Prenatal drug exposure moderates the association between stress reactivity and cognitive function in adolescence.

Prenatal drug exposure (PDE) can undermine subsequent health and development. In a prospective longitudinal study we examine whether PDE moderates the link between stress reactivity and cognitive functioning in adolescence. Participants were 76 prenatally drug-exposed and 61 nonexposed (NE) community comparison African American youth (50% male, mean age 14.17 years) living in an urban setting. All participants completed neuropsychological and academic achievement tests (Children's Memory Scales, the California Verbal Learning Test - Children's version and the Wide Range Achievement Test 4) over the course of 1 day in a laboratory setting. Two mild stressors (Balloon Analog Risk Task - Youth and Behavioral Indicator of Resilience to Distress) were administered, with saliva samples (assayed for cortisol) collected pre- and poststress task. A higher percentage in the NE group, compared to the PDE group (26% vs. 12%, χ(2) = 4.70, d.f. = 1, n = 137, p = 0.03), exhibited task-related increases in salivary cortisol. PDE moderated the association between stress reactivity and 11 of 15 cognitive performance scales. In each case, the NE stress reactive group had better cognitive performance than either the NE lower cortisol reactive group or the PDE group regardless of stress reactivity status. Stress-related reactivity and regulation of the hypothalamic-pituitary-adrenal axis in adolescence may be disrupted by PDE, and the disruption may be linked to lower cognitive performance.

Relations among prospective memory, cognitive abilities, and brain structure in adolescents who vary in prenatal drug exposure.

This investigation examined how prospective memory (PM) relates to cognitive abilities (i.e., executive function, attention, working memory, and retrospective memory) and brain structure in adolescents who vary in prenatal drug exposure (PDE). The sample consisted of 105 (55 female and 50 male) urban, primarily African American adolescents (mean age=15.5 years) from low socioeconomic status (SES) families. Approximately 56% (n=59) were prenatally exposed to drugs (heroin and/or cocaine) and 44% (n=46) were not prenatally exposed, but the adolescents were similar in age, gender, race, and SES. Executive functioning, attentional control, working memory, retrospective memory, and overall cognitive ability were assessed by validated performance measures. Executive functioning was also measured by caregiver report. A subset of 52 adolescents completed MRI (magnetic resonance imaging) scans, which provided measures of subcortical gray matter volumes and thickness of prefrontal, parietal, and temporal cortices. Results revealed no differences in PM performance by PDE status, even after adjusting for age and IQ. Executive function, retrospective memory, cortical thickness in frontal and parietal regions, and volume of subcortical regions (i.e., putamen and hippocampus) were related to PM performance in the sample overall, even after adjusting for age, IQ, and total gray matter volume. Findings suggest that variations in PM ability during adolescence are robustly related to individual differences in cognitive abilities, in particular executive function and retrospective memory, and brain structure, but do not vary by PDE status.

Early emotional caregiving environment and associations with memory performance and hippocampal volume in adolescents with prenatal drug exposure.

Early adversities, including prenatal drug exposure (PDE) and a negative postnatal emotional caregiving environment, impact children's long-term development. The protracted developmental course of memory and its underlying neural systems offer a valuable framework for understanding the longitudinal associations of pre- and postnatal factors on children with PDE. This study longitudinally examines memory and hippocampal development in 69 parent-child dyads to investigate how the early caregiving emotional environment affects children with PDE's neural and cognitive systems. Measures of physical health, drug exposure, caregiver stress, depression, and distress were collected between 0 and 24 months At age 14 years, adolescents completed multiple measures of episodic memory, and at ages 14 and 18 years, adolescents underwent magnetic resonance imaging (MRI) scans. Latent constructs of episodic memory and the caregiving environment were created using Confirmatory Factor Analysis. Multiple regressions revealed a negative emotional caregiving environment during infancy was associated with poor memory performance and smaller left hippocampal volumes at 14 years. Better memory performance at 14 years predicted larger right hippocampal volume at 18 years. At 18 years, the association between the emotional caregiving environment and hippocampal volume was moderated by sex, such that a negative emotional caregiving environment was associated with larger left hippocampal volumes in males but not females. Findings suggest that the postnatal caregiving environment may modulate the effects of PDE across development, influencing neurocognitive development.

