Executive Function In Pre-Adolescent Prenatally Cocaine-Exposed Chidlren

Objective: To assess differences in both caregiver reported and objective measures of executive function in prenatally cocaine exposed (PCE) and non cocaine- exposed (NCE) pre-adolescent children. Methods: One Hundred and ninety (190 PCE) and 183 (NCE) primarily African American, low socioeconomic status children participated in a prospective longitudinal study on the developmental effects of prenatal cocaine exposure. Executive function was assessed using the Behavior Rating of Inventory of Executive Function (BRIEF) caregiver report and the Cambridge Cognitions's CANTAB executive function subtests. Two broadband BRIEF scores (Behavioral Regulation Index (BRI), (subscales -inhibit, shift and emotional control) and Metacognition Index (MI) (subscales – initiate, working memory, planning/organization, organization of material and self-monitoring) were rated by caregivers at 12 years. Intra/extradimensional shift (IED), stockings of Cambridge (SOC), Spatial Span (SSP) and Spatial Working Memory (SWM) were administered to children at 10 years. Multiple and logistic regression analyses were used to assess the effects of group status and amount of prenatal cocaine exposure on executive function, controlling for covariates including caregiver (rater) psychological distress and other prenatal drug exposure. Results: Unadjusted mean BRI (52.5±12.5 vs 56.1±12.5) and MI (51.6±10.8 vs 55.2±11.0) scores were more problematic for children with PCE compared to NCE (p's < .01). After control for covariates problems of metacognition were associated with higher amounts of PCE (â=0.23 p<.007). Among the MI subscale PCE (yes/no) predicted poorer initiation of activities (â=0.22 p<.008) and self monitoring abilities (â=0.22 p<.006). There was a significant cocaine by gender interaction for initiative (p<.004) and a non significant trend for self monitoring (p<.08) with PCE females being rated as having more negative effects. Greater prenatal cocaine exposure was related to poorer organization of materials (â=0.30 p < .001). After adjustment for covariates there was no significant prenatal cocaine effect on either the BRI, its subscales. There was cocaine by gender interaction on number of stages correct on the CANTAB IED with PCE females achieving fewer stages than NCE females (p<.04). SOC number of problems solved was positively associated with higher cocaine exposure (â=0.17, p<.02) with PCE males performing better than NCE males and females in either group. Greater caregiver reported psychological distress was associated with higher ratings of executive function problems for all BRIEF broadband and subscales (p<.001) but not with CANTAB results. Conclusions: Caregiver report and an objective measure of executive function indicated that prenatally cocaine-exposed children had more problems initiating activities, self-monitoring, organizing materials and acquiring rules. These effects are more prominent among PCE females. Deficits in metacognition contribute to poor school performance and other activities requiring initiative, self monitoring and correction and organization. However, greater PCE males performed better on spatial planning tasks. These data suggest that particular aspects of executive function are negatively affected by PCE and that targeted interventions for improvements in metacognitive and rule acquisition be recommended for high risk children.