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Published on: May 6, 2019
Cognitive outcomes of preschool children with prenatal cocaine exposure
Lynn T Singer1, Sonia Minnes, Elizabeth Short
1Department of General Medical Sciences, School of Medicine, Case Western Reserve University, Cleveland, Ohio 44106, USA. Lynn.Singer@case.edu
Insights
Prenatal cocaine exposure did not impact overall IQ scores at age 4, but it was linked to specific cognitive deficits. A supportive caregiving environment significantly improved cognitive outcomes for exposed children.
Area of Science:
- Neuroscience
- Developmental Psychology
- Pediatrics
Background:
- Methodological limitations in prior studies yield inconsistent findings on long-term cognitive effects of prenatal cocaine exposure.
- Assessing the impact of prenatal cocaine exposure on cognitive development requires robust, longitudinal research.
Purpose of the Study:
- To evaluate the effects of prenatal cocaine exposure on cognitive outcomes at 4 years of age.
- To determine the influence of the caregiving environment on cognitive development in children with prenatal cocaine exposure.
Main Methods:
- A longitudinal, prospective, masked cohort study followed 376 children from birth to 4 years.
- Cognitive outcomes were assessed using the Wechsler Preschool and Primary Scales of Intelligence-Revised.
- Data were collected from a high-risk urban population screened for drug exposure.
Main Results:
- Prenatal cocaine exposure was not associated with lower full-scale, verbal, or performance IQ scores at age 4.
- However, cocaine-exposed children showed deficits in visual-spatial skills, general knowledge, and arithmetic.
- The quality of the caregiving environment was the strongest predictor of cognitive outcomes, with better environments linked to higher IQ scores.
Conclusions:
- Prenatal cocaine exposure poses a risk for specific cognitive impairments, not global IQ deficits, by age 4.
- A nurturing and stimulating caregiving environment can mitigate cognitive deficits in children exposed to cocaine prenatally.
- Interventions focused on improving the home environment may be crucial for optimizing developmental trajectories.
Context:
Because of methodological limitations, the results of the few prospective studies assessing long-term cognitive effects of prenatal cocaine exposure are inconsistent.
Objective:
To assess effects of prenatal cocaine exposure and quality of caregiving environment on 4-year cognitive outcomes.
Design:
Longitudinal, prospective, masked comparison cohort study from birth (September 1994-June 1996) to 4 years.
Setting:
Research laboratory of a US urban county teaching hospital.
Participants:
A total of 415 consecutively enrolled infants identified from a high-risk population screened for drug use through clinical interview, urine, and meconium screens. Ninety-three percent retention for surviving participants at 4 years of age resulted in 376 children (190 cocaine-exposed and 186 nonexposed).
Main Outcome Measure:
The Wechsler Preschool and Primary Scales of Intelligence-Revised.
Results:
After control for covariates, prenatal cocaine exposure was not related to lower full-scale IQ (cocaine exposed [80.7] vs nonexposed [82.9]; P =.09) scores or summary verbal (cocaine exposed [79.9] vs nonexposed [81.9]; P =.11) or performance (cocaine exposed [85.5] vs nonexposed [87.5]; P =.18) IQ scores at age 4 years. However, prenatal cocaine exposure was related to small but significant deficits on several subscales (mean [SE]): visual-spatial skills (cocaine exposed [7.3 (0.22)] vs nonexposed [8.2 (0.22)]; P =.01), general knowledge (cocaine exposed [6.1 (0.18)] vs nonexposed [6.7 (0.17)]; P =.04), and arithmetic skills (cocaine exposed [6.2 (0.20)] vs nonexposed [6.8 (0.20)]; P =.05). Prenatal cocaine exposure was also associated with a lower likelihood of achievement of IQ above normative means (odds ratio, 0.26 [95% confidence interval, 0.10-0.65]; P =.004). The quality of the caregiving environment was the strongest independent predictor of outcomes. Cocaine-exposed children placed in nonrelative foster or adoptive care lived in homes with more stimulating environments and had caregivers with better vocabulary scores, and they attained full-scale and performance IQ scores (83 and 87, respectively) similar to nonexposed children in biological maternal or relative care (full-scale IQ, 82; performance IQ, 88) and higher than cocaine-exposed children in biological maternal or relative care (full-scale IQ, 79; performance IQ, 84).
Conclusions:
Prenatal cocaine exposure was not associated with lower full-scale, verbal, or performance IQ scores but was associated with an increased risk for specific cognitive impairments and lower likelihood of IQ above the normative mean at 4 years. A better home environment was associated with IQ scores for cocaine-exposed children that are similar to scores in nonexposed children.
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