Trajectories of adolescent mother-grandmother psychological conflict during early parenting and children's problem behaviors at age 7.

This study extends the determinants of parenting model to adolescent mothers by examining how adolescent mother-grandmother psychological conflict and perceptions of infant fussiness from birth through age 2 years relate to children's problem behaviors at age 7. Participants were 181 adolescent mother, child, and grandmother triads living in multigenerational households and recruited at delivery. Psychological conflict was characterized by two stable trajectories. In multivariate models that included maternal depression, both psychological conflict and perceptions of infant fussiness predicted externalizing behavior at age 7. Perceptions of infant fussiness, but not psychological conflict, predicted internalizing behavior at age 7.

Prolonged Financial Distress After the Deepwater Horizon Oil Spill Predicts Behavioral Health.

The economic impact of disasters is well known; however, the link between financial loss and behavioral health problems is unknown. Participants included 198 adults of ages 21 to 82, living within 10 miles of the Gulf Coast during the Deepwater Horizon Oil Spill and were involved in the fishing, harvesting, seafood processing, or service/tourism industries. The functional impact of financial resource loss at 2.5 years post spill was measured using the 26-item Financial Life Events Checklist (FLEC). Individuals responded to financial distress by reducing social events and utility bills and changing food-shopping habits. The FLEC significantly predicted higher drug use (Drug Abuse Screening Test), alcohol use (Alcohol Use Disorders Identification Test), mood problems (Profile of Mood States), and depressive symptoms (Beck Depression Inventory II) (p values ≤ 0.05) 4.5 years after the spill. This preliminary study supports the notion that the functional impact of financial loss has a long-term impact on behavioral health after an oil spill.

BMI and disordered eating in urban, African American, adolescent girls: The mediating role of body dissatisfaction.

OBJECTIVE: This study examined the mediating role of body dissatisfaction between Body Mass Index (BMI) and subsequent disordered eating (e.g. dieting and restricting/purging) among early adolescent African American girls. STUDY DESIGN: Participants included 701 African American girls in 6th and 7th grades in urban schools serving low-income communities, mean age 12.15 (SD = 0.72) years. Participants were assessed at baseline and approximately 6 months later. Objectively measured height and weight were used to calculate BMI z-score. Participants completed questionnaires on body size dissatisfaction and recent dieting and restricting/purging behaviors. RESULTS: At baseline, 51.5% of participants were overweight/obese, and 60.4% expressed body dissatisfaction and a desire to be smaller. Path analytic analyses revealed change in body dissatisfaction significantly mediates the relation between initial BMI z-score and increases in dieting behaviors (B = 0.924, SE = 0.280, p = 0.001) but not restricting/purging behaviors (p = 0.05). CONCLUSIONS: Body dissatisfaction explains some associations between excess body weight and subsequent disordered eating symptoms among early adolescent, African American girls. Body dissatisfaction, identified by screening, may be an indicator of further negative consequences, including disordered eating behaviors.

Early maternal depressive symptom trajectories: Associations with 7-year maternal depressive symptoms and child behavior.

This study examines potential mechanisms linking maternal depressive symptoms over 2 years postpartum with child behavior problems at school-age in a sample of adolescent mothers and their first-born child. Potential mechanisms include: mother-reported caregiving engagement at 6 months; observed parental nurturance and control, and child competence and affect at 24 months; and mother-reported resilience at 7 years based on achievement of adult developmental tasks. One hundred eighteen low-income African American adolescent mothers were recruited at delivery and followed through child age 7 years. Maternal depressive symptom trajectories over 24 months were estimated (low, medium, and high) based on mother-reported depressive symptoms. Direct and indirect associations between depressive symptom trajectories with 7-year maternal depressive symptoms and child behavior problems were examined. The high maternal depressive symptom trajectory was associated with 7-year maternal depressive symptoms (b = 5.52, SE = 1.65, p < .01) and child internalizing problems (b = 7.60, SE = 3.12, p = .02) and externalizing problems (b = 6.23, SE = 3.22, p = .05). Caregiving engagement among high depressive symptom trajectory mothers was significantly associated with observed child affect (b = -0.21, SE = 0.11, p = 0.05). Parental nurturance in toddlerhood mediated the association between high maternal depressive symptom trajectory and child internalizing problems at 7 years (indirect effect b = 2.33, 95% CI: 0.32-5.88). Findings suggest that family based interventions to promote parenting and adolescent resiliency strengthening may be beneficial in this population. (PsycINFO Database Record

Prenatal Drug Exposure and Adolescent Cortisol Reactivity: Association with Behavioral Concerns.

