Preadolescent behavior problems after prenatal cocaine exposure: Relationship between teacher and caretaker ratings (Maternal Lifestyle Study)

Henrietta S. Bada, Carla M. Bann, Charles R. Bauer, Seetha Shankaran, Barry Lester, Linda LaGasse, Jane Hammond, Toni Whitaker, Abhik Das, Sylvia Tan, Rosemary Higgins

Research output: Contribution to journalArticlepeer-review

57 Scopus citations


Background: We previously reported an association between prenatal cocaine exposure (PCE) and childhood behavior problems as observed by the parent or caretaker. However, these behavior problems may not manifest in a structured environment, such as a school setting. Objective: We determined whether there is an association between PCE and school behavior problems and whether ratings of behavior problems from the teacher differ from those noted by the parent or caretaker. Methods: The Maternal Lifestyle Study, a multicenter study, enrolled 1388 children with and without PCE at one month of age for longitudinal assessment. Teachers masked to prenatal drug exposure status completed the Teacher Report Form (TRF/6-18) when children were 7, 9, and 11. years old. We also administered the Child Behavior Checklist-parent report (CBCL) to the parent/caretaker at same ages and then at 13. years. We performed latent growth curve modeling to determine whether high PCE will predict externalizing, internalizing, total behavior, and attention problems at 7. years of age and whether changes in problems' scores over time differ between those exposed and non-exposed from both teacher and parent report. Besides levels of PCE as predictors, we controlled for the following covariates, namely: site, child characteristics (gender and other prenatal drug exposures), family level influences (maternal age, depression and psychological symptomatology, continuing drug use, exposure to domestic violence, home environment, and socioeconomic status), and community level factors (neighborhood and community violence). Results: The mean behavior problem T scores from the teacher report were significantly higher than ratings by the parent or caretaker. Latent growth curve modeling revealed a significant relationship between intercepts of problem T scores from teacher and parent ratings; i.e., children that were rated poorly by teachers were also rated poorly by their parent/caretaker or vice versa. After controlling for covariates, we found high PCE to be a significant predictor of higher externalizing behavior problem T scores from both parent and teacher report at 7. years (p. = 0.034 and p. = 0.021, respectively) in comparison to non-PCE children. These differences in scores from either teacher or caregiver were stable through subsequent years or did not change significantly over time. Boys had higher T scores than girls on internalizing and total problems by caretaker report; they also had significantly higher T scores for internalizing, total, and attention problems by teacher ratings; the difference was marginally significant for externalizing behavior (p. = 0.070). Caretaker postnatal use of tobacco, depression, and community violence were significant predictors of all behavior problems rated by parent/caretaker, while lower scores on the home environment predicted all behavior outcomes by the teacher report. Conclusions: Children with high PCE are likely to manifest externalizing behavior problems; their behavior problem scores at 7. years from either report of teacher or parent remained higher than scores of non-exposed children on subsequent years. Screening and identification of behavior problems at earlier ages could make possible initiation of intervention, while considering the likely effects of other confounders.

Original languageEnglish
Pages (from-to)78-87
Number of pages10
JournalNeurotoxicology and Teratology
Issue number1
StatePublished - Jan 2011

Bibliographical note

Funding Information:
The months corrected age (Phase I and Phase II); at 31/2, 4, 41/2, 5, 51/2, 6, and 7 years of age (Phase III); and at 8, 9, 10, and 11 years of age (Phase IV). NICHD, NIDA, and NIMH provided continuing funding for ages 12, 13, 14, 15, and 16 years (Phase V). The funding agencies provided overall oversight of study conduct, but all data analyses and interpretation were completed independent of the funding agencies. We are indebted to our medical and nursing colleagues and the infants and their parents who agreed to take part in this study. National Institutes of Health , the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) , the National Institute on Drug Abuse (NIDA) , the Administration on Children, Youth, and Families , and the Center for Substance Abuse and Treatment provided grant support for recruiting subjects into the Maternal Lifestyle Study in 1993–1995. NIDA and NICHD provided funding to conduct follow-up examinations in five phases: at 1, 4, 8, 10, 12, 18, 24, and 36


  • Attention problems
  • Caretaker depression
  • Community violence
  • Externalizing behavior
  • Prenatal cocaine
  • Prenatal opiate
  • School behavior

ASJC Scopus subject areas

  • Toxicology
  • Developmental Neuroscience
  • Cellular and Molecular Neuroscience


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