Cognitive and Behavioral Development Among Children Prenatally Exposed to Substances: An Examination of Models of Risk

The combined effects of drug exposure and environmental adversity may have important implications for several developmental outcomes. The existent literature presents mixed findings regarding the direct effect of cumulative risk among drug exposed samples on cognitive and behavioral outcomes. The present research was divided into two studies to examine the nature of the relation between cumulative risk during the first year of life and cognitive and behavioral outcomes at 60 months. Both studies used a sample of 132 primarily low-income African American children exposed to cocaine (30.8%), heroin (14.0%), or both (55.1%). The first study examined cumulative risk using four models: cumulative risk, threshold effects, specific indices, and unique effects. There were no direct linear or nonlinear relations between cumulative risk with cognitive or behavioral outcomes. There was a direct association between psychosocial risk (specifically negative life events) with both internalizing and externalizing behaviors. None of the models of risk were associated with intelligence. The second study examined process variables (mental development scores, harsh caregiving, and caregiver change) to determine whether proximal risk factors may explain the relation between cumulative risk and cognitive and behavioral development. The results of the second study suggested that mental development scores at 12, 18, 24, and 30 months were predictive of intelligence at 60 months, but not behavior. Harsh caregiving was directly associated with internalizing behaviors, and moderated the relation between cumulative risk and internalizing behaviors. Finally, the number of caregiver changes from birth-60 months was associated with greater attention problems at 60 months. Overall, the findings from the present study provide little support for an association between cumulative risk with developmental outcomes within a drug exposed sample. The overall cognitive scores were very low and not associated with any risk factors, suggesting that the present sample was relatively low functioning, cognitively. Psychosocial risk was associated with behavior problems, especially caregiver negative life events and harsh caregiving. These findings suggest that the caregiving environment represents an important context for behavioral development. Implications for theory, practice, and policy are discussed