OBJECTIVE: To examine stress reactivity in a sample of adolescents with prenatal drug exposure (PDE) by examining the consequences of PDE on stress-related adrenocortical reactivity, behavioral problems, and drug experimentation during adolescence. METHODS: Participants (76 PDE, 61 non-drug exposed [NE]; 99% African-American; 50% male; mean age = 14.17 yr, SD = 1.17) provided a urine sample, completed a drug use questionnaire, and provided saliva samples (later assayed for cortisol) before and after a mild laboratory stress task. Caregivers completed the Behavior Assessment System for Children, Second Edition (BASC II) and reported their relationship to the adolescent. RESULTS: The NE group was more likely to exhibit task-related cortisol reactivity compared to the PDE group. Overall behavior problems and drug experimentation were comparable across groups with no differences between PDE and NE groups. In unadjusted mediation analyses, cortisol reactivity mediated the association between PDE and BASC II aggression scores (95% bootstrap confidence interval [CI], 0.04-4.28), externalizing problems scores (95% bootstrap CI, 0.03-4.50), and drug experimentation (95% bootstrap CI, 0.001-0.54). The associations remain with the inclusion of gender as a covariate but not when age is included. CONCLUSION: Findings support and expand current research in cortisol reactivity and PDE by demonstrating that cortisol reactivity attenuates the association between PDE and behavioral problems (aggression) and drug experimentation. If replicated, PDE may have long-lasting effects on stress-sensitive physiological mechanisms associated with behavioral problems (aggression) and drug experimentation in adolescence.

Prenatal drug exposure, behavioral problems, and drug experimentation among African-American urban adolescents.

PURPOSE: To examine how prenatal drug exposure (PDE) to heroin/cocaine and behavioral problems relate to adolescent drug experimentation. METHODS: The sample included African-American adolescents (mean age = 14.2 years, SD = 1.2) with PDE (n = 73) and a nonexposed community comparison (n = 61). PDE status was determined at delivery through toxicology analysis and maternal report. Internalizing/externalizing problems were assessed during adolescence with the Behavior Assessment System for Children, Second Edition. Drug experimentation was assessed by adolescent report and urine analysis. Logistic regression evaluated the likelihood of drug experimentation related to PDE and behavioral problems, adjusting for age, gender, PDE, perceived peer drug use, and caregiver drug use. Interaction terms examined gender modification. RESULTS: Sixty-seven subjects (50%) used drugs: 25 (19%) used tobacco/alcohol only and 42 (31%) used marijuana/illegal drugs. Ninety-four subjects (70%) perceived peer drug use. PDE significantly increased the risk of tobacco/alcohol experimentation (odds ratio = 3.07, 95% confidence interval [CI] 1.09-8.66, p = .034) but not after covariate adjustment (adjusted odds ratio [aOR] = 1.16, 95% CI .31-4.33, p > .05). PDE was not related to the overall or marijuana/illegal drug experimentation. The likelihood of overall drug experimentation was doubled per SD increase in externalizing problems (aOR = 2.28, 95% CI 1.33-3.91, p = .003) and, among girls, 2.82 times greater (aOR = 2.82, 95% CI 1.34-5.94, p = .006) per SD increase in internalizing problems. Age and perceived peer drug use were significant covariates. CONCLUSIONS: Drug experimentation was relatively common (50%), especially in the context of externalizing problems, internalizing problems (girls only), older age, and perceived peer drug use. Findings support the Problem Behavior Theory and suggest that adolescent drug prevention addresses behavioral problems and promotes prosocial peer groups.

Systematic review of prenatal cocaine exposure and adolescent development.

