alcohol syndrome (FAS) was first described in 1973 by Jones and colleagues. Since then, results of epidemiological studies and clinical experience have shown that exposure of the foetus to high maternal alcohol consumption has a range of consequences. It can result in both major and minor malformations, permanent impairment of growth with a disproportionately low weight-to-height ratio and reduced head growth, and CNS dysfunction ranging from learning disability to specific learning disorders - all characteristics that can, however, have other causes. Effects within all domains can range from mild to severe. Effects seen in a child and the diagnosis reached depend on the duration of exposure to substantial maternal alcohol consumption during pregnancy, the range and timing of peak blood-alcohol levels, the nutritional state of the mother, and individual susceptibility. Copyright 2002, Cambridge University PressAutti-Ramo I. Twelve-year follow-up of children exposed to alcohol in utero. Developmental Medicine and Child Neurology 42(6): 406-411, 2000. (32 refs.)Eighty-two women who were consuming alcohol while pregnant attended a special clinic at the University central Hospital ital, Helsinki with the aim of reducing heavy drinking during pregnancy. The children born to these women were followed up regularly. During their preschool years the children were assessed to have fetal alcohol syndrome, fetal alcohol effects, alcohol-related neurodevelopmental disorder, pre- and/or postnatal growth retardation, or they were assessed to have normal cognitive and somatic growth. Of the original children, 70 of 82 could be traced at the age of 12 years. Through semistructured interview and contact with the health and social care authorities, information was gathered about schooling, family structure, whether help had been sought for behavioural difficulties and major adverse events in the family. The longer the intrauterine alcohol exposure and the more severe the diagnosis related to prenatal alcohol exposure, the more often the children required special education, were temporarily or permanently taken into care, and had behavioural problems. There is a considerable need for prolonged multidisciplinary follow-up and support of all children whose mothers have not been able to reduce drinking in early pregnancy, whether or not cognitive disturbances are evident in early childhood. Copyright 2000, Cambridge University PressAutti-Ramo I; Autti T; Korkman M; Kettunen S; Salonen O; Valanne L. MRI findings in children with school problems who had been exposed prenatally to alcohol. Developmental Medicine and Child Neurology 44(2): 98-106, 2002. (67 refs.)This study examined 17 children (nine males, eight females; mean age 13 years) with prenatal alcohol exposure of various durations. The aim of the study was to detect specific brain morphological alterations by means of MRI and to see if findings correlated with particular cognitive deficits. Of the 17 children, five had been exposed to heavy maternal consumption of alcohol (over 10 drinks/week) during the first trimester only; four had been exposed during the first and second trimester; and eight had been exposed throughout pregnancy. Five children had alcohol related neurobehavioural disorder, seven were diagnosed as having foetal alcohol effects and five were diagnosed as having foetal alcohol syndrome. Hypoplasia of the vermis was observed in 10 children and malformed posterior vermis in one additional child. Five children had hypoplastic cerebellar hemispheres. Hypoplasia of the corpus callosum was observed in two children. Small hippocampi were observed in three children and wide cortical sulci in six. No specific structural anomaly correlated with a particular neuropsychological deficit. In this study, deviations in the development of the vermis was the most sensitive morphological indicator of the effects of prenatal alcohol exposure. It was seen in every diagnostic group including children who had been exposed during only the first trimester of pregnancy. Copyright 2002, Cambridge University PressBandstra ES; Morrow CE; Anthony JC; Accornero VH; Fried PA. Longitudinal investigation of task persistence and sustained attention in children with prenatal cocaine exposure. Neurotoxicology and Teratology 23(6): 545-559, 2001. (91 refs.)The present study estimates the longitudinal effects of prenatal cocaine exposure on indicators of sustained attention processing at 3, 5 and 7 years of age in an urban sample of full-term African- American children (235 cocaine-exposed, 207 noncocaine-exposed). The sample was enrolled prospectively at birth, with documentation of prenatal drug exposure status through maternal interview, urine and meconium. toxicology assays. Sustained attention was measured at age 3 years using a standardized measure of task persistence during a challenging task [G.A. Morgan, N.A. Busch-Rossnagel, C.A. Maslin-Cole and R.J. Harmon, Individualized Assessment of Mastery Motivation: Manual for 15-36 Month Old Children, 1992.], and at ages 5 and 7 years using omission error sc ores from computerized continuous pperformance tasks (CPT) [L. Greenberg, R. Leark, T. Dupuy, C. Corman, C. Kindschi, M. Cenedela, Test of Variables of Attention (T.O.VA. and T.O.V.A.-A.), 22, Universal Attention Disorders, Los Alamitos, CA, 1996; C.K. Conners, Conners' Continuous Performance Test (CPT), second ed., Multi-Health Systems, Canada, 1995.]. Findings from longitudinal GLM/GEE analyses of the three measured time points support a stable influence of prenatal cocaine exposure on indicators of sustained attention, after controlling for prenatal exposure to alcohol, marijuana, tobacco and over 20 additional medical and social-demographic covariates drawn from potentially confounding influences assessed at birth and later assessment visits (D = 0.21; 95% Cl = 0.04, 0.38; P=.017). This effect was not mediated by fetal growth or gestational age and remained highly stable with increasing levels of covariate control. Separately, using the age 7 data, a structural equations model (SEM) was constructed combining all available self-report and bioassay data to measure magnitude of cocaine exposure in relationship to attention task performance. Results indicated a gradient of influence, with each standard deviation increase in the level of prenatal cocaine exposure relating to a 16% standard deviation increase in omission error scores at age 7. Overall findings support a stable cocaine-specific effect on indicators of sustained attention processing during the early childhood years. Results are discussed within the context of neurobiological and behavioral research linking prenatal cocaine exposure to long-lasting disruption of the brain systems subserving arousal and attention. Copyright 2001, Pergamon PressBerger LM; Waldfogel J. Prenatal cocaine exposure: Long-run effects and policy implications. Social Service Review 74(1): 28-54, 2000. (95 refs.)In this article, we review the literature regarding prenatal cocaine exposure and child development. We then reexamine current child welfare policies in light of that literature, paying particular attention to laws that mandate reporting substance-exposed newborns and substance use during pregnancy as well as policies that view such reports as prima facie evidence of child maltreatment Finally, we reassess the utility of such policies, given our current knowledge of the long-term effects of prenatal exposure, and consider alternative approaches to protecting children who are born to parents who are using crack cocaine. Copyright 2000, University of ChicagoBrook JS; Brook DW; Whiteman M. The influence of maternal smoking during pregnancy on the toddler's negativity. Archives of Pediatrics & Adolescent Medicine 154(4): 381-385, 2000. (35 refs.)Objective: To extend previous studies by looking at the effect of the mother's smoking during pregnancy on her toddler's negative behavior. Design: A survey consisting of a structured questionnaire was administered to the mothers of 2-year-old toddlers. Setting: The subjects were drawn from a community sample, as part of a larger study of mothers and their children. Subjects: The subjects were 99 toddlers and their mothers taken from a community sample. Fifty-two of the mothers smoked throughout pregnancy, while 47 either stopped smoking during pregnancy or started smoking after childbirth. Measures: The measures consisted of scales with adequate psychometric properties, which, for the most part, were adapted from the literature. Measures included assessment of smoking behavior, the mother's personality/behavior, perinatal variables, demographic variables, and aspects of the mother-child relationship. Results: Using logistic regression analyses, maternal smoking during pregnancy was found to be related to negativity in the child, controlling for demographic factors, perinatal factors, maternal personality attributes, and the mother-child relationship. Conclusions: The findings suggest that maternal smoking during pregnancy has an adverse effect on the child's negativity, and that a decrease in maternal smoking during pregnancy might be expected to lead to a decrease in the child's negativity. The relationship of maternal smoking during pregnancy and early childhood negativity to other problem behaviors remains to be explored. Copyright 2000, American Medical AssociationButz AM; Pulsifer M; Marano N; Belcher H; Lears MK; Royall R. Effectiveness of a home intervention for perceived child behavioral problems and parenting stress in children with in utero drug exposure. Archives of Pediatrics & Adolescent Medicine 155(9): 1029-1037, 2001. (37 refs.)Objective: To determine if a home-based nurse intervention (INT), focusing on parenting education/skills and caregiver emotional support, reduces child behavioral problems and parenting stress in caregivers of in utero drug-exposed children. Design: Randomized clinical trial of a home-based INT. Settings: Two urban hospital newborn nurseries; homes of infants (the term infant is used interchangeably in this study with the term child to denote those from birth to the age of 36 months); and a research clinic in Baltimore, Md. Participants: In utero drug-exposed children and their caregivers (N =100) were examined when the child was between the ages of 2 and 3 years. Two groups were studied: standard care (SC) (n = 51) and INT (n = 49). Intervention: A home nurse INT consisting of 16 home visits from birth to the age of 18 months to provide caregivers with emotional support and parenting education and to provide health monitoring for the infant. Main Outcome Measures: Scores on the Child Behavior Checklist and the Parenting Stress Index. Results: Significantly more drug-exposed children in the SC group earned t scores indicative of significant emotional or behavioral problems than did children in the INT group on the Child Behavior Checklist Total (16 [31%] vs 7 [14%]; P = .04), Externalizing (19 [37%] vs 8 [16%]; P = .02), and Internalizing (14 [27%] vs 6 [12%]; P = .05) scales and on the anxiety-depression subscale (16 [31%] vs 5 [10%]; P = .009). There was a trend (P = .06) in more caregivers of children in the SC group reporting higher parenting distress than caregivers of children in the INT group. Conclusions: In utero drug-exposed children receiving a home-based nurse INT had significantly fewer behavioral problems than did in utero drug-exposed children receiving SC (P = .04). Furthermore, those caregivers receiving the home-based INT reported a trend toward lower total parenting distress compared with caregivers of children who received SC with no home visits. Copyright 2001, American Medical AssociationCarta JJ; Atwater JB; Greenwood CR; McConnell SR; McEvoy MA; Williams R. Effects of cumulative prenatal substance exposure and environmental risks on children's developmental trajectories. Journal of Clinical Child Psychology 30(3): 327-337, 2001. (41 refs.)Examined the effects of cumulative prenatal substance exposure and cumulative environmental risk on the developmental trajectories of 278 infants, toddlers, and preschool children. Results indicated that both cumulative risk indexes were significantly correlated. Results also indicated that both indexes were related to decrements in developmental trajectories (intercept and slope) from 3 to 57 months of age. Both prenatal exposure and environmental risk added unique variance to the prediction of developmental level and rate of growth when entered after covariates (i.e., birth weight and sex). However, across a number of models with and without covariates, environmental risk accounted for more variance in developmental trajectories than did prenatal exposure. Implications are discussed. Copyright 2001, American Psychological AssociationChavkin W. Cocaine and pregnancy. Time to look at the evidence. (editorial). Journal of the American Medical Association 285(12): 1626-1628, 2001. (15 refs.)Clark CM; Li D; Conry J; Conry R; Loock C. Structural and functional brain integrity of fetal alcohol syndrome in nonretarded cases. Pediatrics 105(5): 1096-1099, 2000. (18 refs.)Purpose. To determine the structural and functional integrity of the brain in a sample of nonretarded individuals diagnosed with fetal alcohol syndrome. Subjects. The sample consisted of nineteen individuals who met the diagnostic criteria for fetal alcohol syndrome. Methods. Intellectual function was assessed using the Wechsler Adult Intelligence Scale-Revised. Structural integrity of the brain was assessed using magnetic resonance imaging whereas functional integrity was assessed using positron emission tomography and F-18- fluorodeoxyglucose. Results. The mean Full Scale IQ was 80.2 (range: 66-92). Only 1 magnetic resonance imaging was found to be abnormal. This abnormality was found for the subject with the lowest IQ. Decreases in relative regional cerebral metabolic rates were found in 5 brain regions comprising the thalamus and basal ganglia. Conclusion. These results when coupled with previous findings suggest a continuum of neuropathology in fetal alcohol syndrome. For cases with relatively mild intellectual deficits, the cause of the deficit is at a microlevel rather than a macro-level. Copyright 2000, American Academy of PediatricsColes CD; Platzman KA; Lynch ME; Freides D. Auditory and visual sustained attention in adolescents prenatally exposed to alcohol. Alcoholism: Clinical and Experimental Research 26(2): 263-271, 2002. (34 refs.)Background: Sustained attention problems and impulsivity are reported in association with prenatal alcohol exposure and fetal alcohol syndrome, but research in this area is limited and contradictory. Methods: Auditory and visual sustained attention were investigated in 265 low-income, predominantly African-American, adolescents (mean age, 15.12 years; SD, 0.92). Included were 53 unexposed controls and 128 exposed to alcohol and other drugs prenatally, with 46 of these exhibiting dysmorphic features and growth retardation, as well as a special-education contrast group (n = 84). Sustained attention was measured with "AK" subtests from a commercially available Continuous Performance Task program. Outcomes included total correct, total errors, omissions, commissions, preservations, hit rate, false alarms, reaction time, and response sensitivity (d'). A repeated- measures multivariate analysis of variance procedure was used with the exposure group (four groups) as the independent variable and presentation mode (visual or auditory) and trial block (four blocks) as within-subject repeated measures. Results: There was an interaction of group with presentation mode for total correct, errors, error type, hit rate, and d'. Most groups processed visual information more effectively than auditory information. In contrast, dysmorphic adolescents performed as effectively when presented with auditory stimuli but were less efficient in processing visual information. Significantly higher error rates, particularly omission errors [17(3,261) = 7.16; p < 0.000], as well as lower d' [17(3,261) = 5.77; p < 0.001], were noted in this group. Conclusions: These results suggest that there may be specific patterns to the effect of prenatal alcohol exposure on cognitive performance that can be identified during adolescence. In this study of sustained attention, processing in the visual modality was more affected than that in the auditory modality. Deficits in visual processing seemed to result from insensitivity to target stimuli. Copyright 2002, Research Society on Alcoholism. Used with permissionConner PD; Sampson PD; Bookstein FL; Barr HM; Streissguth AP. Direct and indirect effects of prenatal alcohol damage on executive function. Developmental Neuropsychology 18(3): 331-354, 2000. (49 refs.)Patients with Fetal Alcohol Syndrome (FAS) and Fetal Alcohol Effects (FAE) often have difficulty functioning appropriately in everyday life and seem to employ poor problem-solving strategies. Tests of executive function are relevant for quantifying the functional deficits and underlying real-life problems associated with prenatal alcohol exposure. This study considers two pathways for the effects of prenatal alcohol on executive function: a direct effect and an indirect effect through prenatal alcohol's effect on IQ. We compared 30 men who had been diagnosed with FAS or FAE with young adults participating in a longitudinal prospective study (n = 419)and 15 control participants that comprised a comparison group. This study is unique in its analysis of the same battery of assessments of executive function in both a large low dose longitudinal study sample and a clinically diagnosed group. Participants were evaluated on 9 tests (including 58 scores) of executive function. For some but not all of the tests in this executive function battery, the decrement in the alcohol exposure group is greater than would be predicted from their IQ scores. We found that 3 of 6 Stroop scores, 2 of 4 Trails scores, 9 of 16 Wisconsin Card Sorting scores, 1 of 2 Ruffs Figural Fluency scores, and 2 of 4 Consonant Trigrams scores appear to be particularly sensitive to the direct effects of prenatal alcohol damage for patients with FAS and FAE. The findings suggest that these executive function tests would be particularly useful in clinical evaluations of persons suspected of fetal alcohol damage because they would not simply reflect deficits in IQ or facial stigmata. Copyright 2000, Lawrence Erlbaum Associates, Inc.Das Eiden R; Leonard KE; Morrisey S. Paternal alcoholism and toddler noncompliance. Alcoholism: Clinical and Experimental Research 25(11): 1621-1633, 2001. (54 refs.)Background: This study examined the effect of fathers' alcoholism and associated risk factors on toddler compliance with parental directives at 18 and 24 months of age. Methods: Participants were 215 families with 12-month-old children, recruited through birth records, who completed assessments of parental substance use. family functioning, and parent-child interactions at 12, 18, and 24 months of child age. Of these families, 96 were in the control group, 89 families were in the father-alcoholic-only group, and 30 families were in the group with two alcohol-problem parents. Child compliance with parents during cleanup situations after free play was measured at 18 and 24 months. The focus of this paper is on four measures of compliance: committed compliance, passive noncompliance, overt resistance, and defiance. Results: Sons of alcohol-problem parents exhibited higher rates of noncompliance compared with sons of nonalcoholic parents. Sons in the two-alcohol-problem parent group seemed to be following a trajectory toward increasing rates of noncompliance. Daughters in the two- alcohol-problem parent group followed an opposite pattern. Other risk factors associated with parental alcohol problems also predicted compliance, but in unexpected ways. Conclusions: Results indicate that early risk for behavioral undercontrol is present in the toddler period among sons of alcoholic fathers, but not among daughters. Copyright 2001, Research Society on Alcoholism. Used with permission.Day NL; Richardson GA; Goldschmidt L; Cornelius MD. Effects of prenatal tobacco exposure on preschoolers' behavior. Journal of Developmental and Behavioral Pediatrics 21(3): 180-188, 2000. (45 refs.)This is a longitudinal study of the relationship between prenatal tobacco exposure and the development of behavior problems in 672 children at the age of 3 years. Women from a prenatal clinic were interviewed about substance use at the end of each trimester of their pregnancy and at 3 years postpartum. Children were assessed at the age of 3 years with maternal ratings of behavior problems, activity, and attention. The prevalence of tobacco use was high in this cohort; 54.3% and 52.3% of the women smoked tobacco in the first and third trimesters of pregnancy, respectively. At 3 years postpartum, 61.6% of the women were smokers. There were significant effects of prenatal tobacco exposure on the children's behavior at age 3 years. Increases in scores on the Oppositional Behavior, Immaturity, Emotional Instituteability, Physical Aggression, and Activity scales and in the total score on the Toddler Behavior Checklist (TBC) were significantly associated with prenatal tobacco exposure. Smoking one pack of tobacco cigarettes per day during the third trimester of pregnancy was associated with an increase of 6 points in the total problem behavior score. Among the subscales of the TBC, tobacco exposure had the largest effect on oppositional behavior. Impulsivity and peer problems were associated with both prenatal and current tobacco exposure. Only current tobacco exposure predicted attention problems. Prenatal tobacco exposure had a significant negative effect on the development of behavior problems among preschoolers. Copyright 2000, Williams & WilkinsDelaney-Black V; Covington C; Templin T; Kershaw T; Nordstrom-Klee B; Ager J et al. Expressive language development of children exposed to cocaine prenatally: Literature review and report of a prospective cohort study. Journal of Communication Disorders 33(6): 463-481, 2000. (33 refs.)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. Copyright 2000, Elsevier Science Publishing Co., Inc.Delaney-Black V; Covington C; Templin T; Ager J; Nordstrom-Klee B; Martier S et al. Teacher-assessed behavior of children prenatally exposed to cocaine. Pediatrics 106(4): 782-791, 2000. (68 refs.)OBJECTIVE: Prenatal cocaine exposure has been associated with alterations in neonatal behavior and more recently a dose-response relationship has been identified. However, few data are available to address the long-term behavioral effects of prenatal exposures in humans. The specific aim of this report is to evaluate the school-age behavior of children prenatally exposed to cocaine. METHODS: All black non-human immunodeficiency virus-positive participants in a larger pregnancy outcomes study who delivered singleton live born infants between September 1, 1989 and August 31, 1991 were eligible for study participation. Staff members of the larger study extensively screened study participants during pregnancy for cocaine, alcohol, cigarettes, and other illicit drugs. Prenatal drug exposure was defined by maternal history elicited by structured interviews with maternal and infant drug testing as clinically indicated. Cocaine exposure was considered positive if either history or laboratory results were positive. Six years later, 665 families were contacted; 94% agreed to participate. The child, primary caretaker (parent), and, when available, the biologic mothers were tested in our research facilities. Permission was elicited to obtain blinded teacher assessments of child behavior with the Achenbach Teacher's Report Form (TRF). Drug use since the child's birth was assessed by trained researchers using a structured interview. RESULTS: Complete laboratory and teacher data were available for 499 parent-child dyads, with a final sample size for all analyses of 471 (201 cocaine-exposed) after the elimination of mentally retarded subjects. A comparison of relative Externalizing (Aggressive, Delinquent) to Internalizing (Anxious/Depressed, Withdrawn, Somatic Complaints) behaviors of the offspring was computed for the TRF by taking the difference between the 2 subscales to create an Externalizing-Internalizing Difference (T. M. Achenbach, personal communication, 1998). Univariate comparisons revealed that boys were significantly more likely to score in the clinically significant range on total TRF, Externalizing-Internalizing, and Aggressive Behaviors than were girls. Children prenatally exposed to cocaine had higher Externalizing-Internalizing Differences compared with controls but did not have significantly higher scores on any of the other TRF variables. Additionally, boys prenatally exposed to cocaine were twice as likely as controls to have clinically significant scores for externalizing (25% vs 13%) and delinquent behavior (22% vs 11%). Gender, prenatal exposures (cocaine and alcohol), and postnatal risk factors (custody changes, current drug use in the home, child's report of violence exposure) were all related to problem behaviors. Even after controlling for gender, other prenatal substance exposures, and home environment variables, cocaine-exposed children had higher Externalizing-Internalizing Difference scores. Prenatal exposure to alcohol was associated with higher total score, increased attention problems, and more delinquent behaviors. Prenatal exposure to cigarettes was not significantly related to the total TRF score or any of the TRF subscales. Postnatal factors associated with problem behaviors included both changes in custody status and current drug use in the home. Change in custody status of the cocaine-exposed children, but not of the controls, was related to higher total scores on the TRF and more externalizing and aggressive behaviors. Current drug use in the home was associated with higher scores on the externalizing and aggressive subscales. CONCLUSIONS: Results of this study suggest gender-specific behavioral effects related to prenatal cocaine exposure. Prenatal alcohol exposure also had a significant impact on the TRF. Postnatal exposures, including current drug use in the home and the child's report of violence exposure, had an independent effect on teacher-assessed child behavioral problems. Copyright 2000, American Academy of PediatricsDempsey DA; Hajnal BL; Partridge JC; Jacobson SN; Good W; Jones RT et al. Tone abnormalities are associated with maternal cigarette smoking during pregnancy in in utero cocaine-exposed infants. Pediatrics 106(1): 79-85, 2000. (39 refs.)Objective. Maternal cigarette smoking, alcohol use, and other factors confound studies of in utero cocaine exposure. Our goal was to determine whether in utero cocaine exposure is associated with an abnormal neurologic examination in infants, while controlling for concomitant cigarette smoke exposure and other confounding variables. Design. Healthy newborns with birth weights greater than or equal to 2000 g were prospectively enrolled into a race-matched study of cocaine-exposed and cocaine-unexposed infants. Urine and meconium samples were analyzed for illicit drugs, the cocaine metabolite, benzoylecgonine, and the nicotine metabolite, cotinine. A detailed neurological examination was performed