Preadolescent behavior problems after prenatal cocaine exposure: Relationship between teacher and caretaker ratings (Maternal Lifestyle Study)
Preadolescent behavior problems after prenatal cocaine exposure: Relationship between teacher and caretaker ratings (Maternal Lifestyle Study)
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DOI：
10.1016/j.ntt.2010.06.005
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发表时间：
2011-01-01
影响因子：
2.9
通讯作者：
Higgins, Rosemary
中科院分区：
文献类型：
--
作者：
Bada, Henrietta S.;Bann, Carla M.;Higgins, Rosemary
背景：我们之前报道了父母或监护人观察到的产前可卡因暴露（PCE）与儿童行为问题之间的关联。然而，这些行为问题可能不会在结构化的环境中表现出来，比如学校环境。目的：我们确定PCE与学校行为问题之间是否存在关联，以及教师对行为问题的评分是否与家长或看护人对行为问题的评分不同。方法：母亲生活方式研究是一项多中心研究，招募了1388名1月龄有和没有PCE的儿童进行纵向评估。在儿童7岁、9岁和11岁时，对产前药物暴露状况隐瞒的教师填写教师报告表（TRF/6-18）。我们还对父母/监护人在相同年龄和13岁时进行了儿童行为检查表-家长报告（CBCL）。我们采用潜在增长曲线模型来确定高PCE是否会预测7岁时的外化、内化、总行为和注意力问题，以及在教师和家长报告中暴露儿童和未暴露儿童的问题分数随时间的变化是否不同。除了PCE水平作为预测因子外，我们还控制了以下协变量，即：地点、儿童特征（性别和其他产前药物暴露）、家庭层面的影响（母亲年龄、抑郁和心理症状、持续吸毒、家庭暴力暴露、家庭环境和社会经济地位）和社区层面的因素（邻里和社区暴力）。结果：教师报告的平均行为问题T得分显著高于家长或监护人的评分。潜在增长曲线模型显示，教师和家长对问题T得分的截距之间存在显著关系；也就是说，被老师评价差的孩子也会被他们的父母/监护人评价差，反之亦然。在控制了协变量后，我们发现，与非PCE儿童相比，高PCE是7岁时父母和老师报告的较高外化行为问题T得分的显著预测因子（p = 0.034和p = 0.021分别）。这些来自老师或照顾者的分数差异在随后的几年里保持稳定，或者随着时间的推移没有显著变化。照顾者报告的内化问题和总问题T分男生高于女生；在教师评分中，他们在内化、总体和注意力问题上的T分也明显更高；外化行为的差异有统计学意义（p = 0.070）。看护人产后吸烟、抑郁和社区暴力是父母/看护人评定的所有行为问题的显著预测因素，而在教师报告中，家庭环境得分较低可以预测所有行为结果。结论：高PCE患儿易出现外化行为问题；从老师或家长的报告中，他们在7岁时的行为问题得分仍然高于随后几年未接触儿童的得分。在考虑其他混杂因素可能产生的影响的同时，对早期行为问题的筛查和识别可以使干预措施的启动成为可能。(C) 2010爱思唯尔公司版权所有。
Background: We previously reported an association between prenatal cocaine exposure (PCE) and childhood behavior problems as observed by the parent or caretaker. However, these behavior problems may not manifest in a structured environment, such as a school setting.Objective: We determined whether there is an association between PCE and school behavior problems and whether ratings of behavior problems from the teacher differ from those noted by the parent or caretaker.Methods: The Maternal Lifestyle Study, a multicenter study, enrolled 1388 children with and without PCE at one month of age for longitudinal assessment Teachers masked to prenatal drug exposure status completed the Teacher Report Form (TRF/6-18) when children were 7, 9, and 11 years old. We also administered the Child Behavior Checklist-parent report (CBCL) to the parent/caretaker at same ages and then at 13 years. We performed latent growth curve modeling to determine whether high PCE will predict externalizing, internalizing, total behavior, and attention problems at 7 years of age and whether changes in problems' scores over time differ between those exposed and non-exposed from both teacher and parent report. Besides levels of PCE as predictors, we controlled for the following covariates, namely: site, child characteristics (gender and other prenatal drug exposures), family level influences (maternal age, depression and psychological symptomatology, continuing drug use, exposure to domestic violence, home environment and socioeconomic status), and community level factors (neighborhood and community violence).Results: The mean behavior problem T scores from the teacher report were significantly higher than ratings by the parent or caretaker. Latent growth curve modeling revealed a significant relationship between intercepts of problem T scores from teacher and parent ratings; i.e., children that were rated poorly by teachers were also rated poorly by their parent/caretaker or vice versa. After controlling for covariates, we found high PCE to be a significant predictor of higher externalizing behavior problem T scores from both parent and teacher report at 7 years (p = 0.034 and p = 0.021, respectively) in comparison to non-PCE children. These differences in scores from either teacher or caregiver were stable through subsequent years or did not change significantly over time. Boys had higher T scores than girls on internalizing and total problems by caretaker report; they also had significantly higher T scores for internalizing, total, and attention problems by teacher ratings; the difference was marginally significant for externalizing behavior (p = 0.070). Caretaker postnatal use of tobacco, depression, and community violence were significant predictors of all behavior problems rated by parent/caretaker, while lower scores on the home environment predicted all behavior outcomes by the teacher report.Conclusions: Children with high PCE are likely to manifest externalizing behavior problems; their behavior problem scores at 7 years from either report of teacher or parent remained higher than scores of non-exposed children on subsequent years. Screening and identification of behavior problems at earlier ages could make possible initiation of intervention, while considering the likely effects of other confounders. (C) 2010 Elsevier Inc. All rights reserved.