Caregiver and self-report of mental health symptoms in 9-year old children with prenatal cocaine exposure

ObjectiveTo assess the effect of prenatal cocaine exposure on mental health symptoms in 9-year old children controlling for potential confounders.Methods332 children (170 prenatally cocaine-exposed (PCE), 162 non cocaine-exposed (NCE) were assessed using self (Dominic Interactive; DI) and caregiver report (Child Behavior Checklist; CBCL).ResultsHigher levels of PCE were associated with caregiver report of clinically elevated aggressive and delinquent behavior. With each increased unit of PCE, children were 1.3 times more likely to be rated as aggressive (OR = 1.30, 95% CI: 1.02–1.67, p < 0.04). For each increased unit of PCE, girls were 2 times more likely to be rated as having delinquent behavior (OR = 2.08, 95% CI: 1.46–2.96, p < 0.0001). PCE status was also associated with increased odds of delinquent behavior (OR = 2.41; 95% CI: 1.16–4.97, p = 0.02), primarily due to the increased risk among girls with PCE. While girls with PCE status were 7 times more likely than NCE girls to have delinquent behaviors (OR = 7.42; 95% CI: 2.03–27.11, p < 0.002) boys with PCE did not demonstrate increased risk (OR = 0.98; 95% CI: 0.36–2.65, p > 0.97). Foster or adoptive parents were more likely to rate their PCE children as having more thought problems, inattention, delinquent behavior, aggression, externalizing and overall problems (p < 0.05) than biologic mothers or relative caregivers. Higher 2nd trimester tobacco exposure was associated with increased odds of caregiver reported anxiety (OR = 1.73; 95% CI 1.06–2.81, p < 0.03) and marijuana exposure increased the odds of thought problems (OR = 1.68; 95% CI 1.01–2.79, p < 0.05). Children with PCE self-reported fewer symptoms of oppositional defiant disorder (ODD) compared to NCE children (OR = 0.44, 95% CI: 0.21–0.92, p < 0.03). Greater tobacco exposure was associated with increased odds of child reported ODD (OR = 1.24; 95% CI 1.03–1.78, p < 0.03).ConclusionHigher PCE was associated with disruptive behaviors including aggression and delinquent behavior among girls by caregiver report, but not child report. These findings highlight the need for early behavioral assessment using multiple informants in multi-risk children.

► Prenatal cocaine-exposure was associated with elevated externalizing behavior among girls.
► Foster/adoptive caregivers rated cocaine-exposed children as having more behavior problems.
► Cocaine-exposed children did not self-report more behavioral problems.