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Estimated Risk of Developing Selected DSM-IV Disorders Among 5-Year-Old Children with Prenatal Cocaine Exposure
Connie E Morrow1, Lihua Xue1, Sudha Manjunath2
1Department of Pediatrics, Miller School of Medicine, University of Miami, Miami, Florida.
Insights
Prenatal cocaine exposure (PCE) in children may slightly increase the risk of Attention-Deficit Hyperactivity Disorder (ADHD). However, this study found no significant link between PCE and Oppositional Defiant Disorder (ODD) or Separation Anxiety Disorder (SAD).
Area of Science:
- Neuroscience
- Developmental Psychology
- Pediatrics
Background:
- Prenatal cocaine exposure (PCE) is a significant concern with potential long-term neurodevelopmental consequences.
- Understanding the specific risks of psychiatric disorders following PCE is crucial for early intervention and support.
Purpose of the Study:
- To estimate the childhood risk of Attention-Deficit Hyperactivity Disorder (ADHD), Oppositional Defiant Disorder (ODD), and Separation Anxiety Disorder (SAD) in children with PCE.
- To investigate the association between the level of PCE and the risk of developing these specific disorders.
Main Methods:
- Prospective birth cohort study of 476 children, with detailed documentation of prenatal drug exposures.
- Follow-up assessment at 5 years for 400 African-American children (208 cocaine-exposed [CE] and 192 non-cocaine-exposed [NCE]).
- Diagnostic interviews using the Computerized Diagnostic Interview Schedule for Children and statistical analysis with generalized linear models.
Main Results:
- A modest but statistically significant elevation in ADHD risk was associated with increasing levels of PCE (p<0.05).
- No significant association was found between PCE and the risk of ODD or SAD when comparing CE and NCE children.
- Cumulative incidence proportions showed similar rates for ADHD, SAD, and ODD between CE and NCE groups, with a trend towards higher ADHD risk in CE.
Conclusions:
- Findings suggest a potential increased risk of ADHD in children with higher levels of prenatal cocaine exposure.
- The study did not find evidence linking PCE to increased risks of ODD or SAD at the 5-year follow-up.
- Further research is warranted to fully understand the neurodevelopmental impact of PCE on childhood psychiatric disorders.
Abstract:
This study estimated childhood risk of developing selected DSM-IV Disorders, including Attention-Deficit Hyperactivity Disorder (ADHD), Oppositional Defiant Disorder (ODD), and Separation Anxiety Disorder (SAD), in children with prenatal cocaine exposure (PCE). Children were enrolled prospectively at birth (n=476) with prenatal drug exposures documented by maternal interview, urine and meconium assays. Study participants included 400 African-American children from the birth cohort, 208 cocaine-exposed (CE) and 192 non-cocaine-exposed (NCE) who attended a 5-year follow-up assessment and whose caregiver completed the Computerized Diagnostic Interview Schedule for Children. Under a generalized linear model (logistic link), Fisher's exact methods were used to estimate the CE-associated relative risk (RR) of these disorders. Results indicated a modest but statistically robust elevation of ADHD risk associated with increasing levels of PCE (p<0.05). Binary comparison of CE versus NCE children indicated no CE-associated RR. Estimated cumulative incidence proportions among CE children were 2.9% for ADHD (vs 3.1% NCE); 1.4% for SAD (vs 1.6% NCE); and 4.3% for ODD (vs 6.8% NCE). Findings offer suggestive evidence of increased risk of ADHD (but not ODD or SAD) in relation to an increasing gradient of PCE during gestation.