at similar to 6 weeks of age by an examiner blinded to history. Results. At 6 weeks of age, 40 cocaine-exposed infants and 56 cocaine- unexposed infants were examined. Tone abnormalities were the only neurologic abnormalities discovered, predominantly generalized hypertonia. Logistic models found that maternal urine cotinine levels were predictive of an abnormal neurologic examination, whereas cocaine exposure or benzoylecgonine levels were not. No interaction was found between maternal cigarette smoking and cocaine exposure. Race, ethanol exposure, prenatal care, homelessness, and head circumference were not predictive of an abnormal tone examination. The odds ratio for an abnormal examination was 2.9 (95% confidence interval: 1.04-8.25), if the maternal urine cotinine level was >200 ng/mL. Conclusion. Our findings suggest that maternal cigarette smoking may be the major predictor of tone abnormalities reported in cocaine- exposed infants. Copyright 2000, American Academy of PediatricsEriksson M; Jonsson B; Steneroth G; Zetterstrom R. Amphetamine abuse during pregnancy: Environmental factors and outcome after 14-15 years. Scandinavian Journal of Public Health 28(2): 154-157, 2000. (21 refs.)The aim of this study was to assess the influence of social environmental factors on school performance and behavioural problems among 14-year-old children who had been exposed to amphetamine during foetal life. The study group comprised a cohort of 65 children who had suffered intrauterine exposure to amphetamine due to maternal drug abuse. This group has been followed since birth and examined at regular intervals. Information regarding the academic performance of the children was gathered from the school authorities. The psychosocial environment of the children was determined through interviews and through information obtained from the social authorities. Of the 64 children who attended a school within the state school system, 10 (15%) were a year behind for their age. The mean grades were significantly lower than those of their classmates. Behavioural problems were mentioned in the social authority documentation of one-third of the children, regardless of whether the child was placed in a foster home or was residing with the biological mother. A positive significant correlation was found between maternal age and the outcome of the children, as well as between therapy during pregnancy and outcome, whilst several environmental factors, particularly during the child's first four years, correlate negatively to outcome. Psychosocial factors early in life influence the outcome at 14 years. The positive effect of intervention during pregnancy illustrates the importance of early identification preferable during pregnancy. Copyright 2000, Scandinavian University PressEriksson M; Jonsson B; Zetterstrom R. Children of mothers abusing amphetamine: Head circumference during infancy and psychosocial development until 14 years of age. Acta Paediatrica 89(12): 1474-1478, 2000. (24 refs.)Objective. To study the relationship between head circumference (HC) at birth (HO) and at 1 y of age (HI) and later outcome variables in children exposed to amphetamine during fetal life through maternal drug abuse. Method: Prospective longitudinal study of 65 children born to women abusing amphetamine. Potential bivariate and partial correlations between HC and outcome variables at 4, 8 and 14 y of age were studied. In multivariate analyses on outcome variables, HC, maternal and perinatal factors were used as predictors. Analyses were performed for all children and separately for boys and girls. Results: Head circumference at birth and 1 y of age were significant predictors for the level of achievement in Swedish language at 14 y. Head circumference at birth was a significant predictor for grades in mathematics in boys. Combined assessment of psychomotor development and psychosocial adjustment at 4 and 8 y correlated with HI in girls. Conclusion: Head circumference at birth and at 1 y of age correlated with school achievement at 14 y. It also correlated with adjustment at 4 and 8 y in girls. A difference in vulnerability between girls and boys is important and should be considered in longitudinal studies of risk cohorts. Copyright 2000, Scandinavian University PressEspy KA; Francis DJ; Riese ML. Prenatal cocaine exposure and prematurity: Neurodevelopmental growth. Journal of Developmental and Behavioral Pediatrics 21(4): 262-270, 2000. (34 refs.)The consequences of prematurity and prenatal cocaine exposure on early neurobehavior and physical growth were examined longitudinally in a sample of 20 cocaine-exposed and 20 non-exposed preterm neonates. The magnitude of the difference in physical growth acceleration related to prenatal cocaine exposure increased with increasing birth gestational age, whereas growth rate differences in irritability decreased. In contrast, prenatal cocaine exposure, independent of prematurity, was related to reduced attention skills at 36 weeks conceptional age and increased rates of neurobehavioral change. The effects of prenatal cocaine exposure differed with respect to the degree of prematurity, depending on the nature of the outcome examined, suggesting differing windows of vulnerability for different outcome domains. The usefulness of a developmental growth perspective was demonstrated. Copyright 2000, Williams & WilkinsFombonne E. Is exposure to alcohol during pregnancy a risk factor for autism? (letter). Journal of Autism and Developmental Disorders 32(3): 243-243, 2002. (3 refs.)Fried PA. Conceptual issues in behavioral teratology and their application in determining long-term sequelae of prenatal marihuana exposures. (review). Journal of Child Psychology and Psychiatry and Allied Disciplines 43(1): 81-102, 2002. (161 refs.)Background: Behavioral teratology, particularly as it is applied to the evaluation of cognition and behavior of children beyond the toddler stage, has become an area of burgeoning activity. In the area of drug abuse, children exposed in utero are often at developmental peril because of non-drug pre- and postnatal risk factors that make a causal association between the drug of interest and a behavioral teratogenic outcome increasingly problematic as the child gets older. Methods: In the first portion of this review, the strategies that behavioral teratologists have undertaken to investigate the putative consequences of in utero exposure are discussed in terms of research design, statistical methods and interpretative approaches. In the second part of the paper, the relatively limited literature dealing with the behavioral teratological consequences of prenatal marihuana exposure, particularly in school age offspring, is reviewed. Results: An emergent theme arising from primarily two longitudinal investigations is that in utero cannabis exposure does not impact upon standardized derived IQ scores but is negatively associated with attentional behavior and visual analysis/hypothesis testing. These findings are interpreted as supporting the hypothesis that, among offspring beyond the toddler stage, prenatal marihuana exposure has a negative influence on aspects of executive function. Executive function is a 'top-down', multifaceted cognitive construct involved in organizing and integrating specific cognitive and output processes over a interval of time and is largely mediated by the late developing, prefrontal region of the brain. Conclusions: The results and the interpretation of the prenatal marihuana findings are discussed in terms of the behavioral teratogenic effects (or lack of effects) during the various developmental stages of the offspring, the non-unitary nature of executive function, cannabis receptors, and the consequences of chronic marihuana use in the non-pregnant population. Copyright 2002, Cambridge University PressFried PA; James DS; Watkinson B. Growth and pubertal milestones during adolescence in offspring prenatally exposed to cigarettes and marihuana. Neurotoxicology and Teratology 23(5): 431-436, 2001. (27 refs.)Weight, height, head circumference, and pubertal milestones were examined in one hundred fifty-two 13- to 16-year-old adolescents for whom prenatal exposure to marihuana and cigarettes had been ascertained. The subjects were from a low-risk, predominantly middle- class sample participating in an ongoing, longitudinal study and whose growth has been monitored since birth. The weight of the 13- to 16-year-old children of heavy cigarette smokers, after statistical adjustment, did not differ from control subjects but they had a significantly higher Ponderal Index (PI). These observations continued those noted when these subjects were 9 to 12 years of age. Among the male offspring of cigarette smokers, pubertal milestones occurred at an earlier age than among male adolescents born to nonsmokers. Active smoking by the offspring did not moderate these findings. Maternal marihuana use was not associated with any growth measurement or the timing of pubertal milestones. Copyright 2001, Pergamon PressFried PA; Watkinson B. Differential effects on facets of attention in adolescents prenatally exposed to cigarettes and marihuana. Neurotoxicology and Teratology 23(5): 421-430, 2001. (52 refs.)Facets of attention were examined in 152 13- to 16-year-old adolescents for whom prenatal exposure to marihuana and cigarettes had been ascertained. The subjects, participants in an ongoing longitudinal study, were from a low-risk, predominantly middle-class sample. The assessment battery included 11 variables derived from a Continuous Performance Test, the Wisconsin Card Sorting Test, the Stroop Test, a number of memory tasks and four subtests of the Wechsler Intelligence Scale for Children. A principal components analysis yielded a five-factor model that was highly concordant with a recent model of attention proposed by Mirsky. Prenatal cigarette exposure was associated with an encode/retain (working memory) component of attention and, at the younger age, with the impulsivity element. Prenatal marihuana was associated with the factor describing stability of attention over time. The differential drug findings were consistent with and extend observations noted when this sample was assessed at earlier ages. Copyright 2001, Pergamon PressGoldschmidt L; Day NL; Richardson GA. Effects of prenatal marijuana exposure on child behavior problems at age 10. Neurotoxicology and Teratology 22(3): 325-336, 2000. (45 refs.)This is a prospective study of the effects of prenatal marijuana exposure on child behavior problems at age 10. The sample consisted of low-income women attending a prenatal clinic. Half of the women were African-American and half were Caucasian. The majority of the women decreased their use of marijuana during pregnancy. The assessments of child behavior problems included the Child Behavior Checklist (CBCL), Teacher's Report Form (TRF), and the Swanson, Noland, and Pelham (SNAP) checklist. Multiple and logistic regressions were employed to analyze the relations between marijuana use and behavior problems of the children, while controlling for the effects of other extraneous variables. Prenatal marijuana use was significantly related to increased hyperactivity, impulsivity, and inattention symptoms as measured by the SNAP, increased delinquency as measured by the CBCL, and increased delinquency and externalizing problems as measured by the TRF. The pathway between prenatal marijuana exposure and delinquency was mediated by the effects of marijuana exposure on inattention symptoms. These findings indicate that prenatal marijuana exposure has an effect on child behavior problems at age 10. Copyright 2000, Pergamon PressHammer CS; Tomblin JB; Zhang XY; Weiss AL. Relationship between parenting behaviours and specific language impairment in children. International Journal of Language and Communication Disorders 36(2): 185-205, 2001. (49 refs.)This study investigated the relationship between parenting behaviours and specific language impairment (SLI) in children. Using a case-control design, data on 177 kindergarten children with SLI and 925 kindergarten children who were typically developing were collected using a parental questionnaire. Parents were interviewed about parenting practices classified into the following categories: conversing with children, teaching behaviours, the child's daily routine and discipline. The results revealed that parents of children who were normally developing had engaged their children in particular conversational activities more frequently than had parents with children with SLI. Parents of children diagnosed with SLI tended to teach their children school readiness skills (the alphabet and colours) and discipline their children more frequently. These relationships continued to hold after controlling for maternal education and family economic need with the exception of teaching children colour names. The results suggested that additional investigations that examine the association between these parental behaviours and children's language status through direct observation are warranted. Copyright 2001, Taylor & Francis Ltd.Hans SL; Jeremy RJ. Postneonatal mental and motor development of infants exposed in utero to opioid drugs. Infant Mental Health Journal 22(3): 300-315, 2001. (60 refs.)We compared the mental and motor development of 33 infants from innercity, African American families whose mothers used opioid drugs during pregnancy with that of 45 infants from demographically comparable families where the mothers were not users of opioids. We found that during the first 2 years of life, the children exposed to opioid drugs showed poorer functioning on Bayley Scales mental and psychomotor