Sharon L. Leech

Prenatal substance exposure : Effects on attention and impulsivity of 6-year-olds

Attention and impulsivity of prenatally substance-exposed 6 year olds were assessed as part of a longitudinal study. Most of the women were light to moderate users of alcohol and marijuana who decreased their use after the first trimester of pregnancy. Tobacco was used by a majority of women and did not change during pregnancy. The women, recruited from a prenatal clinic, were of lower socio-economic status, and over half were African American. Attention and impulsivity were assessed using a Continuous Performance Task. Second and third trimester tobacco exposure and first trimester cocaine use predicted increased omission errors. Second trimester marijuana use predicted more commission errors and fewer omission errors. There were no significant effects of prenatal alcohol exposure. Lower Stanford-Binet Intelligence Scale composite scores, male gender, and an adult male in the household also predicted more errors of commission. Lower SBIS composite scores, younger child age, maternal work/ school status, and higher maternal hostility scores predicted more omission errors. These findings indicate that prenatal substance use has an effect on attentional processes.

Verbal and visuospatial learning and memory function in children with moderate prenatal alcohol exposure.

BACKGROUND This study investigated the effects of moderate prenatal alcohol exposure on learning and memory in 14-year-old adolescents. The Childrens Memory Scale was used to assess learning and memory function in the verbal/auditory and visual/spatial domains. In addition, both short- and long-term memory function were assessed. METHODS Data were collected as part of the Maternal Health Practices and Child Development Project, a longitudinal study including 580 children and their mothers. Women were assessed during each trimester of pregnancy and with their children from birth to 16 years of age. At age 14, memory function was evaluated using the Childrens Memory Scale, an assessment tool that measures learning and immediate and delayed memory function in the verbal and visual-spatial domains. RESULTS Prenatal alcohol exposure during the first trimester predicted deficits in learning, short-term memory, and long-term memory, specifically in the verbal domain. Deficits in performance were specific to learning and memory of word-pairs. In addition, deficits in memory were mediated by learning performance. CONCLUSIONS Results demonstrated that prenatal alcohol exposure lead to deficits in encoding processes as indicated by deficits in verbal learning. Initial deficits in acquisition were responsible for deficits in immediate and delayed recall of verbal information in children who were exposed to alcohol during pregnancy but did not have fetal alcohol syndrome.

Prenatal tobacco exposure: is it a risk factor for early tobacco experimentation?

Few studies have considered the etiological role of the fetal environment on the offsprings substance use. This prospective study examines the relations between the mothers prenatal and current smoking and the offsprings smoking experimentation. A low SES birth cohort of 589 10-year-olds, who have been followed since their gestation, completed a self-report questionnaire about their substance use. Half were female, and 52% were African-American. Detailed data on exposure to tobacco and other substances in the prenatal and postnatal periods were collected from the mothers. During pregnancy, 52.6% of the mothers were smokers; 59.7% were smokers when their children were 10. Six per cent of the children (37/589) reported ever smoking cigarettes, 3% had had one full alcoholic drink, and none had started to use other drugs. Maternal smoking during pregnancy was significantly associated with an increased risk of the childs tobacco experimentation. Offspring exposed to more than 1/2 pack per day during gestation had a 5.5-fold increased risk for early experimentation. Structural equation modeling showed that prenatal tobacco exposure had a direct and significant effect on the childs smoking and that maternal current smoking was not significant. Prenatal tobacco exposure also predicted child anxiety/depression and externalizing behaviors, and these outcomes affected child smoking through the mediating effect of peer tobacco use.

