94P
Cocaine-Exposed Toddler Caregiver Dyads during Free Play at 24 Months
Prenatal cocaine exposure is a risk factor for behavioral deficits. Other risk factors for non-optimal physical and social development include inadequate resources and continued maternal drug use. A cocaine-exposed child’s dysfunctional behavior may reflect deficits in parenting rather than drug exposure. This study addresses two vital questions: Are children’s deficits related to non-optimal caregiving or drug exposure? Which toddlers and caregivers need services focusing on improving their interactions to reduce their behaviors?
Methods:
This is part of a larger, prospective, longitudinal study of 361 mother-infant pairs. Pregnant women were assigned to a cocaine or non-cocaine group depending upon drug use. At 24 months, demographic information and drug use of caregivers (mothers, fathers, foster parents, grandparents) was taken and developmental indices of toddlers were measured. Videotapes of 31 boys and 32 girls were assessed for caregiver-toddler interactions. Every five minutes, a research assistant (RA) brought a different toy for them to play with. Researchers, who were blind to exposure status, instructed caregivers to play with the child as usual and simply said, “Here is a new toy to play with” when a toy was brought in. RAs coded three minutes of their interactions, second-by-second for contingent vocalizations and toddlers’ behaviors using the Achenbach Child Behavior Checklist (CBCL). Two sets of outcomes are assessed. One includes eight CBCL indices, and another six indices from the Diagnostic and Statistical Manual, 4th edition (DSM-IV). Maternal vocalizations and number of caregiver-toddler contingency pairs of vocalizations before, during, and after receiving the toy were calculated. We report bivariate trends, as well as multivariate General Linear Model (GLM) and Weighted Multiple Regression results.
Results:
At 24 month, there were no differences in neurological age, weight, length, and head circumferences of the two groups of toddlers, but differences emerged among caregivers for age, schooling, living arrangement, number of dependents, smoking, receiving welfare, and counseling. Cocaine exposed toddlers performed consistently worse than their non-exposed counterparts in CBCL Internalizing T and Total T problems, Anxiety, Pervasive Developmental Problems, Attention Deficits/Hyperactivity, and DSM-oriented scales Emotionally Reactive, Anxious/Depressed, and Withdrawn problems. When controlling for caregiver-toddler interactions, there were fewer contingency pairs with the cocaine-exposed group, indicative of lack of interactions.
Conclusions and Implications:
Findings suggest that prenatal cocaine exposure put children at risk for developmental problems and dysfunctional behaviors that can be observed during a Free Play test. Non-optimal communications during social experiences can reduce opportunities for learning from the environment. Low income and high number of dependents limits opportunities for enriched environments, threatening wellbeing by contributing additional risks to development of prenatally-exposed toddlers. Caregivers, including foster parents and grandparents can benefit by parenting education focused on their communication with their at-risk children. Effective policies for low-income families can provide greater access to high-quality early intervention services to increase pre-school readiness.