development indices as well as on Infant Behavior Record ratings of mental and motor functioning. Although both groups of children performed in the normal range during infancy, both groups showed sharp declines in their developmental scores during the second year of life relative to norms. The poorer performance of the opioid- exposed group in mental development was related to social- environmental risk factors; in psychomotor development, to reduced birth weight. Copyright 2001, Michigan Association for Infant Mental HealthHill SY; Lowers L; Locke-Wellman J; Shen SA. Maternal smoking and drinking during pregnancy and the risk for child and adolescent psychiatric disorders. Journal of Studies on Alcohol 61(5): 661-668, 2000. (26 refs.)Objective: To examine the relative importance of prenatal exposure to cigarettes and alcohol and familial/genetic susceptibility for alcohol dependence in the etiology of childhood psychopathology. Method: A longitudinal prospective study of 150 children/adolescents (51.3% male), who were at either high or low risk for developing alcohol dependence because of their familial loading for alcoholism, provided multiple diagnostic assessments (N = 318) of these subjects. High-risk families were identified through the presence of two adult alcoholic sisters; low-risk control families were selected from the community. Annual assessments of offspring from these families included an in-depth psychiatric interview of each child and his/her parent to determine the presence or absence of childhood disorders. Mothers were interviewed concerning their prenatal use of substances, and information was gathered concerning their personal and familial loading for psychiatric disorders. Results: Using conventional logistic regression analyses, internalizing and externalizing disorders were found to be associated with familial loading for alcoholism and prenatal exposure to cigarettes and alcohol. In addition, a specialized statistical analysis, a multivariate confounder score approach, was conducted using familial risk status and the child's exposure to maternal prenatal use of alcohol and cigarettes. This analysis demonstrated that only one relationship between a single variable and a childhood disorder was significant while controlling for the other two variables: Oppositional disorder remained significant in association with familial risk status. Three additional analyses were performed to evaluate the effects of familial risk status, prenatal alcohol exposure and prenatal cigarette exposure on childhood psychopathology while controlling for two known risk factors (SES and parental ASPD) for externalizing disorders. Results of these analyses revealed that the only childhood disorder that was elevated was ADHD, and that this was the result of the familial risk Variable only. Conclusions: Familial loading for alcohol dependence is an important risk factor for the development of childhood psychopathology and may account for the previously reported associations between prenatal exposure to nicotine and alcohol. Studies of substance abuse/dependence etiology and childhood psychopathology need to include consideration of both prenatal exposures and familial loading for alcohol dependence and other psychiatric disorders. Copyright 2000, Alcohol Research Documentation, Inc. Used with permissionHill SY; Shen S; Locke J; Lowers L; Steinhauer SA; Konicky C. Developmental changes in postural sway in children at high and low risk for developing alcohol-related disorders. Biological Psychiatry 47(6): 501 -511, 2000. (47 refs.)Background: To utilize the power of latent growth analysis to evaluate changes in postural sway during development in children who are either at high or low risk for developing alcoholism. Methods: A total of 629 assessments of postural sway have been performed in children and adolescents (n = 126) who were evaluated annually over a 7-year period. Results: Latent curve models indicated that these children/adolescents show a linear decrease in sway with age. Moreover, significantly different rates of change in the amount of sway between high- and low-risk offspring were seen. With the exception of one of the four stances tested, high-risk boys consistently showed a slower rate of improvement with respect to the amount of sway exhibited compared to low-risk boys. In girls, similar rates of improvement with age were seen in high- and low-risk individuals, though in one stance the high-risk girls showed a deterioration (greater sway with increasing age). Conclusions: Previous reports of increased postural sway in high-risk offspring most likely reflect a developmental delay thigh-risk children have greater sway than is appropriate for their age based on normative values by age). Copyright 2000, Society of Biological PsychiatryHurt H; Giannetta J; Brodsky NL; Malmud E; Pelham T. Are there neurologic correlates of in utero cocaine exposure at age 6 years? Journal of Pediatrics 138(6): 911-913, 2001. (12 refs.)At age 6 years, a cohort of non-asphyxiated children, 52 with gestational cocaine exposure and 63 control subjects, underwent a neurologic examination. Groups did not differ on any aspect of the examination. This finding, while reassuring, does not exclude the possibility of more subtle deficits. Copyright 2001, Mosby-Year Book, Inc.Jacobson SW; Chiodo LM; Sokol RJ; Jacobson JL. Validity of maternal report of prenatal alcohol, cocaine, and smoking in relation to neurobehavioral outcome. Pediatrics 109(5): 815-825, 2002. (65 refs.)Objective. Evidence that mothers report higher levels of drinking retrospectively than during pregnancy has led some investigators to suggest that women systematically underreport alcohol antenatally and that alcohol-related deficits may actually reflect heavier prenatal exposure. This study is the first to compare the validity of antenatal and retrospective reports of pregnancy drinking, drug use, and smoking in relation to effects on infant neurobehavioral outcomes. Methodology. Three hundred fifty-four inner-city mothers were interviewed regarding their alcohol, drug use, and smoking during pregnancy and retrospectively at 13 months' postpartum. Their infants were assessed at 6.5, 12, and 13 months on a large battery of neurobehavioral assessments. Results. Although higher levels of alcohol were reported retrospectively, the correlations of prenatal alcohol exposure with infant outcome were as strong or stronger for the antenatal measures and only the antenatal reports predicted poorer cognitive performance on the Bayley Scales and symbolic play, slower processing speed on the Fagan Test of Infant Intelligence and cross-modal transfer, and slower infant reaction time. Women also reported higher levels of cocaine and marijuana but not cigarette smoking retrospectively. Relations between cocaine use and smoking on birth size and gestational age were as strong for either report. No effects were detected in relation to either report of marijuana use during pregnancy. Conclusions. These findings suggest that antenatal alcohol interviews provide the most valid information and demonstrate the importance of assessing prenatal alcohol use during pregnancy to minimize the risk of failing to detect neurobehavioral deficits. Adverse effects were consistently seen at levels as low as 0.5 oz absolute alcohol/day (the equivalent of 7 drinks per week) based on maternal antenatal report. These data suggest that alcohol-related deficits do not reflect heavier prenatal exposure than that reported during pregnancy and that threshold values derived from antenatal reports are reasonably accurate. Copyright 2002, American Academy of PediatricsJacobson SW; Jacobson JL. Alcohol and drug-related effects on development: A new emphasis on contextual factors. Infant Mental Health Journal 22(3): 416-430, 2001. (62 refs.)The articles in this special issue bring together two lines of research that reflect different perspectives on the effects of parental alcohol and drug abuse-the long-term impact of teratogenic insult due to prenatal exposure and the developmental risks associated with being reared by a substance-abusing parent. These articles reflect major methodological advances, including the use of moderator variables-particularly, parental psychopathology and child temperament-for detecting the adverse impact of parental substance abuse on child outcome. In several articles, more comprehensive sets of control variables are considered than in prior studies, and investigators examine the use of aggregate and cumulative risk factors in an attempt to better model underlying conditions of risk. Another advance is that most of these studies recognize the importance of quantifying levels of prenatal alcohol and drug exposure. In focusing our attention simultaneously on prenatal exposure, parental substance abuse and comorbid psychopathology, child temperament, and contextual factors, these studies offer a better understanding of the complex interrelated influences of risk factors on the child's cognitive and socio-emotional development. Copyright 2001, Michigan Association for Infant Mental HealthJohnson CH; Vicary JR; Heist CL; Corneal DA. Moderate alcohol and tobacco use during pregnancy and child behavior outcomes. Journal of Primary Prevention 21(3): 367-379, 2001. (57 refs.)The goal of this study was to investigate low to moderate intrauterine exposure to alcohol and tobacco and possible behavioral consequences for children. A sample of ninety-eight young mothers were interviewed and their self-reports of substance use during pregnancy, and perceived problem behaviors in their children (ages infancy to 12) were examined. Findings suggest significant differences between perceived problem behaviors in children of mothers who used low to moderate amounts of alcohol and tobacco while pregnant and children of mothers who had used these substances. This offers important implications for prevention programs for young women. Prevention programs should be targeted not only to alcoholic mothers, but also to social drinkers, that is, those who consume low to moderate amounts of alcohol during pregnancy. Identifying even a small attributable risk for maternal substance use during pregnancy could lead to significant savings to families and society in terms of economic and human misery. More research should be undertaken to examine potential long-term effects of any level of prenatal substance exposure, especially alcohol and tobacco, which are more socially acceptable. Copyright 2001, Human Sciences Press, Inc.Kilbride H; Castor C; Hoffman E; Fuger KL. Thirty-six-month outcome of prenatal cocaine exposure for term or near-term infants: Impact of early case management. Journal of Developmental and Behavioral Pediatrics 21(1): 19-26, 2000. (40 refs.)Gestational cocaine use is associated with serious pregnancy complications having fetal and neonatal implications. However, many cocaine-abusing women deliver uneventfully at term. The purpose of this study was to assess the neurodevelopmental outcome for term or near-term infants after prenatal cocaine exposure and to determine whether that outcome would be modified by early, intensive family case management. Cocaine-exposed infants identified after delivery at an urban hospital were alternately assigned to receive case management (n = 70) or routine follow-up (n = 48). A matched, non- drug-exposed group of infants was identified for comparison (n = 41). Infants aged up to 36 months were serially evaluated in a multidisciplinary clinic with cognitive, psychomotor, and language testing. Group comparisons were performed using one-way analysis of variance. There were no statistical differences in mean cognitive, psychomotor, or language quotients between cocaine-exposed and non-drug-exposed infant groups aged up to 36 months. At 6 months of age, case-managed cocaine-exposed infants had a significantly higher mean Bayley Mental Developmental Index score than those who were routinely managed. However, no differences were present at subsequent assessments. Among cocaine-exposed infants who remained with their mothers at 36 months, verbal scores were significantly higher for case-managed compared with routine-managed infants. The negative effects of urban, low socioeconomic status may overshadow the impact of prenatal cocaine exposure on early childhood outcome for those infants born without prenatal complications. Copyright 2000, Williams & WilkinsKoditiwakku PW; May PA; Clericuzio CL; Weers D. Emotion-related learning in individuals prenatally exposed to alcohol: Investigation of the relation between set shifting, extinction of responses, and behavior. Neuropsychologia 39(7): 699-708, 2001. (37 refs.)The association between deficits in emotion-related learning, conceptual set shifting, and behavioral problems was investigated in individuals with substantial prenatal alcohol exposure. Three hypotheses were tested: (1) Alcohol-effected individuals would be deficient in visual discrimination reversal and extinction of learned responses. (2) Deficient performance on reversal learning would be independent of that on a measure of attentional or set shifting. (3) Deficient performance on emotional set shifting tasks would predict behavioral problems. Twenty subjects with confirmed prenatal alcohol exposure (10 of whom were diagnosed as having Fetal Alcohol Syndrome) and 20 normal controls matched for age, gender, and ethnic background participated. The two groups were administered a battery of tests. These included two tests of emotion-related learning (visual discrimination reversal and extinction of reward-response associations), tests of conceptual set shifting and intellectual ability, and