Poverty impacts mental development of children exposed to cocaine before birth

Poverty may have a stronger impact than drug exposure on the mental development of children who had been exposed to cocaine before birth, new research suggests.

Preschool-age children who had been exposed to cocaine before birth performed no worse on a standard test of problem solving than did a similar group of low-income children who had no cocaine exposure. Both groups, however, performed worse than a comparison group of mixed-income children.

"Most reports on the effects of prenatal exposure on children's growth and development are from studies of children found in populations of lower socioeconomic groups," said study head Hallam Hurt, MD, Albert Einstein Medical Center, Philadelphia. "Poverty has been associated with an array of environmental risk factors -- including fewer resources, poorly educated parents, and violence -- that pose a threat to healthy development."

The researchers watched 61 children who had been exposed to cocaine and 81 children with no drug exposure as they played with the "Goodman Lock Box," a large red box with ten compartments each containing a toy. They noted three categories of activity as the children played: "aimless actions" -- such as repeatedly opening and closing a door -- "competence" -- such as successfully unlocking and re-locking a door -- and "mental organization" -- such as successfully exploring a series of compartments. The children were tested at age three and a half and again at four and a half. The researchers report their findings in the current issue of the Journal of Developmental and Behavioral Pediatrics.

Children who had been exposed to cocaine scored no worse than the group without drug exposure on all three kinds of activity. Both groups of children, however, scored 23 to 41 percent lower on measures of mental organization when compared with 232 children from a variety of social and economic backgrounds. These differences remained significant even after the investigators controlled for differences in the children's IQ scores and their attendance at preschool, two factors associated with performance on such tests.

"If in utero cocaine exposure does contribute to these children's long-term outcomes, the effect may be overshadowed by the larger impact of pervasive disadvantage that is characteristic of our group," said Hurt. "For these children, increasing access to public resources and creating a stable learning environment may foster the development of more organized approaches to problem solving. Such interventions can improve learning and adaptive skills which, in turn, will increase the children's chances for success in more complex environments such as school."

The research was supported by a grant from the National Institute on Drug Abuse and the Albert Einstein Society of the Albert Einstein Health Care Network.

The Journal of Developmental and Behavioral Pediatrics is published bimonthly by the Society for Developmental and Behavioral Pediatrics. For information about the journal, contact Mary Sharkey at 212-595-7717.

Posted by the Center for the Advancement of Health http://www.cfah.org. For information about the Center, call Petrina Chong, pchong@cfah.org 202-387-2829.