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Child behavior problems among cocaine-exposed toddlers: Indirect and interactive effects

Published online by Cambridge University Press:  18 April 2011

Rina D. Eiden*
University at Buffalo
Douglas A. Granger
Johns Hopkins University
Pamela Schuetze
Buffalo State College
Yvette Veira
University at Buffalo
Address correspondence and reprint requests to: Rina D. Eiden, Research Institute on Addictions, 1021 Main Street, University at Buffalo, Buffalo, NY 14203; E-mail:


This study examined the role of maternal psychopathology and maternal warmth as mediators of the association between prenatal cocaine and other substance exposure and toddler behavior problems. It was also hypothesized that infant cortisol reactivity and environmental risk may moderate these associations. Participants were 220 caregiver–infant dyads (119 cocaine exposed, 101 not cocaine exposed; 49% boys). Mother–infant dyads were recruited at delivery with assessments at 4–8 weeks and 7, 13, and 18 months of child ages. Results yielded no direct associations between prenatal cocaine/other substance exposure and toddler behavior problems, but significant indirect associations between prenatal cigarette/alcohol exposure and toddler behavior problems at 18 months. With regard to moderation, results indicated an indirect association between prenatal cocaine exposure and toddler behavior problems via lower maternal warmth for children with higher, but not lower, cortisol reactivity at 7 months. Results suggest potential pathways to toddler behavior problems among children at high biological risk.

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Accornero, V. H., Anthony, J. C., Morrow, C. E., Xue, L., & Bandstra, E. S. (2006). Prenatal cocaine exposure: An examination of childhood externalizing and internalizing behavior problems at age 7 years. Epidemiologia e Psichiatria Social, 15, 2029.Google ScholarPubMed
Achenbach, T. M. (1992). Manual for the Child Behavior Checklist/2–3 and 1992 profile. Unpublished manuscript.Google Scholar
Arbuckle, J. L. (1996). Full information estimation in the presence of incomplete data. In Marcoulides, G. A. & Schumacker, R. E. (Eds.), Advanced structural equation modeling: Issues and techniques (pp. 243–277). Mahwah, NJ: Erlbaum.Google Scholar
Bada, H. S., Das, A., Bauer, C. R., Shankaran, S., Lester, B., LaGasse, L., et al. (2007). Impact of prenatal cocaine exposure on child behavior problems through school age. Journal of the American Academy of Pediatrics, 119, 348359.Google ScholarPubMed
Bada, H. S., Langer, J., Twomey, J., Bursi, C., Lagasse, L., Bauer, C. R., et al. (2008). Importance of stability of early living arrangements on behavior outcomes of children with and without prenatal drug exposure. Journal of Developmental & Behavioral Pediatrics, 29, 173182.CrossRefGoogle ScholarPubMed
Bagner, D. M., Sheinkopf, S. J., Miller-Loncar, C., LaGasse, L. L., Lester, B. M., Liu, J., et al. (2009). The effect of parenting stress on child behavior problems in high-risk children with prenatal drug exposure. Child Psychiatry Human Development, 40, 7384.CrossRefGoogle ScholarPubMed
Bailey, B. N., Sood, B. G., Sokol, R. J., Ager, J., Janisse, J., Hannigan, J. H., et al. (2005). Gender and alcohol moderate prenatal cocaine effects on teacher-report of child behavior. Neurotoxicology and Teratology, 27, 181189.Google Scholar
Bailey, M. T., Avitsur, R., Engler, H., Padgett, D. A., & Sheridan, J. F. (2004). Physical defeat reduces the sensitivity of murine splenocytes to the suppressive effects of corticosterone. Brain Behavior Immunity, 18, 416424.CrossRefGoogle ScholarPubMed
Baumgartner, W. A., Hill, V. A., & Blahd, W. H. (1989). Hair analysis for drugs of abuse. Journal of Forensic Science, 34, 14331453.CrossRefGoogle Scholar
Belsky, J., & Pluess, M. (2009). Beyond diathesis stress: Differential susceptibility to environmental influences. Psychological Bulletin, 135, 885908.CrossRefGoogle ScholarPubMed
Bendersky, M., Alessandri, S., Gilbert, P., & Lewis, M. (1996). Characteristics of pregnant substance abusers in two cities in the northeast. American Journal of Drug and Alcohol Abuse, 22, 349362.CrossRefGoogle ScholarPubMed
