Cocaine Exposed Children at School Age

描述（由申请人提供）：孕妇在怀孕期间使用可卡因/多种药物仍然是美国的一个重大公共卫生问题，特别是在贫困的城市地区。尽管在20世纪80年代可卡因流行时期出生的数十万婴儿现在都是学龄儿童，但我们对胎儿接触可卡因的长期影响几乎没有确切的了解。母亲使用可卡因也与许多其他风险状况有关，这些风险状况可能会对儿童的结局产生负面影响，例如虐待/忽视儿童的风险增加，母亲心理压力更大，父母行为改变和暴力暴露。除了记录学龄儿童的一系列结果外，拟议的研究旨在评估环境和母亲心理因素，这些因素可能增加或减少可卡因暴露儿童的风险。 拟议的研究将是对胎儿可卡因暴露的医学、环境和发育相关性进行的纵向、前瞻性研究（NIDA 07957）的延续，该队列先前从出生-2岁、4岁和6岁开始观察。377名儿童（195名可卡因暴露者; 182名非暴露者）从出生起接受随访，他们的母亲/照顾者将在9岁、10岁、11岁和12岁时接受随访，并对生长、认知、情感行为、语言和神经心理结局进行标准化评估。通过生物学（尿液/胎粪）和自我报告措施确定CO2暴露，所有儿童均来自同一种族/社会阶层人群，并与极低出生体重状态相匹配。出生时，人口统计学，医疗和产前药物滥用暴露注意到图表审查，临床访谈，胎粪分析。将更新以前评估过的评估产妇心理状况、应对方式、社会支持、智力和暴力暴露的标准化问卷。与药物使用相关的母亲精神病理学将被描述，使用标准化的访谈，以产生DSM-IV诊断。环境风险，包括虐待/忽视、生长失败、家庭外安置和家庭环境的特征，都已记录在案。 将通过MANOVAS/MANCOVAS或混合模型分析以及分层多元回归和结构方程模型对数据进行连续性评价，以描述学龄期可卡因暴露儿童的功能，以及可卡因和其他药物暴露对（NB）儿童结局、母亲心理功能和环境风险的相对影响。先前纵向研究的数据集将与当前数据合并，以评估儿童风险随时间的变化和预测模型，使用线性混合模型或结构方程模型。拟议的研究将提供有关胎儿可卡因暴露的长期儿童发育后遗症，母亲的心理状况，养育行为和环境因素的信息，这些信息可以指导有效的母亲药物治疗和儿童干预计划的设计。

DESCRIPTION (provided by applicant): Maternal cocaine/polydrug use during pregnancy continues to be a significant public health problem in the United States, especially in poor, urban areas. Although hundreds of thousands of infants born in the cocaine epidemic of the 1980's are now children of school age, we have little definitive knowledge of the long-term effects of fetal cocaine exposure. Maternal use of cocaine is also associated with numerous other risk conditions which can negatively affect child outcomes, such as increased risk for child abuse/neglect, greater maternal psychological distress, altered parenting behavior, and violence exposure. In addition to documenting a range of child outcomes at school age, the proposed study aims to assess environmental and maternal psychological factors, which may increase or reduce risk in cocaine-exposed children. The proposed study will be a continuation of a longitudinal, prospective investigation (NIDA 07957) of the medical, environmental, and developmental correlates of fetal cocaine exposure, with the cohort previously seen from birth-2 years, and at 4 and 6 years. 377 children (195 cocaine-exposed; 182 non-exposed) followed from birth and their mothers/caregivers will be seen at 9, 10, 11, and 12 years of age, and given standardized assessments of growth, cognitive, emotional-behavioral, language, and neuropsychological outcomes. Cocaine exposure was determined by biologic (urine/meconium) and self-report measures, with all children drawn from the same race/social class population, and matched for very low birth weight status. At birth, demographic, medical, and prenatal substance abuse exposure were noted from chart review, clinical interview, and meconium analysis. Standardized questionnaires assessing maternal psychological status, coping style, social supports, intellectual ability, and exposure to violence, which were previously assessed, will be updated. Maternal psychopathology associated with drug use will be described, using standardized interviews to yield DSM-IV diagnoses. Environmental risks, including abuse/neglect, growth failure, out of home placement, and characteristics of the home environment, have been documented throughout. Data will be evaluated descriptively, through MANOVAS/MANCOVAS or mixed model analyses, and hierarchical multiple regression and structural equation models to describe the functioning of cocaine-exposed children at school age, and the relative impact of cocaine and other drug exposures on (NB) child outcomes, maternal psychological functioning, and environmental risk. Data sets from the prior longitudinal studies will be merged with the current data to assess change over time and predictive models of child risk, using linear mixed models or structural equation models. The proposed research will provide information about long-term child developmental sequelae of fetal cocaine exposure, maternal psychological status, parenting behaviors, and environmental factors which can guide the design of effective maternal drug treatment and child intervention programs.