Dr. Virginia Delaney-Black and a research team from Wayne State School of Medicine and the Detroit Public Schools conducted an extensive follow-up study of children whose mothers had been screened for substance use during pregnancy.

Screening procedures included extensive structured interviews; prenatal and neonatal medical records; and testing of mothers and their infants for prenatal exposure to alcohol, tobacco, cocaine, and other illicit drugs. When the children were 6 years old, the research team carried out extensive assessments of parental psychopathology, social support, home environments, parental drug use, the children’s cognitive functioning, blood lead level, custody status, and exposure to violence.

To assess the children’s problems and adaptive functioning in school, teachers completed the TRF. Excluding mentally retarded children, the research team analyzed TRFs for 201 children who had been prenatally exposed to cocaine and 270 children who had not been exposed. After controlling for prenatal exposure to other drugs and a host of other variables, the researchers found that prenatal exposure to cocaine predicted problem scores that were significantly higher on the TRF Externalizing than Internalizing scale. In addition, prenatal alcohol exposure predicted significantly higher TRF Total Problems, Attention Problems, and Delinquent Behavior scale scores. Postnatal variables were also significantly associated with TRF scores as follows: Exposure to violence was associated with higher TRF Total Problems, Externalizing, and Delinquent Behavior scores; current drug use in the home was associated with higher TRF Externalizing and Aggressive Behavior scores; and current blood lead level was associated with higher TRF Externalizing, Aggressive Behavior, and Attention Problems scores, plus higher elevations of Externalizing than Internalizing scores.

When boys and girls were analyzed separately, cocaine-exposed boys were twice as likely as non-exposed boys to have Externalizing and Delinquent Behavior scores in the clinical range. Prenatal cocaine exposure thus appears to raise risks for teacher-reported Externalizing behavior problems, especially among boys. Among the many other risk factors, prenatal alcohol exposure, exposure to violence, current drug use in the home, and high blood lead levels also significantly predicted high TRF problem scores.

Reference: Delaney-Black, V., Covington, C., Templin, T., Ager, J., Nordstrom-Klee, B., Martier, S., Leddick, L., Czerwinski, R.H., & Sokol, R.J. (2000). Teacher-assessed behavior of children prenatally exposed to cocaine. Pediatrics, 106, 782-791.