behavioral measures. The alcohol-exposed group made fewer reversals than the control group in visual discrimination reversal and exhibited more variability in extinction. These group differences remained significant after controlling for intellectual ability and conceptual set shifting. Variability in extinction and two measures of set shifting, perseverative errors on the Wisconsin Card Sorting Test and omission errors on reversal learning, were found to be strong predictors of parent-rated behavioral problems. Copyright 2001, Pergamon PressLarroque B; Kaminski M; Dehaene P; Subtil D; Querleu D. Prenatal alcohol exposure and signs of minor neurological dysfunction at preschool age. Developmental Medicine and Child Neurology 42(8): 508-514, 2000. (51 refs.)High levels of alcohol consumption during pregnancy affect the development of the baby's central nervous system. Pregnant women were interviewed about their alcohol consumption during pregnancy, when they first visited the maternity hospital in Roubaix, France. Of the 698 women interviewed, 156 of their children were investigated at the age of 4 1/2 years with a standardised examination to assess the effects of prenatal alcohol exposure on neurological status. Two scores were calculated: a posture score, which measured items while the child was standing; and a minor neurological signs score. The posture score was not related to prenatal alcohol exposure. Consumption of 821 drinks/week (3 drinks/day) or more during pregnancy was significantly associated with a higher number of minor neurological signs, after controlling for relevant covariables. Although prenatal alcohol exposure was related to a lower General Cognitive Index (GCI), minor neurological signs were associated with prenatal alcohol exposure after controlling for GCI. Copyright 2000, Cambridge University PressLeitschuh CA; Dunn JM. Prediction of the gross motor development quotient in young children prenatally exposed to cocaine/polydrugs. Adapted Physical Activity Quarterly 18(3): 240-256, 2001. (82 refs.)The purpose was to determine predictors of the gross motor development quotient of the Test of Gross Motor Development (Ulrich, 1985) for young children prenatally exposed to cocaine/polydrugs. Data were collected on 11 variables hypothesized to influence young children's development. Participants were 28 children (15 males, 13 females), ages 3 to 6 years, exposed prenatally to cocaine/polydrugs and their nonbiological mothers (i.e., primary care providers). Multiple regression procedures indicated support for the hypothesis that the gross motor development quotient is predicted by the interaction of the child's effortful control, the primary care provider's understanding and confidence, and the amount of early intervention service the child received. Correlational analysis supported the hypothesis that with this group of children, early motor skill did not predict delay in the gross motor development quotient at ages 3 to 6 years. Copyright 2001, Human Kinetics Publishing Inc.Little RE; Northstone K; Golding J. Alcohol, breastfeeding, and development at 18 months. Pediatrics 109(5): NIL_9-NIL_14, 2002. (14 refs.)Objective. We aimed to replicate a previous study of 1-year-olds that reported a deficit in motor development associated with moderate alcohol use during lactation, using a different but comparable population. Methodology. The mental development of 915 18-month-old toddlers from a random sample of a longitudinal population-based study in the United Kingdom was measured using the Griffiths Developmental Scales. Frequent self-administered questionnaires during and after pregnancy provided maternal data. The dose of alcohol available to the lactating infant was obtained by multiplying the alcohol intake of the mother by the proportion of breast milk in the infant's diet. We compared this dose with the Griffiths Scales of Mental Development, taking into account potentially confounding variables. Result. Three of the Griffiths scales increased slightly but significantly with increasing infant alcohol exposure; there was no association in the remaining 2 or average of the scales. Discussion. We were unable to replicate the earlier deficit in motor skills associated with lactation alcohol use. One reason may be that the dose of alcohol reaching the lactating infant is small, and tests of infants and toddlers have limited ability to pick up small effects. Studies of older children may resolve the question of the safety of drinking while nursing. Copyright 2002, American Academy of PediatricsMattson SN; Riley EP. Parent ratings of behavior in children with heavy prenatal alcohol exposure and IQ-matched controls. Alcoholism: Clinical and Experimental Research 24(2): 226-231, 2000. (25 refs.)Background: Behavioral disturbances are well documented in children with heavy prenatal alcohol exposure. However, the degree to which these disturbances are related to factors other than alcohol, such as general intellectual functioning or socioeconomic status, is not known. Methods: Using the Child Behavior Checklist, parent-rated behaviors of children with histories of heavy prenatal alcohol exposure were compared with those of a control group matched by age, sex socioeconomic status. ethnicity, and verbal IQ score. Using this same questionnaire, children with fetal alcohol syndrome were compared with children with heavy prenatal alcohol exposure that did nor meet the criteria for fetal alcohol syndrome classification. Results: Data were analyzed by multivariate analyses of covariance. In the comparison of children with and without a history of prenatal alcohol exposure, significant differences were found on the competence, problem, and summary scales (all p < 0.05). For the secondary comparison between the fetal alcohol syndrome and the heavy prenatal alcohol exposure groups, there were no significant differences on any of the scales (all p > 0.10). Conclusions: These results suggest that prenatal alcohol exposure results in the significant and profound impairment of parent-rated behaviors and that these deficits are not explained entirely by the presence or absence of facial dysmorphology, general intellectual functioning, or demographic factors. Copyright 2000, Research Society on Alcoholism. Used with permission.McNichol T; Tash C. Parental substance abuse and the development of children in family foster care. Child Welfare 80(2): 239-256, 2001. (15 refs.)To determine the impact of parental substance abuse on children, the cognitive skills and behavior ratings of 268 school-age children placed in family foster care were examined. As a group, the children in family foster care presented with low average cognitive skills and made significant improvement in cognitive functioning during placement. The children with prenatal exposure to drugs scored significantly lower in cognitive skills at the beginning of placement but made significantly more progress than the other children during placement. Behavior ratings by the foster parents and teachers revealed that 29% of the children had scores in the significant range, and the children exposed prenatally to drugs had a higher incidence of behavior problems at school compared to family foster care peers. Recommendations for further study of these factors and for enhancing outcomes for children in care are provided. Copyright 2001, Child Welfare League of AmericaMoe V; Slinning K. Children prenatally exposed to substances: Gender-related differences in outcome from infancy to 3 years of age. Infant Mental Health Journal 22(3): 334-350, 2001. (33 refs.)A group of 78 children with polysubstance exposure in utero and a comparison group of 58 children with no known risk status were followed from infancy to age 3 years. Sixty-six children (84.6%) in the exposed group were taken into custody, and were either placed in foster homes or adopted. The foster parents were specially recruited to provide care to infants at risk. The substance-exposed group exhibited significantly lower birthweight, gestational age, and head circumference than the comparison group. The perinatal data demonstrated no gender differences. The children were assessed on the Bayley-II Scales of Infant Development at 1, 2, and 3 years of age. The results yielded a significant group by gender interaction on the Bayley-II MDI. The boys, but not the girls who had been prenatally exposed g en to polydrugs, alcohol, and tobacco earned significantly lower MDI scores at 1, 2, and 3 years of age than the comparison group at the corresponding ages. The gender differences were still statistically significant when controlling for the effects of prematurity and the caregivers' socioeconomic status. This suggests a special vulnerability in prenatally substance-exposed boys, perhaps because of cumulative risk. However, this group of exposed children did show a developmental catch-up across the first 3 years of life. We suggest that the optimized caregiving environment had a buffering effect, and may have compensated for initial developmental lags in this group of children. Copyright 2001, Michigan Association for Infant Mental HealthMoe V; Slinning K. Prenatal drug exposure and the conceptualization of long-term effects. Scandinavian Journal of Psychology 43(1): 41-47, 2002. (57 refs.)This paper discusses several factors affecting the development of children prenatally exposed to drugs. In the "first generation" of research in this field a main factor model of disease formed the basis for a belief in the feasibility of detecting the direct pharmacological or teratogenic effects of drug exposure on long-term child development. However, the clustering of confounding variables has constituted a major problem in identifying these effects. In the last few years a "second generation" of research in this field has emerged, and investigators have moved beyond simple main-effect models. The importance of controlling for confounding variables has been underscored. However, prenatal substance exposure is still often studied within a teratology model where the main goal is the search for unique effects of a specific drug or substance. Based on this review it is suggested that an appropriate model for understanding the development of drug-exposed children cannot be based on a main- effect perspective. Rather, such a model must evolve from a contextual perspective, and it is suggested that a transactional model, where both potential risk factors and protective factors are considered, should replace the traditional teratology model in this field. Copyright 2002, Almquist & WiksellMun EY; Fitzgerald HE; Von Eye A; Puttler LI; Zucker RA. Temperamental characteristics as predictors of externalizing and internalizing child behavior problems in the contexts of high and low parental psychopathology. Infant Mental Health Journal 22(3): 393-415, 2001. (79 refs.)This study investigated whether the relationships between dimensions of early child temperament and externalizing and internalizing behavior problems differ in relation to the degree of parental psychopathology to which children are exposed. In addition, the reciprocal relation between externalizing and internalizing behavior problems, and stability patterns (i.e., autoregression) of externalizing and internalizing behavior problems were investigated using a two-group structural model. A sample of 215 boys (mean age = 4.22) and their parents were assessed when the boys were 3-5 years old and again when they were 6-8 years old. For the children of parents with two or more lifetime psychopathology diagnoses, high activity, short attention span/distractibility, and high reactivity were linked to extemalizing behavior problems, whereas withdrawal was linked to internalizing behavior problems. For children from low parental psychopathology families, only reactivity was linked to externalizing behavior problems, whereas withdrawal was linked to internalizing behavior problems. Children from high parental psychopathology families (alcohol use disorder and antisocial personality disorder) showed lower stability (autoregression) estimates of behavior problems. The reciprocal relation between externalizing and internalizing behavior problems was supported when children were 6-8 years old, but not when they were 3-5 years old. Copyright 2001, Michigan Association for Infant Mental HealthNiaura R; Bock B; Lloyd EE; Brown R; Lipsitt LP; Buka S. Maternal transmission of nicotine dependence: Psychiatric, neurocognitive and prenatal factors. (review). American Journal on Addictions 10(1): 16-29, 2001. (115 refs.)This paper reviews the literature on maternal influences on smoking behaviors of offspring from the perspective of neuropsychiatric deficits that may be transmitted from mother to child. In particular, we review what is known regarding associations between: (1) in-utero exposure to smoking, (2) adolescent neurocognitive functioning and psychiatric comorbidity, and (3) the patterns of smoking and progression of nicotine dependence. Furthering our knowledge of these differences in susceptibility to nicotine dependence among youth will proving additional for prevention and intervention efforts targeted toward those at high risk for dependence. Copyright 2001, American Academy of Psychiatrists in Alcoholism and AddictionsNulman I; Rovet J; Greenbaum R; Loebstein M; Wolpin J; Pace-Asciak P; Koren G. Neurodevelopment of adopted children exposed in utero to cocaine: the Toronto Adoption Study. Clinical and Investigative Medicine 24(3): 129-137, 2001. (38 refs.)Background: Published studies of children's neurodevelopment after in utero exposure to cocaine have not separated intrauterine from postnatal environmental