The development of cocaine-exposed children

Abstract

children were the only articles available in the medical literature.‘, * Since then, large, controlled studies have shown that the effects of cocaine exposure are not as drastic as once feared, and that the majority of cocaine-exposed infants display no severe medical or neurobehavioral problems at birth.3-7 (Hutchings’ provides an excellent history of research and media reporting on prenatal cocaine exposure.) The longer-term outcomes of children born exposed to cocaine, however, are still not clearly understood. Few longitudinal studies have been conducted, and most have reported data only through ages 18 to 36 months.‘-‘* Furthermore, studies of the effects of prenatal drug exposure are frequently fraught with methodologic problems that make the results difficult to interpret or generalize. For example, most women who abuse cocaine are polydrug abusers; they use alcohol, other stimulants, opiates, or various combinations of these drugs in addition to cocaine. Most longitudinal studies do not have sufficient sample sizes to statistically control for the effects of these other drugs, and therefore it is difficult to discern what, if any, effects may be attributed to cocaine exposure per se. Similarly, many women who abuse cocaine have other risk factors for poor pregnancy outcome, including a lack of prenatal care, poor nutrition, and high gravidity. I3 Again these confounding factors generally are not controlled for adequately in longitudinal studies of the effects of prenatal cocaine exposure. Finally, most longitudinal studies of this population have high attrition rates, and their follow-up samples may not be representative of the majority of cocaineexposed children.g-” Given these caveats, however, it is useful to examine the results of the few longitudinal studies currently available to gain a preliminary picture of what, if any, developmental difficulties tend to arise from prenatal exposure to cocaine. Shorter-term studies that examine the severity of neurologic problems among cocaine-exposed infants are also useful in helping to predict the longer-term outcomes for these children.