Related Experiment Video
Updated: Jun 15, 2026
Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
The effects of prenatal cocaine exposure on problem behavior in children 4-10 years
Sonia Minnes1, Lynn T Singer, H Lester Kirchner
1Case Western Reserve University, The Mandel School of Applied Social Science, Cleveland, Ohio 44106, USA. sonia.minnes@case.edu
Insights
Prenatal cocaine and tobacco exposure are linked to increased externalizing behaviors in children up to age 10. Interventions targeting maternal substance use and psychological distress are crucial for prevention.
Area of Science:
- Developmental Psychology
- Neuroscience
- Public Health
Background:
- Prenatal cocaine exposure may lead to behavioral issues via disrupted arousal systems.
- Environmental factors also play a role in child development.
Purpose of the Study:
- To evaluate behavioral outcomes in children exposed to cocaine prenatally (CE) versus non-cocaine-exposed (NCE) children.
- To control for other prenatal drug exposures and environmental influences.
Main Methods:
- Longitudinal study of 381 low SES, primarily African American children from birth to 10 years.
- Generalized Estimating Equation (GEE) analyses assessed prenatal cocaine exposure's link to behavioral problems.
- Controlled for confounders including socioeconomic status, other drug exposures, and caregiving factors.
Main Results:
- Prenatal cocaine exposure associated with increased delinquency, particularly in females.
- Prenatal tobacco exposure linked to higher externalizing symptoms.
- Children in foster/adoptive care showed more behavioral problems; caregiver distress worsened ratings.
Conclusions:
- Prenatal cocaine and tobacco exposure predict externalizing behaviors, independent of other factors.
- Maternal psychological distress significantly impacts child behavior ratings.
- Prenatal education, drug treatment, and mental health support are vital for prevention.
Background:
Children prenatally exposed to cocaine may be at increased risk for behavioral problems due to disruptions of monaminergically regulated arousal systems and/or environmental conditions.
Objective:
To assess behavioral outcomes of cocaine (CE) and non-cocaine-exposed (NCE) children, 4 through 10 years old, controlling for other prenatal drug exposures and environmental factors.
Methods:
Low socioeconomic status (SES), primarily African American children (n=381 (193 (CE), 188 (NCE)) were recruited from birth. Generalized Estimating Equation (GEE) analyses were used to assess the predictive relationship of prenatal cocaine exposure to odds of caregiver reported clinically elevated behavioral problems at 4, 6, 9 and 10y ears of age, controlling for confounders.
Results:
Prenatal cocaine exposure was associated with increased rates of caregiver reported delinquency (OR=1.93, CI: 1.09-3.42, p<0.02). A significant prenatal cocaine exposure by sex interaction was found for delinquency indicating that only females were affected (OR=3.57, CI: 1.67-7.60, p<0.001). There was no effect of cocaine on increased odds of other CBCL subscales. Higher prenatal tobacco exposure was associated with increased odds of externalizing symptoms at 4, 9 and 10 years of age. For CE children, those in foster or adoptive care were rated as having more behavior problems than those in biologic mother or relative care. Greater caregiver psychological distress was associated with increased behavioral problems. There were no independent effects of elevated blood lead level on increased behavior problems after control for prenatal drug exposure and other environmental conditions.
Conclusion:
Prenatal cocaine and tobacco exposure were associated with greater externalizing behavior after control for multiple prenatal drug exposures, other environmental and caregiving factors and lead exposure from 4 through 10 years of age. Greater caregiver psychological distress negatively affected caregiver ratings of all CBCL domains. Since cocaine and tobacco use during pregnancy and maternal psychological distress have the potential to be altered through prenatal educational, drug treatment and mental health interventions, they warrant attention in efforts to reduce rates of problem behaviors in children.
Related Concept Videos
01:30Attention-Deficit/Hyperactivity Disorder
Diagnostic Criteria and Symptoms
To diagnose ADHD, symptoms must manifest before age 12 and be evident across multiple settings.
01:28Conduct Disorder