Bendersky, M., Bennett, D., & Lewis, M. (2006). Aggression at age 5 as a function of prenatal exposure to cocaine, gender, and environmental risk. Journal of Pediatric Psychology, 31, 7184.CrossRefGoogle ScholarPubMed
Bennett, D., Bendersky, M., & Lewis, M. (2002). Children's intellectual and emotional-behavioral adjustment at 4 years as a function of cocaine exposure, maternal characteristics, and environmental risk. Developmental Psychology, 38, 648–568.CrossRefGoogle ScholarPubMed
Bennett, D., Bendersky, M., & Lewis, M. (2007). Preadolescent health risk behavior as a function of prenatal cocaine exposure and gender. Journal of Development Behavioral Pediatric, 28, 467472.CrossRefGoogle ScholarPubMed
Boyce, W. T., & Ellis, B. J. (2005). Biological sensitivity to context: I. An evolutionary-developmental theory of the origins and functions of stress reactivity. Development and Psychopathology, 17, 271301.CrossRefGoogle ScholarPubMed
Brown, R. A., Burgess, E. S., Sales, S. D., Whiteley, J. A., Evans, D. M., & Miller, I. W. (1998). Reliability and validity of a smoking Timeline Follow-Back Interview. Psychology of Addictive Behavior, 12, 101112.CrossRefGoogle Scholar
Burns, K. A., Chethik, L., Burns, W. J., & Clark, R. (1997). The early relationship of drug abusing mothers and their infants: An assessment at eight to twelve months of age. Journal of Clinical Psychology, 53, 279287.3.0.CO;2-F>CrossRefGoogle ScholarPubMed
Campbell, S. B., Pierce, E. W., Moore, G., Marakovitz, S., & Newby, K. (1996). Boys' externalizing problems at elementary school age: Pathways from early behavior problems, maternal control, and family stress. Development and Psychopathology, 8, 701719.CrossRefGoogle Scholar
Chaplin, T. M., Fahy, T., Sinha, R., & Mayes, L. C. (2009) Emotional arousal in cocaine exposed toddlers: Prediction of behavior problems. Neurotoxicology and Teratology, 31, 275282.CrossRefGoogle ScholarPubMed
Cicchetti, D., & Toth, S. L. (2009). The past achievements and future promises of developmental psychopathology: The coming of age of a discipline. Journal of Child Psychology and Psychiatry, 50, 1625.CrossRefGoogle ScholarPubMed
Clark, R., Musick, J., Scott, F., & Klehr, K. (1980). The Mothers' Project Rating Scale of Mother–Child Interaction. Unpublished manuscript.Google Scholar
Delaney-Black, V., Covington, C., Nordstrom, B., Ager, J., Janisse, J., Chiodo, L., et al. (2004). Prenatal cocaine: Quantity of exposure and gender moderation. Developmental and Behavioral Pediatrics, 25, 254263.CrossRefGoogle ScholarPubMed
Denham, S. A., Workman, E., Cole, P. M., Weissbrod, C., Kendziora, K. T., & Zahn-Waxler, C. (2000). Prediction of externalizing behavior problems from early to middle childhood: The role of parental socialization and emotion expression. Development and Psychopathology, 12, 2345.CrossRefGoogle ScholarPubMed
Derogatis, L. R. (1993). The Brief Symptom Inventory (BSI) administration, scoring, and procedures manual. Minneapolis, MN: National Computer Systems.Google Scholar
Dixon, D. R., Kurtz, P. F., & Chin, M. D. (2008). A systematic review of challenging behaviors in children exposed prenatally to substances of abuse. Research in Developmental Disabilities, 29, 483502.CrossRefGoogle ScholarPubMed
Downey, G., & Coyne, J. C. (1990). Children of depressed parents: An integrative review. Psychological Bulletin, 104, 5076.CrossRefGoogle Scholar
Edwards, E. P., Eiden, R. D., Colder, C., & Leonard, K. E. (2006). The development of aggression in 18 to 48 month old children of alcoholic parents. Journal of Abnormal Child Psychology, 34, 409423.CrossRefGoogle ScholarPubMed
Eiden, R. D., Foote, A., & Schuetze, P. (2007). Maternal cocaine use and caregiving status: Group differences in caregiver and infant risk variables. Addictive Behaviors, 32, 465476.CrossRefGoogle ScholarPubMed
Eiden, R. D., Veira, Y., & Granger, D. A. (2009). Prenatal cocaine exposure and infant cortisol reactivity. Child Development, 80, 528543.CrossRefGoogle ScholarPubMed
Essex, M. J., Klein, M. H., Cho, E., & Kalin, N. H. (2002). Maternal stress beginning in infancy may sensitize children to later stress exposure: Effects on cortisol and behavior. Biological Psychiatry, 52, 776784.CrossRefGoogle ScholarPubMed
Feldman, R., Singer, M., & Zagoory, O. (2010). Touch attenuates infants' physiological reactivity to stress. Developmental Science, 13, 271278.CrossRefGoogle ScholarPubMed