effects as cocaine-using mothers cluster in low socioeconomic classes and have other risk factors. Methods: To overcome this limitation, a study was done to assess physical and neurodevelopmental characteristics of 52 children: 26 were adopted by parents who sought counselling in the Motherisk Program at the University of Toronto for prenatal cocaine exposure, and 26 were controls matched for maternal intelligence quotient (IQ), socioeconomic status and gestational age. Main outcome measures: Head circumference, McCarthy General Cognitive Index (GCI) score, language performance and temperament tests. Results: The children in the study group had smaller head circumferences (34th versus 54th percentiles p 0.009), lower McCarthy GCI scores (102.8 versus 114.2, p = 0.02), poorer receptive and expressive language performance on the Reynell test, and higher activity levels, less persistence and increased distractibility on temperament tests. On multivariate analysis, cocaine exposure was significantly (p = 0.001) associated with lower IQ and poorer language development independent of intrauterine growth retardation and other potential confounders. Interpretation: By controlling for postnatal environmental factors, this adoption study documents intrauterine developmental risks associated with cocaine exposure. Follow-up into school years is warranted to evaluate the extent of these effects. Copyright 2001, Canadian Medical AssociationNunes EV; Weissman MM; Goldstein R; McAvay G; Beckford C; Seracini A; Verdeli H; Wickramaratne P. Psychiatric disorders and impairment in the children of opiate addicts: Prevalances and distribution by ethnicity. American Journal on Addictions 9(3): 232-241, 2000. (55 refs.)This study examined rates of psychiatric disorders and impairment in 283 children, aged 6 to 17, of 69 Caucasian, 45 African-American, and 47 Hispanic-American methadone maintenance patients. Children were evaluated by direct and/or parental interview with the K-SADS-E. Final DSM-III-R diagnoses and Global Assessment Scale (C-GAS) were assigned by best estimate. Substantial lifetime prevalences of mood (21%), anxiety (24%) and disruptive disorders (30%), school problems (37%), and global impairment (C-GAS < 61) (25%) were observed in the children of opiate-dependent patients. There were few differences between ethnic groups. Effects of proband gender and major depression and their interactions with ethnicity on risk for childhood psychopathology were also examined. The results suggest children of patients in treatment for opiate dependence from diverse ethnic groups are at risk for psychopathology. Programs for early detection and intervention should be devised and evaluated. Copyright 2000, American Academy of Psychiatrists in Alcoholism and AddictionsO'Connor MJ; Kasari C. Prenatal alcohol exposure and depressive features in children. Alcoholism: Clinical and Experimental Research 24(7): 1084-1092, 2000. (56 refs.)Background: This study examined the association between prenatal alcohol exposure and self-report of depressive symptoms in 5- to 6- year-old children. Higher levels of prenatal alcohol exposure were hypothesized to be associated with endorsement of a greater number of depressive symptoms in children. It was also hypothesized that maternal depression, although associated with drinking behavior, would contribute independently to outcome. Finally, the mother's behavior toward the child, as well as current drinking practices, were postulated to mediate the relationship between prenatal alcohol exposure and child depressive symptoms. Methods: Participants were 41 mother-child dyads who had been followed longitudinally since the children were 1 year of age. Self- report questionnaires for maternal and child depression were used. Results: Results revealed that prenatal alcohol exposure, maternal depression, and child gender seemed to be highly associated with child depressive symptoms. Girls who had higher levels of prenatal alcohol exposure and whose mothers acknowledged higher levels of depression endorsed the highest number of depressive symptoms. Neither the mother's behavior in interaction with the child nor her current level of alcohol consumption mediated the relationship. Conclusions: The importance of considering prenatal alcohol exposure as a risk variable in the prediction of childhood-onset depression and the possible neurological mechanisms underlying depression in children with alcohol exposure in utero are discussed. Copyright 2000, Research Society on Alcoholism. Used with permission.Ondersma SJ; Simpson SM; Brestan EV; Ward M. Prenatal drug exposure and social policy: The search for an appropriate response. (review). Child Maltreatment 5(2): 93-108, 2000. (87 refs.)Prenatal drug exposure continues to be a controversial topic. Views of what constitutes an appropriate response to drug-exposed infants vary, in large part due to the many complex issues endemic to perinatal substance use. The purpose of this article is to review the controversy surrounding prenatal drug exposure, outline the policy dilemmas that complicate attempts to respond appropriately, review current practice in this area and the effectiveness of those practices, and offer specific recommendations as a starting point for debate. It is suggested that earlier controversy regarding the sequelae of prenatal drug exposure may be decreasing as research identifies specific and subtle deficits in some affected infants. It is also suggested that the postnatal effects of parental substance abuse (e.g., in terms of abuse/neglect, attachment, and development) are the more appropriate focus of child protection efforts, and that different disciplines must collaborate to reach a consensus regarding the nature of these efforts. Copyright 2000, Thousand OaksOrnoy A; Segal J; Bar-Hamburger R; Greenbaum C. Developmental outcome of school-age children born to mothers with heroin dependency: Importance of environmental factors. Developmental Medicine and Child Neurology 43(10): 668-675, 2001. (44 refs.)Development of children aged 5 to 12 years born to mothers with heroin dependency raised at home or adopted was studied in comparison with: (1) children with environmental deprivation alone (i.e. low parental socioeconomic status [SES] and evidence of neglect), (2) children born to fathers with heroin dependency fathers, and (3) control individuals of average SES. One hundred and sixty children (84 males and 76 females; average age at examination 8 years) were evaluated between 1998 and 1999. All were attending mainstream schools. All participants were examined by a paediatrician and a psychologist using standard neurological and psychological age- appropriate tests, as well as tests and questionnaires to assess learning ability and attention span. The Conners and Achenbach questionnaires and the Pollack Taper test were used to assess possible presence of attention-deficit-hyperactivity disorder (ADHD). Mothers were assessed for ADHD using Wender's questionnaire. Children born to parents with heroin dependency raised at home and those of low SES exhibited intellectual impairment both on verbal and performance skills. They also had impaired reading and arithmetic skills. Children born to mothers with heroin dependency but who were adopted at a young age had normal intellectual and learning abilities, except for some reduced function on the performance Wechsler Intelligence Scale for Children-Revised. We found a high rate of ADHD among all children born to parents with heroin dependency, including those adopted, as well as in children with low parental SES. The highest rate of ADHD was in children born to mothers with heroin dependency raised at home, being twice that observed in the other groups. Mothers of these groups of children also had a high rate of ADHD. Copyright 2001, Cambridge University PressPoon E; Ellis DA; Fitzgerald HE; Zucker RA. Intellectual, cognitive, and academic performance among sons of alcoholics during the early school years: Differences related to subtypes of familial alcoholism. Alcoholism: Clinical and Experimental Research 24(7): 1020-1027, 2000. (74 refs.)Background: Research on intellectual and cognitive functioning of children of alcoholics has been marked by inconsistency, with some studies unable to document deficits. This discrepancy may reflect the substantial heterogeneity found in the alcoholic population and among families of alcoholics. The current study sought to examine the effects of familial alcoholism subtypes on intellectual, cognitive, and academic performance in early school-aged sons of alcoholics. Methods: Subjects for the present study were 198 elementary-age boys who were participants in the larger MSU-UM Longitudinal Study. Familial alcoholism subtypes were determined based on fathers' alcoholism and antisocial personality disorder diagnoses. Intellectual functioning was measured with the Wechsler Intelligence Scale for Children-Revised (WISC-R); academic achievement was measured with the Wide Range Achievement Test-Revised. In addition, Mazes and Freedom from Distractability factor scores of the WISC-R were used to assess abstract planning and attention abilities. Results: Children of antisocial alcoholics (AALs) displayed the worst IQ and academic achievement compared with children of nonantisocial alcoholics (NAALs) and controls. In addition, children of AALs displayed relatively poorer abstract planning and attention abilities compared with children from control families. Regression analyses revealed that familial alcoholism subtype continued to account for variance in child intellectual ability even when other factors were excluded. Conclusions: Findings indicate that children from AAL families are most susceptible to relative intellectual, cognitive, and academic deficits. The study further supports the proposition that familial risk characteristics (i.e., paternal alcoholism and antisociality) may serve as effective indicators of family risk for poor intellectual outcome among offspring as early as the elementary school years. Copyright 2000, Research Society on Alcoholism. Used with permission.Potter SM; Zelazo PR; Stack DM; Papageorgiou AN. Adverse effects of fetal cocaine exposure on neonatal auditory information processing. Pediatrics 105(3): E401-E409, 2000. (72 refs.)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 similar to 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. Whereas nonexposed, control infants exhibited high levels of turning away from the familiarization stimulus during habituation (implying boredom), followed by high levels of turning toward the novel stimulus, indicating recovery of attention, the cocaine-exposed infants turned randomly. Clearly, auditory information processing of cocaine-exposed infants was impaired, despite the fact that they exhibited the same overall number of head-turns and the same high level of positive state as the nonexposed infants. Conclusions. The results imply that cocaine is a neuroteratogenic agent that impairs auditory information processing ability during the newborn period. Cocaine-exposed neonates exhibited a response pattern that is consistent with slower speed of auditory information processing. These deficits were observed within the first few days of birth, before adverse postnatal environmental influences could exert their effect. Moreover, the case-control design increased the probability that the observed information processing deficits were due primarily to the direct effects of fetal exposure to cocaine and not other prenatal factors. However, the long-term implications of these findings for the development of the infant/child are not known and must be addressed in follow-up studies. Copyright 2000, American Academy of PediatricsRamsay MC; Reynolds CR. Does smoking by pregnant women influence IQ, birth weight, and developmental disabilities in their infants? A methodological review and multivariate analysis. (review). Neuropsychology 10(1): 1-40, 2000. (223 refs.)Neuropsychologists are asked frequently to address the issue of the cause of a variety of central nervous system problems that may affect higher cortical function. One such issue is the relationship of maternal smoking to adverse reproductive outcomes involving neocortical insult including mental retardation, learning disabilities, attention-deficit hyperactivity disorder, and other insults that may be related to prolonged hypoxic states in utero. The instant paper develops the issue of causation as a scientific inquiry, reviews several traditional, applicable models, and critiques these models. An additional model of motility is proposed and discussed. The issue of the relationship of maternal smoking to adverse reproductive outcomes is then addressed from a review perspective along with new empirical analyses, the latter demonstrating that researchers tend to draw causal conclusions independent of whether the respective design of their studies would support conclusions about the causation of an event. Causal conclusions in the absence of causal designs have often lead to incomplete and incorrect conclusions. It is necessary to match conclusions not only to the outcomes of a research project but also to its design and accompanying limitations. Copyright 2000, Pergamon PressScher MS; Richardson GA; Day NL. Effects of prenatal cocaine/crack and other drug exposure on electroencephalographic sleep studies at birth and one year. Pediatrics 105(1): 39-48, 2000. (61 refs.)Objective. Little is known about the neurophysiologic effects of prenatal cocaine/crack use. The aim of this study, designed to overcome methodologic limitations of previous research, was to investigate the effects of