BACKGROUND AND OBJECTIVE: Previous research found that prenatal cocaine exposure (PCE) may increase children's vulnerability to behavior and cognition problems. Maturational changes in brain and social development make adolescence an ideal time to reexamine associations. The objective was to conduct a systematic review of published studies examining associations between PCE and adolescent development (behavior, cognition/school outcomes, physiologic responses, and brain morphology/functioning). METHODS: Articles were obtained from PubMed, PsycInfo, Web of Science, and CINAHL databases through July 2012 with search terms: prenatal drug, substance, or cocaine exposure; adolescence/adolescent; and in utero substance/drug exposure. Criteria for inclusion were nonexposed comparison group, human adolescents aged 11 to 19, peer-reviewed, English-language, and adolescent outcomes. RESULTS: Twenty-seven studies representing 9 cohorts met the criteria. Four outcome categories were identified: behavior, cognition/school performance, brain structure/function, and physiologic responses. Eleven examined behavior; 7 found small but significant differences favoring nonexposed adolescents, with small effect sizes. Eight examined cognition/school performance; 6 reported significantly lower scores on language and memory tasks among adolescents with PCE, with varying effect sizes varied. Eight examined brain structure/function and reported morphologic differences with few functional differences. Three examined physiologic responses with discordant findings. Most studies controlled for other prenatal exposures, caregiving environment, and violence exposure; few examined mechanisms. CONCLUSIONS: Consistent with findings among younger children, PCE increases the risk for small but significantly less favorable adolescent functioning. Although the clinical importance of differences is often unknown, the caregiving environment and violence exposure pose additional threats. Future research should investigate mechanisms linking PCE with adolescent functioning.

Prenatal drug exposure and peer victimization in early adolescence: testing childhood anxiety/depression and aggression as possible mediators.

OBJECTIVE: Children who are prenatally exposed to drugs may be at risk for emotion dysregulation, including childhood anxiety/depression and aggression, potentially increasing their risk for peer victimization. The objectives of this study were to investigate how prenatal drug exposure relates to adolescent peer victimization and the mediating effects of childhood anxiety/depression and aggression. METHODS: Seventy-six prenatally drug exposed (PDE) and 38 nonexposed (NE) adolescent-caregiver dyads followed since birth and middle childhood, respectively, participated in an evaluation during adolescence. In middle childhood, caregivers reported on their child's anxiety/depression and aggression, and children reported on violence exposure. In adolescence, caregivers and adolescents responded to a parallel single-item measure of peer victimization. Analyses were conducted using multivariate linear and logistic regression models, adjusting for covariates, including violence exposure. RESULTS: One-third (33.3%, n = 35) of the sample endorsed peer victimization: 40.8% PDE and 17.6% NE, p = .01. In middle childhood, PDE youth had more aggressive behaviors (11.92 vs 7.45, p < .01) and anxiety/depression symptoms (3.43 vs 1.76, p < .01) than NE youth. Anxious/depressed behavior during childhood mediated the association between prenatal drug exposure and adolescent peer victimization. Aggression was not a significant mediator. CONCLUSIONS: The consequences of prenatal drug exposure extend into adolescence. Prenatal drug exposure may interfere with emotion regulation, resulting in anxious/depressed behavior during childhood and significantly increasing the risk for peer victimization during adolescence, even in the presence of violence exposure. Strategies to reduce anxious/depressed behavior among children with a history of prenatal drug exposure may reduce adolescent peer victimization.

Memory ability and hippocampal volume in adolescents with prenatal drug exposure.

The objective of the present study was to examine the influence of prenatal drug exposure (PDE) on memory performance and supporting brain structures (i.e., hippocampus) during adolescence. To achieve this goal, declarative memory ability and hippocampal volume were examined in a well-characterized sample of 138 adolescents (76 with a history of PDE and 62 from a non-exposed comparison group recruited from the same community, mean age=14 years). Analyses were adjusted for: age at time of the assessments, gender, IQ, prenatal exposure to alcohol and tobacco, and indices of early childhood environment (i.e., caregiver depression, potential for child abuse, and number of caregiver changes through 7 years of age). Results revealed that adolescents with a history of PDE performed worse on the California Verbal Learning Test-Child Version (CVLT-C), and story recall from the Children's Memory Scale (CMS), and had larger hippocampal volumes, even after covariate adjustment. Hippocampal volume was negatively correlated with memory performance on the CVLT-C, with lower memory scores associated with larger volumes. These findings provide support for long-term effects of PDE on memory function and point to neural mechanisms that may underlie these outcomes.