Fisher, P. A. & Stoolmiller, M. (2008). Intervention effects on foster parent stress: Associations with child cortisol levels. Development and Psychopathology, 20, 10031021.CrossRefGoogle ScholarPubMed
Gartstein, M. A., Bridgett, D. J., Dishion, T. J., & Kaufman, N. K. (2009). Depressed mood and maternal report of child behavior problems: Another look at the depression–distortion hypothesis. Journal of Applied Developmental Psychology, 30, 149160.CrossRefGoogle Scholar
Goldsmith, H. H., & Rothbart, M. K. (1988). The laboratory temperament assessment battery (LAB-TAB). Technical Report 88-01. Eugene, OR: University of Oregon, Oregon Center for the Study of Emotion, Department of Psychology.Google Scholar
Goodman, S. H., & Gotlib, I. H. (1999). Risk for psychopathology in the children of depressed mothers: A developmental model for understanding mechanisms of transmission. Psychological Review, 106, 458490.CrossRefGoogle ScholarPubMed
Granger, D. A., Serbin, L. A., Schwartzman, A., Lehoux, P., Cooperman, J., & Ikeda, S. (1998). Children's salivary cortisol, internalizing behaviour problems, and family environment: Results from the Concordia Longitudinal Risk Project. International Journal of Behavioral Development, 22, 707728.CrossRefGoogle Scholar
Gunnar, M. R., & Vazquez, D. (2006). Stress neurobiology and developmental psychopathology. In Cicchetti, D. & Cohen, D. J. (Eds.), Developmental psychopathology (Vol. 2, pp. 533577). Hoboken, NJ: Wiley.Google Scholar
Hellhammer, D. H., Wüst, S., & Kudielka, B. M. (2009). Salivary cortisol as a biomarker in stress research. Psychoneuroendocrinology, 34, 163171.CrossRefGoogle ScholarPubMed
Hollingshead, A. (1956). Two-Factor Index of Class Position. Unpublished manuscript, Yale University.Google Scholar
Hollingshead, A. (1975). Four Factor Index of Social Status. Unpublished manuscript, Yale University.Google Scholar
Jones, D. J., Forehand, R., Brody, G., & Armistead, L. (2002). Psychosocial adjustment of african american children in single-mother families: A test of three risk models. Journal of Marriage and Family, 64, 105115.CrossRefGoogle Scholar
Klimes-Dougan, B., Hastings, P. D., Granger, D. A., Usher, B. A., & Zahn-Waxler, C. (2001). Adrenocortical activity in at risk and normally developing adolescents: Individual differences in salivary cortisol basal levels, diurnal variation, and responses to social challenges. Development and Psychopathology, 13, 695719.CrossRefGoogle ScholarPubMed
Linares, T. J., Singer, L. T., Kirchner, H. L., Short, E. J., Min, M. O., Hussey, P., et al. (2006). Mental health outcomes of cocaine-exposed children at 6 years of age. Journal of Pediatric Psychology, 31, 8597.CrossRefGoogle Scholar
Littman, A., & Parmelee, B. (1978). Medical correlation of infant development. Pediatrics, 61, 470474.CrossRefGoogle Scholar
Luthar, S. S., Cicchetti, D., & Becker, B. (2000). The construct of resilence: A critical evaluation and guideline for future work. Child Development, 71, 543562.CrossRefGoogle Scholar
MacKinnon, D. P., Fairchild, A. J., & Fritz, M. S. (2007). Mediation analysis. Annual Review Psychology, 58, 593614.CrossRefGoogle ScholarPubMed
MacKinnon, D. P., Lockwood, C. M., & Williams, J. (2004). Confidence limits for the indirect effect: Distribution of the product and resampling methods. Multivariate Behavioral Research, 39, 99128.CrossRefGoogle ScholarPubMed
Magura, S., Freeman, R. C., Siddiqi, Q., & Lipton, D. S. (1992). The validity of hair analysis for detecting cocaine and heroin use among addicts. International Journal of the Addictions, 27, 5169.CrossRefGoogle ScholarPubMed
McBurnett, K. M., Lahey, B. B., Frick, P. J., Risch, C., Hart, E. L., & Hanson, R. S. (1991). Anxiety, inhibition, and conduct disorder in children: II. Relation to salivary cortisol. Journal of the American Academy of Child & Adolescent Psychiatry, 38, 547555.Google Scholar
McLellan, A. T., Kushner, H., Metzger, D., & Peters, R. (1992). The fifth edition of the Addictions Severity Index. Journal of Substance Abuse Treatment, 9, 199213.CrossRefGoogle Scholar
Monroe, S. M., & Simons, A. D. (1991). Diathesis stress theories in the context of life stress research: Implications for depressive disorders. Psychological Bulletin, 110, 406425.CrossRefGoogle ScholarPubMed