prenatal cocaine use on electroencephalographic (EEG) sleep patterns, a marker of central nervous system development. Methods. In a longitudinal study of prenatal cocaine/crack exposure, women were interviewed at the end of each trimester about cocaine, crack, alcohol, tobacco, marijuana, and other drug use. Two-hour paper- and computer-generated EEG sleep recordings were obtained on a sample of the full-term infants on the second day of life and at 1 year postpartum. Eligible newborns were fullterm, had received no general anesthesia, and had a 5-minute Apgar score >5. All infants whose mothers used one or more lines of cocaine during their first trimester or any crack (n = 37) were selected. A comparison group was chosen randomly from the group of women who did not use cocaine or crack during their pregnancy (n = 34). Results. Women who used cocaine/crack during the first trimester were older, less educated, less likely to be working, and used more tobacco, alcohol, marijuana, and other illicit drugs than women who did not use cocaine/crack during the first trimester. There were no differences in infant birth weight, length, head circumference, or gestational age between the two exposure groups. After controlling for the significant covariates, prenatal cocaine exposure was associated with less well developed spectral correlations between homologous brain regions at birth, and with lower spectral EEG power values at 1 year of age. Prenatal alcohol, marijuana, and tobacco use were found to affect state regulation and cortical activities. Conclusions. These results indicate that the neurotoxic effects of prenatal cocaine/crack use can be detected with quantitative EEG measures. Copyright 2000, American Academy of PediatricsSchonfeld AM; Mattson SN; Lang AR; Delis DC; Riley EP. Verbal and nonverbal fluency in children with heavy prenatal alcohol exposure. Journal of Studies on Alcohol 62(2): 239-246, 2001. (24 refs.)Objective: Executive function deficits, including Verbal fluency, have been documented in children with histories of prenatal alcohol exposure. Whereas nonverbal fluency impairments have been reported in adults with such exposure, these abilities have not been rested in children. Deficits in both verbal and nonverbal fluency were predicted and assessed in children and adolescents with histories of heavy prenatal alcohol exposure. Method: There was a total of 28 (54% female) subjects; children with heavy prenatal alcohol exposure with (n = 10) and without (n = 8) fetal alcohol syndrome (FAS) were compared to nonexposed controls (n = 10) on the design and verbal fluency measures from the Delis-Kaplan Executive Function System. Both fluency measures consist of three conditions, including a new set-shifting task. All tests require the generation of multiple responses within both rule and time constraints. Results: Data were analyzed using repeated measures analyses of variance and hierarchical regression analyses. Compared to controls, children with heavy prenatal alcohol exposure with and without FAS displayed deficits in both fluency domains, but did not differ from each other. In addition, prenatal alcohol exposure was a significant predictor of performance on the set-shifting design fluency task above and beyond performance on more traditional fluency tasks. IQ was not a significant predictor for the traditional or set-shifting fluency measures, whereas diagnostic group remained a significant predictor when IQ was included in the model. Conclusions: This study adds to the literature on the integrity of executive functions in children with heavy prenatal alcohol exposure, documenting fluency impairment in both verbal and nonverbal domains. It is important to note that these impairments were demonstrated in higher functioning alcohol-exposed children, both with and without FAS, and that diagnostic group explained such deficiencies above and beyond general intellectual ability. Copyright 2001, Alcohol Research Documentation, Inc. Used with permissionSchuler ME; Nair P; Black MM. Ongoing maternal drug use, parenting attitudes, and a home intervention: Effects on mother-child interaction at 18 months. Journal of Developmental and Behavioral Pediatrics 23(2): 87-94, 2002. (29 refs.)This prospective study examined the effects of ongoing maternal drug use, parenting attitudes, and a home-based intervention on mother- child interaction among drug-using women and their children. At 2 weeks postpartum, mothers and infants were randomly assigned to either an Intervention (n = 67) or Control (n = 64) Group. Intervention families received weekly visits until 6 months postpartum and biweekly visits from 6 to 18 months by trained lay visitors. The home intervention was designed to increase maternal empowerment and promote child development. Control families received brief monthly tracking visits. Mother-child interaction was evaluated at 18 months through observation of play. Mothers who continued to use cocaine and/or heroin had lower competence scores (p < .05); poor parenting attitude was also associated with lower competence scores during mother-child interaction (p < .05). Although the intervention had no measured effect, ongoing maternal drug use and poor parenting attitudes were associated with less optimal maternal behavior during mother-child interaction. Copyright 2002, Lippincott, Williams and WilkensShulman LH; Shapira SR; Hirshfield S. Outreach developmental services to children of patients in treatment for substance abuse. American Journal of Public Health 90(12): 1930-1933, 2000. (8 refs.)Objectives. This report describes a model for delivering developmental services to children of patients in treatment for substance abuse. Methods. A multidisciplinary team provides developmental evaluations of children at a substance abuse treatment clinic. Results. In 3 years of operation, 85% of 117 children completed individualized developmental evaluations. Cognitive limitations were diagnosed in 69%, speech and language impairments in 68%, emotional or behavioral problems in 16%, and medical problems in 83%. Follow-up information on children completing evaluation indicated that 72% of eligible children are receiving services as recommended. Conclusions. This high-risk population of children of substance-abusing parents can be effectively served by providing developmental services at a substance abuse treatment program. Copyright 2000, American Public Health Association. Used with permissionSinger LT; Arendt R; Minnes S; Farkas K; Salvator A; Kirchner HL et al. Cognitive and motor outcomes of cocaine-exposed infants. Journal of the American Medical Association 287(15): 1952-1960, 2002. (44 refs.)Context Maternal use of cocaine during pregnancy remains a significant public health problem, particularly in urban areas of the United States and among women of low socioeconomic status. Few longitudinal studies have examined cocaine-exposed infants, however, and findings are contradictory because of methodologic limitations. Objective To assess the effects of prenatal cocaine exposure on child developmental outcomes. Design Longitudinal, prospective, masked, comparison birth cohort study with recruitment in 1994-1996. Setting Obstetric unit of a large US urban teaching hospital. Participants Four hundred fifteen consecutively enrolled infants (218 cocaine-exposed and 197 unexposed) identified from a high-risk, low- socioeconomic status, primarily black (80%) population screened through clinical interview and urine and meconium samples for drug use. The retention rate was 94% at 2 years of age. Main Outcome Measures The Bayley Mental and Motor Scales of Infant Development, assessed at 6.5, 12, and 24 months of corrected age. Results Controlled for confounding variables, cocaine exposure had significant effects on cognitive development, accounting for a 6- point deficit in Bayley Mental and Motor Scales of Infant Development scores at 2 years, with cocaine-exposed children twice as likely to have significant delay (mental development index <80) (odds ratio, 1.98; 95% confidence interval, 1.21-3.24; P=.006). For motor outcomes, there were no significant cocaine effects. Conclusions Cocaine-exposed children had significant cognitive deficits and a doubling of the rate of developmental delay during the first 2 years of life. Because 2-year outcomes are predictive of later cognitive outcomes, it is possible that these children will continue to have learning difficulties at school age. Copyright 2002, American Medical Association. Used with permissionSinger LT; Arendt R; Minnes S; Salvator A; Siegel AC; Lewis BA. Developing language skills of cocaine-exposed infants. Pediatrics 107(5): 1057-1064, 2001. (58 refs.)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. Copyright 2001, American Academy of PediatricsSinger LT; Hawkins S; Huang J; Davillier M; Baley J. Developmental outcomes and environmental correlates of very low birthweight, cocaine-exposed infants. Early Human Development 64(2): 91-103, 2001. (50 refs.)Fetal cocaine exposure may have differentially adverse effects on developmental outcomes of very low birthweight (VLBW) infants. As part of a longitudinal study, 31 cocaine-positive very low birthweight infants, and age, race and socioeconomic status matched VLBW controls enrolled at birth were followed. Neonatal maternal- child interactions, concurrent maternal psychological characteristics and environmental factors conceptualized as important for child outcome were assessed as well as standard developmental outcomes at 3 years. In the neonatal period, cocaine-exposed VLBW infants who remained in maternal custody tended to be rated as less responsive and their mothers as less nurturing, less emotionally available and with a tendency to use more maladaptive coping mechanisms than nonexposed VLBW infants. At followup, cocaine-exposed VLBW children were delayed in cognitive, motor and language development compared to controls. Almost half (45%) of the exposed children scored in the range of mental retardation compared to 16% of the comparison VLBW children. The persistent cognitive, motor and language delays of the cocaine- exposed VLBW children, combined with the poorer behavioral interactions of cocaine-using women with their infants in the neonatal period, indicate a need for increased developmental surveillance of cocaine-exposed VLBW infants with a focus on maternal drug treatment and parenting interventions. Copyright 2001, Elsevier Scientific Publishers Ireland Ltd.Smith LM; Chang L; Yonekura ML; Grob C; Ernst T. Brain proton magnetic resonance spectroscopy in children exposed to methamphetamine in utero. Neurology 57(2): 255-260, 2001. (36 refs.)Objective: To examine the possible neurotoxic effects of prenatal methamphetamine exposure on the developing brain using H-1-MRS. Methods: Methamphetamine-exposed children (n = 12) and age-matched unexposed control subjects (n = 14) were evaluated with MRI, localized H-1-MRS, and a Child Behavior Checklist. Metabolite concentrations of N-acetyl-containing compounds (NA), total creatine (Cr), choline-containing compounds, myoinositol, and glutamate + glutamine were measured in the frontal white matter and striatum. Results: Despite an absence of visible structural abnormalities in either group, children exposed to methamphetamine in utero had higher [Cr] (+10%, p = 0.02) in the striatum, [NA], primarily a measure of N- acetylaspartate was normal in both regions, which suggests no significant neuronal loss or damage in the two brain regions examined. There were no differences in reported behavior problems among the methamphetamine-exposed children relative to the unexposed group. Conclusions: The authors found increased [Cr] in the striatum with relatively normal [NA] in children exposed to methamphetamine. These findings suggest an abnormality in energy metabolism in the brains of children exposed to methamphetamine in utero. Copyright 2001, Edgell Communications, Inc.Sood B; Delaney-Black V; Covington C; Nordstrom-Klee B; Ager J; Templin T; Janisse J; Martier S; Sokol RJ. Prenatal alcohol exposure and childhood behavior at age 6 to 7 years: I. Dose-response effect. Pediatrics 108(2): U90-U98, 2001. (39 refs.)Objective. Moderate to heavy levels of prenatal alcohol exposure have been associated with alterations in child behavior, but limited data are available on adverse effects after low levels of exposure. The objective of this study was to evaluate the dose-response effect of prenatal alcohol exposure for adverse child behavior outcomes at 6 to 7 years of age. Methods. Beginning in 1986, women attending the urban university- based maternity clinic were routinely screened at their first prenatal visit for alcohol and drug use by trained research assistants from the Fetal Alcohol Research Center. All women reporting alcohol consumption at conception of at least 0.5 oz absolute alcohol/day and a 5% random sample of lower level drinkers and abstainers were invited to participate to be able to identify the associations between alcohol intake and child development. Maternal alcohol, cigarette, and illicit drug use were prospectively assessed during pregnancy and postnatally. The independent variable in this study, prenatal alcohol exposure, was computed as the average absolute alcohol intake (oz) per day across pregnancy. At each prenatal visit, mothers were interviewed about alcohol use during the previous 2 weeks. Quantities and types of alcohol consumed were converted to fluid ounces of absolute alcohol and averaged across visits to generate a summary measure of alcohol exposure throughout pregnancy. Alcohol was initially used as a dichotomous variable comparing children with no prenatal