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Children with in utero cocaine exposure may be at risk for adverse neurodevelopmental outcome. To evaluate such outcome in young children, we administered the Battelle Developmental Inventory (BDI) to a group of inner-city children with (COC) and without (CON) in utero cocaine exposure at ages 3 and 5 years. Sixty-five COC and 68 CON, similar at age of testing, were evaluated at both time points by examiners masked to child group status. Both groups scored poorly and worsened over time. Although Total BDI raw scores were lower in the COC group than in the CON group at 3 years, this difference was related to postnatal environmental factors, caregiver (p = .022), and home environment (p = .010), not to in utero cocaine exposure (p = .88). At 5 years, the Total BDI score was related to the home environment (p < .001) but not to the caregiver (p = .36) or in utero cocaine exposure (p = .83). We conclude that inner-city children are at risk for adverse developmental outcome regardless of in utero cocaine exposure. [ABSTRACT FROM AUTHOR]

Objectives: Animal studies have clearly demonstrated the effects of in utero cocaine exposure on neural ontogeny, especially in dopamine-rich areas of cerebral cortex; however, less is known about how in utero cocaine exposure affects longitudinal neurocognitive development of the human brain. We used continuous arterial spin-labeling perfusion functional MRI to measure the effect of in utero cocaine exposure on resting brain function by comparing resting cerebral blood flow of cocaine-exposed adolescents with non-cocaine-exposed control subjects., Patients and Methods: Twenty-four cocaine-exposed adolescents and 25 matched non-cocaine-exposed control subjects underwent structural and perfusion functional MRI during resting states. Direct subtraction, voxel-wise general linear modeling, and region-of-interest analyses were performed on the cerebral blood flow images to compare the resting cerebral blood flow between the 2 groups., Results: Compared with control subjects, cocaine-exposed adolescents showed significantly reduced global cerebral blood flow. The decrease of cerebral blood flow in cocaine-exposed adolescents was observed mainly in posterior and inferior brain regions, including the occipital cortex and thalamus. After adjusting for global cerebral blood flow, however, a significant increase in relative cerebral blood flow in cocaine-exposed adolescents was found in anterior and superior brain regions, including the prefrontal, cingulate, insular, amygdala, and superior parietal cortex. Furthermore, the functional modulations by in utero cocaine exposure on all of these regions except amygdala cannot be accounted for by the variation in brain anatomy., Conclusions: In utero cocaine exposure may reduce global cerebral blood flow, and this reduction may persist into adolescence. The relative increase of cerebral blood flow in anterior and superior brain regions in cocaine-exposed adolescent participants suggests that compensatory mechanisms for reduced global cerebral blood flow may develop during neural ontogeny. Arterial spin-labeling perfusion MRI may be a valuable tool for investigating the long-term effects of in utero drug exposure.

A multivariate classification approach has been presented to examine the brain abnormalities, i.e., due to prenatal cocaine exposure, using both structural and functional brain images. First, a regional statistical feature extraction scheme was adopted to capture discriminative features from voxel-wise morphometric and functional representations of brain images, in order to reduce the dimensionality of the features used for classification, as well as to achieve the robustness to registration error and inter-subject variations. Then, this feature extraction method was used in conjunction with a hybrid feature selection method and a nonlinear support vector machine for the classification of brain abnormalities. This brain classification approach has been applied to detecting the brain abnormality associated with prenatal cocaine exposure in adolescents. A promising classification performance was achieved on a data set of 49 subjects (24 normal and 25 prenatally cocaine-exposed teenagers), with a leave-one-out cross-validation. Experimental results demonstrated the efficacy of our method, as well as the importance of incorporating both structural and functional images for brain classification. Moreover, spatial patterns of group difference derived from the constructed classifier were mostly consistent with the results of the conventional statistical analysis method. Therefore, the proposed approach provided not only a multivariate classification method for detecting brain abnormalities, but also an alternative way for group analysis of multimodality images.

A number of neurological diseases are associated with structural and functional alterations in the brain. This paper presents a method of using both structural and functional MR images for brain disease diagnosis, by machine learning and high-dimensional template warping. First, a high-dimensional template warping technique is used to compute morphological and functional representations for each individual brain in a template space, within a mass preserving framework. Then, statistical regional features are extracted to reduce the dimensionality of morphological and functional representations, as well as to achieve the robustness to registration errors and inter-subject variations. Finally, the most discriminative regional features are selected by a hybrid feature selection method for brain classification, using a nonlinear support vector machine. The proposed method has been applied to classifying the brain images of prenatally cocaine-exposed young adults from those of socioeconomically matched controls, resulting in 91.8% correct classification rate using a leave-one-out cross-validation. Comparison results show the effectiveness of our method and also the importance of simultaneously using both structural and functional images for brain classification.

