title: Neurobehavioral disinhibition predicts initiation of substance use in children with prenatal cocaine exposure.
abstract: BACKGROUND
  In previous work we (Fisher et al., 2011) examined the emergence of neurobehavioral disinhibition (ND) in adolescents with prenatal substance exposure. We computed ND factor scores at three age points (8/9, 11 and 13/14 years) and found that both prenatal substance exposure and early adversity predicted ND. The purpose of the current study was to determine the association between these ND scores and initiation of substance use between ages 8 and 16 in this cohort as early initiation of substance use has been related to later substance use disorders. Our hypothesis was that prenatal cocaine exposure predisposes the child to ND, which, in turn, is associated with initiation of substance use by age 16.
  
  
  METHODS
  We studied 386 cocaine exposed and 517 unexposed children followed since birth in a longitudinal study. Five dichotomous variables were computed based on the subject's report of substance use: alcohol only; tobacco only; marijuana only; illicit substances and any substance.
  
  
  RESULTS
  Cox proportional hazard regression showed that the 8/9 year ND score was related to initiation of alcohol, tobacco, illicit and any substance use but not marijuana use. The trajectory of ND across the three age periods was related to substance use initiation in all five substance use categories. Prenatal cocaine exposure, although initially related to tobacco, marijuana and illicit substance initiation, was no longer significant with ND scores in the models.
  
  
  CONCLUSIONS
  Prenatal drug exposure appears to be a risk pathway to ND, which by 8/9 years portends substance use initiation.
authors.affiliation: Brown Center for the Study of Children at Risk, Department of Pediatrics, Women & Infants Hospital of Rhode Island, Providence, RI 02905, USA. Barry_Lester@Brown.edu
authors.forename: Barry M
authors.initials: BM
authors.lastname: Lester
authors.forename: Hai
authors.initials: H
authors.lastname: Lin
authors.forename: David S
authors.initials: DS
authors.lastname: Degarmo
authors.forename: Philip A
authors.initials: PA
authors.lastname: Fisher
authors.forename: Linda L
authors.initials: LL
authors.lastname: Lagasse
authors.forename: Todd P
authors.initials: TP
authors.lastname: Levine
authors.forename: Seetha
authors.initials: S
authors.lastname: Shankaran
authors.forename: Henrietta S
authors.initials: HS
authors.lastname: Bada
authors.forename: Charles R
authors.initials: CR
authors.lastname: Bauer
authors.forename: Jane A
authors.initials: JA
authors.lastname: Hammond
authors.forename: Toni M
authors.initials: TM
authors.lastname: Whitaker
authors.forename: Rosemary D
authors.initials: RD
authors.lastname: Higgins
mesh_terms: D000293:Adolescent; D000328:Adult; D017028:Caregivers / Q000523:psychology; D002648:Child; D002649:Child Abuse / Q000523:psychology; D002653:Child Behavior Disorders / Q000523:psychology; D003042:Cocaine / Q000009:adverse effects*; D003863:Depression / Q000523:psychology; D017579:Domestic Violence; D005260:Female; D006801:Humans; D007266:Inhibition, Psychological; D008137:Longitudinal Studies; D002189:Marijuana Abuse / Q000523:psychology; D011247:Pregnancy; D011297:Prenatal Exposure Delayed Effects / Q000523:psychology*; D016016:Proportional Hazards Models; D011627:Puberty / Q000502:physiology / Q000523:psychology; D012907:Smoking / Q000523:psychology; D012931:Social Environment; D012959:Socioeconomic Factors; D013315:Stress, Psychological / Q000523:psychology; D019966:Substance-Related Disorders / Q000523:psychology*; D014754:Violence
chemical_list: D003042:Cocaine