alcohol exposure to children with any exposure. To evaluate the effects of different levels of exposure, the average absolute alcohol intake was relatively arbitrarily categorized into no, low (>0 but <0.3 fl oz of absolute alcohol/day), and moderate/heavy (>0.3 fl oz of absolute alcohol/day) for the purpose of this study. Six years later, 665 families were contacted. Ninety-four percent agreed to testing. Exclusions included children who missed multiple test appointments, had major congenital malformations (other than fetal alcohol syndrome), possessed an IQ >2 standard deviations from the sample mean, or had incomplete data. The Achenbach Child Behavior Check-list (CBCL) was used to assess child behavior. The CBCL is a parent questionnaire applicable to children ages 4 to 16 years. It is widely used in the clinical assessment of children's behavior problems and has been extensively used in research. Eight syndrome scales are further grouped into Externalizing or undercontrolled (Aggressive and Delinquent) behavior and Internalizing or overcontrolled (Anxious/Depressed, Somatic Complaints, and Withdrawn) behaviors. Three syndromes (Social, Thought, and Attention Problems) fit neither group. Higher scores are associated with more problem behaviors. Research assistants who were trained and blinded to exposure status independently interviewed the child and caretaker. Data were collected on a broad range of control variables known to influence childhood behavior and/or to be associated with prenatal alcohol exposure. These included perinatal factors of maternal age, education, cigarette, cocaine, and other substances of abuse and the gestational age of the baby. Postnatal factors studied included maternal psychopathology, continuing alcohol and drug use, family structure, socioeconomic status, children's whole blood lead level, and exposure to violence. Data were collected only from black women as there was inadequate representation of other racial groups. Statistical Analyses. Statistical analyses were performed using the SPSS statistical package. Frequency distribution, cross-tabulation, odds ratio, and chi (2) tests were used for analyzing categorical data. Continuous data were analyzed using t tests, analyses of variance (ANOVAs) with posthoc tests, and regression analysis. Results. Testing was available for 501 parent-children dyads. Almost one fourth of the women denied alcohol use during pregnancy. Low levels of alcohol use were reported in 63.8% and moderate/heavy use in 13% of pregnancies. Increasing prenatal alcohol exposure was associated with lower birth weight and gestational age, higher lead levels, higher maternal age, and lower education level, prenatal exposure to cocaine and smoking, custody changes, lower socioeconomic status, and paternal drinking and drug use at the time of pregnancy. Children with any prenatal alcohol exposure were more likely to have higher CBCL scores on Externalizing (Aggressive and Delinquent) and Internalizing (Anxious/Depressed and Withdrawn) syndrome scales and the Total Problem Score. The odds ratio of scoring in the clinical range for Delinquent behavior was 3.2 (1.3-7.6) in children with any prenatal exposure to alcohol compared with nonexposed controls. The threshold dose was evaluated with the 3 prenatal alcohol exposure groups. One-way ANOVA revealed a significant between group difference for Externalizing (Aggressive and Delinquent) and the Total Problem Score. Posthoc tests revealed the between group differences to be significant (no and low-exposure group) for Aggressive and Externalizing behavior suggesting that the adverse effects of prenatal alcohol exposure on child behavior at age 6 to 7 years are evident even at low levels of exposure. For Delinquent and Total Problem behavior, the difference was significant between the no and moderate-heavy exposure group, suggesting a higher threshold for these behaviors. Prenatal alcohol exposure remained a significant predictor of behavior after adjusting for covariates. Although maternal psychopathology was the most important predictor of behavior, gender was also a significant predictor, with boys having higher scores on Externalizing (Delinquent) and Attention Problems. The amount of variance uniquely accounted for by prenatal alcohol exposure ranged between 0.6% to 1.7%. Conclusions. Maternal alcohol consumption even at low levels was adversely related to child behavior; a dose-response relationship was also identified. The effect was observed at average levels of exposure of as low as 1 drink per week. Although effects on mean scores for Externalizing and Aggressive behaviors were observed at low levels of prenatal alcohol exposure, effects on Delinquent behavior and Total Problem Scores were observed at moderate/heavy levels of exposure. Children with any prenatal alcohol exposure were 3.2 times as likely to have Delinquent behavior scores in the clinical range compared with nonexposed children. The relationship between prenatal alcohol exposure and adverse childhood behavior outcome persisted after controlling for other factors associated with adverse behavioral outcomes. Clinicians are often asked by pregnant women if small amounts of alcohol intake are acceptable during pregnancy. These data suggest that no alcohol during pregnancy remains the best medical advice. Copyright 2001, American Academy of PediatricsSowell ER; Mattson SN; Thompson PM; Jernigan TL; Riley EP; Toga AW. Mapping callosal morphology and cognitive correlates: Effects of heavy prenatal alcohol exposure. Neurology 57(2): 235-244, 2001. (45 refs.)Background: Abnormalities of the corpus callosum (CC) have been documented in fetal alcohol syndrome (FAS), ranging from subtle decrements in its size to partial and even complete agenesis. Prenatal exposure to alcohol is also known to result in neurocognitive deficits. Objective: To 1) investigate abnormalities in size, shape, and location of the CC within the brain in individuals with FAS and in those exposed to high amounts of alcohol prenatally but without FAS (PEA group); and 2) determine if there is a relationship between callosal dysmorphology and cognitive test performance. Methods: MRI and novel surface-based image analytic methods were used. Twenty alcohol-exposed subjects (8 to 22 years) along with 21 normal controls (8 to 25 years) were studied with high- resolution MRI and measures of verbal learning and visuospatial abilities. Results: In addition to callosal area reductions, most severe in the splenium, the CC is significantly displaced in patients exposed to alcohol prenatally. In the alcohol-exposed group, this structure lies more anterior and inferior in posterior regions with relatively normal localization of anterior regions. These findings are significant in the FAS group, and a similar but less severe pattern is observed in the PEA patients. The authors show that the amount of CC displacement is correlated with impairment in verbal learning ability and that CC displacement is a better predictor of verbal learning than regional CC area. The brain-behavior relationship is only significant within the alcohol-exposed group, and the effect is not solely mediated by overall impaired verbal intellectual functioning. Conclusions: These results further emphasize the vulnerability of midline brain structures to prenatal alcohol exposure. Copyright 2001, Edgell Communications, Inc.Sowell ER; Thompson PM; Mattson SN; Tessner KD; Jernigan TL; Riley EP; Toga AW. Voxel-based morphometric analyses of the brain in children and adolescents prenatally exposed to alcohol. Neuroreport 12(3): 515-523, 2001. (30 refs.)Children of mothers who abuse alcohol during pregnancy can suffer varying degrees of neurological abnormality, cognitive impairment, and behavioral problems, and in the worst case, are diagnosed with fetal alcohol syndrome (FAS). The purpose of the present study was to localize brain abnormalities in a group of children and adolescents prenatally exposed to alcohol using high resolution, 3D structural MRI data and whole-brain voxel-based morphometry (VBM). Data were collected for 21 children and adolescents with histories of prenatal alcohol exposure (ALC) and 21 normally developing individuals. Statistical parametric maps revealed abnormalities most prominent in the left hemisphere perisylvian cortices of the temporal and parietal lobes where the ALC patients tended to have too much gray matter and not enough white matter. These results provide further support for dysmorphology in temporo-parietal cortices above and beyond the overall microcephaly that results from severe prenatal alcohol exposure. Copyright 2001, Rapid Science PublishersVan Beveren TT; Little BB; Spence MJ. Effects of prenatal cocaine exposure and postnatal environment on child development. American Journal of Human Biology 12(3): 417-428, 2000. (82 refs.)Studies on the long-term developmental effects of in utero cocaine exposure are few and the small number of studies published do not consider the postnatal environment. The present investigation was conducted to quantify the role that postnatal environment played compared to prenatal exposure. Four groups of 25 infants, each assessed at 12 months of age, were included in the study design: 1.) noncocaine-exposed children residing with their biological parents in low socioeconomic environments, 2) cocaine-exposed children living with their biological parents in low socioeconomic environments, 3) noncocaine-exposed children adopted at birth in middle to upper- middle socioeconomic environments, and 4) cocaine-exposed children adopted at birth. Infants were assessed by the Uzgiris-Hunt Ordinal Scales of Infant Psychological Development, the Fagan Test of Infant Intelligence, and the Infant Monitoring Questionnaire. Height and head circumference were measured. Gender and ethnicity were controlled statistically. Significant differences were found in cognitive functioning, in fine motor development, and in physical growth between control and prenatally cocaine-exposed children. Adoption enhanced cognitive functioning and fine motor skills among infants not exposed to cocaine prenatally, but had no apparent effect on infants prenatally exposed to cocaine. Copyright 2000, Wiley-LissVan der Leeden M; Van Dongen K; Kleinhout M; Phaff J; De Groot CJ; de Groot L; Hesseling PB. Infants exposed to alcohol prenatally: Outcome at 3 and 7 months of age. Annals of Tropical Paediatrics 21(2): 127-134, 2001. (26 refs.)To investigate early recognition of the consequences of alcohol exposure in utero, we studied 79 infants at the ages of 3 and 7 months. Twenty-nine of them were exposed to varying levels of maternal alcohol intake and 50 had no exposure and formed a control group. Special attention was paid to fetal alcohol syndrome-related facial features, neurological development and behavioural performance of the infants. To monitor facial features, pictures were taken at 3 and 7 months of age. Significant differences in facial features were found between the alcohol-exposed and non-exposed children at 3 months only. An age-adequate neurological examination showed no significant difference at 3 months but a significant difference at 7 months of age between the alcohol-exposed infants and the controls. Mothers reported more misbehaviour in the exposed than in the non-exposed group. These results indicate that it is possible to recognise alcohol-related defects within the Ist year of life thus allowing early intervention. Copyright 2001, Carfax PublishingWhaley SE; O'Connor MJ; Gunderson B. Comparison of the adaptive functioning of children prenatally exposed to alcohol to a nonexposed clinical sample. Alcoholism: Clinical and Experimental Research 25(7): 1018-1024, 2001. (29 refs.)Background: Several studies show impairments in the social and adaptive behaviors of children prenatally exposed to alcohol. However, there remains limited consensus on whether the alcohol exposure directly affects social functioning or whether its effect is mediated by deficits in IQ. In addition, no studies have investigated whether deficits in social functioning are significantly more pronounced in children prenatally exposed to alcohol than in children referred to psychiatric treatment who were not prenatally exposed. We explored the effect of alcohol exposure on social and adaptive functioning and explored whether or not social and adaptive functioning are significantly more impaired in children prenatally exposed to alcohol than in a clinical sample of children. Methods: A sample of 33 alcohol-exposed children was compared with a sample of 33 clinic-referred nonexposed children. The groups were compared on measures of communication, daily living skills, and socialization. The groups were matched on sex, age, IQ, and outpatient or inpatient status. Results: Analyses revealed that the prenatally alcohol-exposed children did not differ significantly from the nonexposed children in any of the domains of adaptive functioning. However, with age, exposed children showed a more rapid decline in socialization standard scores compared with the nonexposed clinical sample. Conclusions: Young children who were exposed to alcohol prenatally show deficits in all domains of adaptive functioning. Although these deficits do not seem to differ from those exhibited by young children with psychiatric problems but no prenatal exposure, deficits in socialization behavior of prenatally exposed children may become more significant with age. Copyright 2001,Zuckerman B; Frank DA; Mayes L. Cocaine-exposed infants and developmental outcomes: "Crack kids" revisited. (editorial). Journal of the American Medical Association 287(15): 1990-1991, 2002. (19 refs.) |