title: Estimated effect of prenatal cocaine exposure on examiner-rated behavior at age 7 years.
abstract: Prenatal cocaine exposure has been linked to increased child behavior difficulties in some studies but not others.
  
  
  OBJECTIVE
  The primary aim was to estimate the relationship between in utero cocaine exposure and child behavioral functioning at age 7 years with ratings made by blinded examiners during a structured testing session. A second aim was to examine whether caregiver drug use and psychological problems might mediate suspected relationships between prenatal cocaine exposure and aspects of examiner-rated behavior.
  
  
  METHODS
  407 children (212 cocaine-exposed, 195 non-exposed) participating in the longitudinal Miami Prenatal Cocaine Study (MPCS) were rated with regard to their behavior during a neuropsychological assessment conducted at age 7 years. Raters were trained research psychometricians blinded to drug exposure status. Individual behavioral items were summarized and the cocaine-behavior relationship was estimated within the context of latent variable modeling, using Mplus software.
  
  
  RESULTS
  Two latent variables, Behavioral Regulation and Sociability, were derived via exploratory latent structure analysis with promax rotation. Prenatal cocaine exposure, statistically controlling for child sex, test age, and prenatal exposure to alcohol, tobacco, and marijuana, was associated with Behavioral Regulation (estimated slope ß=-0.25; 95% CI=-0.48, -0.02; p=0.04) but not Sociability (estimated slope ß=-0.03; 95% CI=-0.26, 0.20; p=0.79). Neither postnatal drug use by caregivers nor the severity of their psychological problems at age 5 follow-up predicted levels of child Behavioral Regulation or Sociability at age 7 years (p>0.10).
  
  
  CONCLUSIONS
  Examiner ratings of child behavior at age 7 revealed less optimal behavioral regulation for prenatally cocaine-exposed compared to non-exposed children, in contrast with what had been previously found from parent-report data. This evidence highlights the potential value of trained observers in assessing behavioral outcomes of children exposed in utero to drugs and other toxicants.
authors.affiliation: University of Miami Miller School of Medicine, Department of Pediatrics, Miami, FL 33101, United States. vaccornero@med.miami.edu
authors.forename: Veronica H
authors.initials: VH
authors.lastname: Accornero
authors.forename: James C
authors.initials: JC
authors.lastname: Anthony
authors.forename: Connie E
authors.initials: CE
authors.lastname: Morrow
authors.forename: Lihua
authors.initials: L
authors.lastname: Xue
authors.forename: Elana
authors.initials: E
authors.lastname: Mansoor
authors.forename: Arnise L
authors.initials: AL
authors.lastname: Johnson
authors.forename: Clyde B
authors.initials: CB
authors.lastname: McCoy
authors.forename: Emmalee S
authors.initials: ES
authors.lastname: Bandstra
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D002648:Child; D002652:Child Behavior / Q000187:drug effects* / Q000523:psychology*; D002675:Child, Preschool; D003042:Cocaine / Q000633:toxicity*; D019970:Cocaine-Related Disorders / Q000523:psychology*; D003627:Data Interpretation, Statistical; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007361:Intelligence Tests; D009483:Neuropsychological Tests; D011247:Pregnancy; D011297:Prenatal Exposure Delayed Effects / Q000139:chemically induced / Q000523:psychology*; D011446:Prospective Studies; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D055815:Young Adult
chemical_list: D003042:Cocaine