Really Underage Drinkers: Alcohol Use Among Elementary Students

Despite the current societal concern with underage drinking, little attention has been paid to alcohol use within the preadolescent population. This article presents the proceedings of a symposium held at the 2003 Research Society on Alcoholism meeting in Fort Lauderdale, Florida, that was organized and chaired by John E. Donovan. The intent of the symposium was to kick start research on alcohol use among elementary school children by reviewing what is known regarding drinking in childhood. Presentations included (1) The Epidemiology of Childrens Alcohol Use, by John E. Donovan; (2) The Validity of Childrens Self-Reports of Alcohol Use, by Sharon L. Leech; (3) Predicting Onset of Drinking From Behavior at Three Years of Age: Influence of Early Child Expectancies and Parental Alcohol Involvement Upon Early First Use, by Robert A. Zucker; and (4) Parent, Peer, and Child Risk Factors for Alcohol Use in Two Cohorts of Elementary School Children, by Carol J. Loveland-Cherry. Presentations indicated the need for better nationwide surveillance of childrens experience with alcohol; suggested that childrens reports of their use of alcohol tend to be reliable and valid; supported childrens alcohol use schemas and parental drinking and alcoholism at child age three as independent predictors of early onset drinking; and showed that onset of drinking before fourth or fifth grade, peer pressure, and parental norms and monitoring predict elementary student alcohol use and misuse.

The effects of prenatal marijuana exposure on delinquent behaviors are mediated by measures of neurocognitive functioning

We hypothesized that there would be an association between prenatal marijuana exposure (PME) and delinquency and that the effects of PME on neurocognitive development would mediate this association. Mothers and offspring enrolled in a longitudinal study of the effects of prenatal substance exposure on child development, were interviewed from the fourth prenatal month through 14 years. There were 580 mother/child dyads at the 14-year phase. A standardized protocol assessed psychological, neurocognitive, social, environmental, and demographic characteristics, and substance use at each phase. The Self Report Delinquency scale (Loeber et al., 1998) and the Child Behavior checklist (Achenbach, 1991) delinquency subscale were combined to represent delinquent behavior. First trimester PME was used as a dichotomous variable, daily use versus all other use. Offspring of heavier marijuana users were significantly more likely to report delinquent behavior at age 14. The odds ratio for delinquency among those who were exposed to one or more joints per day during gestation was 1.76 (C.I. 1.05-2.96). PME significantly predicted child depressive symptoms and attention problems at age 10, after controlling for other significant covariates. Child depressive symptoms and attention problems at age 10 significantly predicted delinquency at 14 years. The association between PME and delinquent behavior at 14 years was mediated by depressive symptoms and attention problems in the offspring at 10 years.

Effects of prenatal cigarette smoke exposure on neurobehavioral outcomes in 10-year-old children of adolescent mothers.

In this prospective study, adolescent mothers (mean age=16; range=12-18; 70% African-American) were interviewed about their tobacco use during pregnancy. When their children were ten, mothers reported on their childs behavior and the children completed a neuropsychological battery. We examined the association between prenatal cigarette smoke exposure (PCSE) and offspring neurobehavioral outcomes on data from the 10-year phase (n=330). Multivariate regression analyses were conducted to test if PCSE predicted neurobehavioral outcomes, adjusting for demographic characteristics, maternal psychological characteristics, prenatal exposure to other substances, and exposure to environmental tobacco smoke. Independent effects of PCSE were found. Exposed offspring had more delinquent, aggressive, and externalizing behaviors (CBCL). They were more active (Routh, EAS, and SNAP) and impulsive (SNAP) and had more problems with peers (SNAP). On the Stroop test, deficits were observed on the more complex interference task that requires both selective attention and response inhibition. The significant effects of PCSE on neurobehavioral outcomes were found for exposure to as few as 10 cigarettes per day. Most effects were found from first trimester PCSE exposure. These results are consistent with results from an earlier assessment when the children were age 6, demonstrating that the effects of prenatal tobacco exposure can be identified early and are consistent through middle childhood.

Predictors of Self-Reported Delinquent Behavior in a Sample of Young Adolescents.

Relations among characteristics at 3 years and 10 years of age and delinquent behavior at 10 years of age were investigated. Four hundred sixty mother/child pairs were interviewed. Psychological status, substance use, IQ, temperament, and behavior problems were assessed. Logistic regression and structural equation modeling were used. Pathways to delinquent behavior were identified using Configural Frequency Analysis. Race and gender were significant predictors of delinquent behavior at age 10. Temperament, IQ, and emotional instability at age 3 predicted delinquent behavior at age 10. Psychological status, perceived peer substance use, IQ, and temperament at age 10 were correlates of delinquent behavior. Three distinct pathways to delinquent behavior were identified. Early childhood characteristics can identify risks of delinquent behavior at age 10. Characteristics at age 3 were mediated by parallel measures at age 10. Early identification might reduce onset of delinquent behaviors and guide targeted prevention and intervention efforts.