Background: Inner-city children are frequently exposed to violence; however, there are few data regarding the psychological and academic correlates of such exposure in young children at school entry., Objectives: To document exposure to violence in inner-city children aged 7 years; assess their feelings of distress; and evaluate the relationships of exposure to violence with school performance, behavior, and self-esteem., Setting: A study center in an inner-city hospital., Participants: One hundred nineteen inner-city children evaluated at age 7 years; 119 caregivers (biological and foster)., Design: As part of a longitudinal study, children were administered the following by a masked examiner: Things I Have Seen and Heard (TISH) to assess exposure to violence; Levonn, a cartoon-based interview for assessing children's distress symptoms; and the Culture-Free Self-Esteem Inventory, Second Edition. School performance was assessed by school reports and child behavior by the Child Behavior Checklist (CBCL), the Parent Report Form, and the Teacher Report Form. Caregivers for children were administered the parent report version of the Checklist of Children's Distress Symptoms (CCDS-PRV) as well as the CBCL Parent Report Form., Main Outcome Measures: Exposure to violence (TISH); feelings of distress (Levonn); school performance; behavior (CBCL Parent Report Form and CBCL Teacher Report Form); and self-esteem (Culture-Free Self-Esteem Inventory)., Results: We found that these children were frequently exposed to violence. For example, 75% had heard gun shots, 60% had seen drug deals, 18% had seen a dead body outside, and 10% had seen a shooting or stabbing in the home (TISH). Many showed signs of depression and anxiety; eg, 61% worried some or a lot of the time that they might get killed or die and 19% sometimes wished they were dead (Levonn). Higher exposure to violence (TISH Total Violence score) was correlated with higher Levonn composite scores for depression and anxiety and with lower self-esteem (P< or =.04), and was also associated with lower grade point average and more days of school absence (P< or =.02). Caregiver assessment of child anxiety correlated poorly with child report of anxiety (P =.58)., Conclusions: Young inner-city children have a high exposure to violence by age 7 years; many show signs of distress that frequently are not recognized by caregivers. Further, higher exposure to violence in children correlates with poorer performance in school, symptoms of anxiety and depression, and lower self-esteem.

At age 6 years, a cohort of non-asphyxiated children, 52 with gestational cocaine exposure and 63 control subjects, underwent a neurologic examination. Groups did not differ on any aspect of the examination. This finding, while reassuring, does not exclude the possibility of more subtle deficits.

Objective: To define characteristics that differentiate inner-city children with Average or above-Average Full Scale IQ scores (> or =90) from those with below-Average scores (<90)., Design: As part of a prospective study of children with and without in utero cocaine exposure tested at age 4 years on the Wechsler Preschool and Primary Scales of Intelligence-Revised, we found that, taken together, only 32 (21%) scored at or above 90 whereas 118 (79%) scored below 90. The groups (IQ> or =90 and IQ<90) were compared on prenatal, natal, and postnatal factors., Setting: A study center in an inner-city hospital., Participants: One hundred-fifty children of low socioeconomic status, 34 weeks' gestational age or older, and nonasphyxiated at birth, who had intelligence testing at age 4 years; 150 caregivers (biological and foster)., Main Outcome Measures: Association of Full Scale IQ with prenatal, natal, and postnatal characteristics (including caregiver-child interaction measured by the Parent Caregiver Involvement Scale [PCIS], and home environment measured by the Home Observation for Measurement of the Environment [HOME])., Results: The group of children with IQs at or above 90 (n = 32) did not differ from the group with IQs below 90 (n = 118) in prenatal or natal characteristics (all P> or =.18) or proportion in foster care, attendance at day care or Head Start, continued caregiver cocaine use, or parental IQ. Children with IQs at or above 90 had more developmentally appropriate interaction by caregivers (P=.043) and higher scores on 6 of 8 subscales and Total HOME (P< or =.05) than the group of children with IQs below 90., Conclusions: Two postnatal factors, home environment and caregiver-child interaction, were associated with Full Scale IQ scores at or above 90 whereas prenatal and natal factors were not. These potentially malleable postnatal factors can be targeted for change to improve cognitive outcome of inner-city children.