Mullineaux, P. Y., Deater-Deckard, K., Petrill, S. A., & Thompson, L. A. (2009). Parenting and child behavior problems: A longitudinal analysis of non-shared environment. Infant and Child Development, 18, 133148.CrossRefGoogle ScholarPubMed
Muthén, L. K., & Muthén, B. O. (2006). Mplus user's guide (1998–2006). Los Angeles: Author.Google Scholar
Obradovic, J., Bush, N. R., Stamperdahl, J., Adler, N. E., & Boyce, W. T. (2010). Biological sensitivity to context: The interactive effects of stress reactivity and family adversity on socioemotional behavior and school readiness. Child Development, 81, 270289.CrossRefGoogle ScholarPubMed
Platzman, K. A., Coles, C. D., Lynch, M. E., Bard, K. A., & Brown, J. V. (2001). Assessment of the caregiving environment and infant functioning in polydrug families: Use of a structured clinical interview. Infant Mental Health Journal, 22, 351373.CrossRefGoogle Scholar
Ramsay, D. S., & Lewis, M. (2003). Reactivity and regulation in cortisol and behavioral responses to stress. Child Development, 74, 456464.CrossRefGoogle ScholarPubMed
Richardson, G. A., Goldschmidt, L., & Willford, J. (2009). Continued effects of prenatal cocaine use: Preschool development. Neurotoxicology and Teratology, 31, 325333.CrossRefGoogle ScholarPubMed
Richters, J., & Pelligrini, D. (1989). Depressed mothers' judgments about their children: An examination of the depression–distortion hypothesis. Child Development, 60, 10681075.CrossRefGoogle ScholarPubMed
Rutter, M., & Garmezy, N. (1983). Developmental psychopathology. In Mussen, P. H. (Ed.), Handbook of child psychology (Vol. 4, pp. 775–912). New York: Wiley.Google Scholar
Sameroff, A. J., Seifer, R., Baldwin, A., & Baldwin, C. (1993). Stability of intelligence from preschool to adolescence: The influence of social and family risk factors. Child Development, 64, 8097.CrossRefGoogle ScholarPubMed
Sheinkopf, S., LaGasse, L. L., Lester, B. M., Liu, J., Seifer, R., Bauer, C.R., et al. (2007). Vagal tone as a resilience in children with prenatal cocaine exposure. Development and Psychopathology, 19, 649673.CrossRefGoogle ScholarPubMed
Singer, L. T., Arendt, R., Minnes, S., Frakas, K., Yamashita, T., & Keligman, R. (1995). Increased psychological distress in post-partum, cocaine-using mothers. Journal of Substance Abuse, 7, 165174.CrossRefGoogle ScholarPubMed
Singer, L. T., Salvator, A., Arendt, R., Minnes, S., Farkas, K., & Kliegman, R. (2002). Effects of cocaine/polydrug exposure and maternal psychological distress on infant birth outcomes. Neurotoxicology and Teratology, 24, 127135.CrossRefGoogle ScholarPubMed
Sobell, M. B., Sobell, L. C., Klajmer, F., Pavan, D., & Basian, E. (1986). The reliability of a timeline method for assessing normal drinker college students' recent drinking history. Addictive Behaviors, 11, 149162.CrossRefGoogle ScholarPubMed
Thomas, A. M., Forehand, R., & Neighbors, B. (1995). Change in maternal depressive mood: Unique contributions to adolescent functioning over time. Adolescence, 30, 4352.Google ScholarPubMed
VanGoozen, S. H. M., Matthys, W., Cohen-Kettenis, P. T., Gispen-deWeid, C., Wiegant, V. M., & Van Engeland, H. (1998). Salivary cortisol and cardiovascular activity during stress in oppositional defiant disorder boys and normal controls. Biologica Psychiatry, 43, 531539.CrossRefGoogle Scholar
Wakschlag, L. S., & Hans, S. L. (2002). Maternal smoking during pregnancy and conduct problems in high risk youth. Development and Psychopathology, 14, 351369.CrossRefGoogle ScholarPubMed
Warner, Z. E., Malik, N. M., Lindahl, K. M., & Claussen, A. H. (2006). Behavioral control dynamics and developmental outcomes in infants prenatally exposed to cocaine. Infant Mental Health Journal, 27, 121140.Google Scholar
Woods, N. S., Eyler, F. D., Behnke, M., & Conlon, M. (1993). Cocaine use during pregnancy: Maternal depressive symptoms and infant neurobehavior over the first month. Infant Behavior & Development, 16, 8398.CrossRefGoogle Scholar
Yutomo, C., Jacobson, S. W., & Jacobson, J. L. (2008). Fetal substance exposure and cumulative environmental risk in an african american cohort. Child Development, 76, 17611776.Google Scholar
Zuckerman, M. (1999). Vulnerability to psychopathology: A biosocial model (p. 3). Washington, DC: American Psychological Association.CrossRefGoogle Scholar
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