Correlates of Alcohol Use and Misuse in Fourth-Grade Children: Psychosocial, Peer, Parental, and Family Factors

To determine level of alcohol use/misuse and to examine correlates of these behaviors, 1,314 fourth-grade students were surveyed. The questionnaire included 55 items concerning tolerance of deviance, deviant self-image, self-efficacy, susceptibility to peer pressure, personal and peer approval of alcohol use, peer adjustment, parent nurturance and monitoring, family adjustment, parental permissiveness, peer use of alcohol, and exposure to alcohol. The items were factor analyzed and indices constructed. The indices generally had acceptable alpha coefficients (α = .61-.91); two exceptions were peer adjustment (α = .51) and parental permissiveness (α = .42). Tolerance of deviance, deviant self-image, susceptibility to peer pressure, personal and peer approval, peer use and exposure by peers, and parental permissiveness were positively correlated with alcohol use/misuse. Self-efficacy, child-parent interactions, family adjustment, and peer adjustment were negatively correlated with alcohol use/misuse. Implications for the design of family-based alcohol use/misuse prevention programs are discussed.

Prenatal cocaine exposure: Effects on mother- and teacher-rated behavior problems and growth in school-age children.

In this longitudinal study of prenatal cocaine exposure (PCE), school-age physical and cognitive development and behavioral characteristics were examined, while controlling for other factors that affect child development. At this follow-up phase, children were on average 7.2 years old, and their caregivers were 33.7 years old, had 12.5 years of education, and 48% were African American. During the first trimester, 20% of the women were frequent cocaine users (≥1 line/day). First trimester cocaine exposure predicted decreased weight and height at 7 years. There was no significant relationship between PCE and the cognitive and neuropsychological measures. Third trimester cocaine use predicted more total and externalizing behavior problems on the Child Behavior Checklist (Achenbach, 1991 [3]) and the Teacher Report Form (Achenbach, 1991 [4]), and increased activity, inattention, and impulsivity on the Routh Activity (Routh et al., 1974 [67]) and SNAP scales (Pelham and Bender, 1982 [55]). Children who were exposed to cocaine throughout pregnancy had more mother- and teacher-rated behavior problems compared to children of women who stopped using early in pregnancy or who never used cocaine prenatally. These detrimental effects of PCE on behavior are consistent with other reports in the literature and with the hypothesis that PCE affects development through changes in neurotransmitter systems. These school-age behaviors may be precursors of later adolescent behavior problems.

Improvement in intelligence test scores from 6 to 10 years in children of teenage mothers.

Objective: This study investigates change in IQ scores among 290 children born to teenage mothers and identifies social, economic, and environmental variables that may be associated with change in intelligence test performance. Methods: The children of 290 teenage mothers (72% African-American and 28% European American) were assessed with the Stanford-Binet Intelligence Scale-4th Edition at ages 6 and 10. Results: The mean composite score at age 6 was 84.8 and 91.2 at age 10, an improvement of 6.4 points. Significant cross-sectional predictors at both ages 6 and 10 of higher Stanford-Binet Intelligence Scale scores were maternal cognitive ability, school grade, white ethnicity, and caregiver education. Having more children in the household significantly predicted lower Stanford-Binet Intelligence Scale scores at age 6. Higher satisfaction with maternal social support predicted higher Stanford-Binet Intelligence Scale scores at age 10. Change in IQ scores was not related to maternal socioeconomic status, social support, home environment, ethnicity, or family interactions. Custodial stability was associated with an improvement in IQ scores, whereas increase in caregiver depression was related to decline in IQ scores. Conclusions: Our findings suggest that improvement in IQ scores of offspring of teenage mothers may be related to stability of maternal custody. More research is needed to determine the impact of the maturation of adolescent mothers’ parenting and the role of early education on improvement in cognitive abilities.