Objective: To determine if in utero cocaine exposure affects IQ scores in children at age 4 years., Design: A prospective, longitudinal evaluation by blinded examiners of the IQ scores of cocaine-exposed and control children of low socioeconomic status who have been observed since birth., Setting: A study center in an inner-city hospital., Participants: One hundred one children with in utero cocaine exposure and 118 control children, all of whom were 34 weeks' gestational age or older and nonasphyxiated at birth., Main Outcome Measure: Intelligence quotient scores on a standardized intelligence test, the Wechsler preschool and Primary Scale of Intelligence--Revised., Results: Seventy-one cocaine-exposed and 78 control children were administered the Wechsler Preschool and Primary Scale of Intelligence--Revised. Maternal, natal, and 30-month characteristics of the children tested did not differ from those not tested. Groups did not differ on mean Performance (83.2 vs 87.0), Verbal (79.0 vs 80.8), or Full Scale (79.0 vs 81.9) IQ scores (all P > or = .10 [values for cocaine-exposed children given first]). None of these 3 scores was associated with cocaine exposure in multivariate linear regressions. Although cocaine-exposed and control groups did not differ in outcome, 93% of cocaine-exposed and 96% of control children had Full Scale IQ scores below 100, the mean IQ score for the test., Conclusions: In an inner-city cohort, IQ scores did not differ between cocaine-exposed and control children. However, both groups performed poorly.

Play behavior was compared between toddlers with in utero cocaine exposure and controls of similar low socioeconomic status enrolled at birth in a prospective, masked study. At 18 and 24 months, 83 cocaine-exposed and 93 control toddlers were videotaped playing on their own for 15 minutes. An observer who was off-site and unaware of project purpose or drug exposure status of toddlers recorded the most cognitively complex play activity per 15-second interval. In a total of 315 play sessions, the groups did not differ in middle and highest level of play achieved at either 18 or 24 months (p > or = .27). After controlling for confounders, the proportions of play behavior in each of six play categories were similar in the two groups at both 18 and 24 months (p > or = .42). We conclude that in utero cocaine exposure was not associated with differences in play behavior in this cohort of cocaine-exposed and control toddlers.

Cocaine use by pregnant women has increased dramatically in recent years. To assess the effect of maternal cocaine use on infant outcome, we enrolled 224 women (105 cocaine users, 119 control subjects) and their infants (all of 34 weeks or more gestational age and nonasphyxiated) in a prospective, blinded study. Results showed that infants exposed to cocaine were more likely to be admitted to the newborn intensive care unit, be treated for congenital syphilis, have a greater length of stay, and be discharged to a person other than the mother (all p < 0.01). Birth weight and head circumference, adjusted for gestational age, were smaller in the infants exposed to cocaine than in control infants (p < 0.001). After statistically controlling for cigarette use and other confounders, however, the odds of infants exposed to cocaine and control infants having birth weight and head circumferences less than the 25th percentile for gestational age did not differ (both p > 0.80). Infants of cocaine-using mothers and control subjects had a similar incidence of abnormal cranial and renal ultrasonographic findings and abnormal pneumocardiograms (all p > or = 0.32). We conclude that in this cohort of nonasphyxiated infants of 34 weeks or more gestational age, infants exposed to cocaine had more medical and social problems than control infants but did not differ statistically in the incidence of severe growth retardation, abnormal cranial or renal ultrasonographic findings, or abnormal pneumocardiograms. We suggest that natal interventions for the nonasphyxiated term and near-term infant exposed to cocaine should include a careful history and physical examination, follow-up plans, and social service involvement.

This prospective, blinded study evaluates the effect of in utero cocaine exposure on outcome of nonasphyxiated, term and near-term children born to women of low socioeconomic status. Two hundred nineteen children (101 cocaine-exposed and 118 control) with extensive natal evaluations are evaluated at 6-month intervals. We report here growth, performance on the Bayley Scales of Infant Development (BSID) through 30 months of age, and tone and reflexes at 6 and 12 months. To date, subjects have had 816 follow-up visits, with subject retention greater than or equal to 73%. Cocaine-exposed children showed statistically lower mean weights and smaller mean head circumferences than control children over the 30-month follow-up period (p < or = .011). The percentage of children with abnormal tone and reflexes, however, was similar in the two groups at 6 and 12 months (p > or = .34). Mean BSID Mental Development Index (MDI) and Psychomotor Development Index scores did not differ between the two groups (p > or = .16), although both groups' scores decreased over time (p < .001). Of concern, both cocaine-exposed and control groups had lower mean MDI scores than those published for a group of children of higher socioeconomic status. We conclude that, in our cohort of children, low socioeconomic or minority status may have had a substantial influence on BSID scores whereas in utero drug exposure did not.