Abstract 1453 Neurodevelopmental Disabilities Poster Symposium, Tuesday, 5/4

Despite recent suggestions that the effects of prenatal cocaine exposure on child outcome may be mediated by parental and environmental factors, little is actually known about the caretaking environment in which drug-exposed children are raised. The purpose of this study was to describe the environmental factors and characteristics of the caretaking environment in a group of infants enrolled in the multisite longitudinal MLS Study (Brown University; University of Miami; University of Tennessee, Memphis, Wayne State University). 1388 infants (11% <1500 gm at birth), group matched for gestational age, race, and gender, were enrolled (658 exposed [EXP] to cocaine/opiates and 730 comparison [COMP]). Alcohol, marijuana, and tobacco exposure occurred in both groups. Based on the literature, questionnaires were selected to measure the psychological co-morbidities of caretakers, and disorganization and poverty in the household and neighborhood. Measures administered by certified interviewers included the Hollingshead SES measure adapted for this population at 1 mo; the Parenting Stress Index, Brief Symptom Inventory, Beck Depression Inventory at 4 mo; the Child Abuse Potential Inventory at 8 mo; and the Home Observation Measurement of the Environment (revised), Neighborhood Scales, Acculturation and Maternal Self-Report Inventory of Self Esteem at 10 mo. Descriptive and correlational statistics were performed on the total scores for each measure; regression analysis adjusted for alcohol, nicotine, marijuana, opiates, and birth weight. 89% of the infants lived with their biological mother. Caretakers were >18 yrs old; predominantly African American (77%), single (81%), and on Medicaid (82%). Increased parenting stress, psychiatric symptoms, and child abuse potential were correlated with power home and neighborhood environments, low SES, and high social risk (a new composite based on the multiple risk model, consisting of the sum of 7 dichotomous predefined variables, e.g., per capita income <$2,000; caretaker only contributor to household; caretaker did not complete high school), all p's<.001. ANOVAs showed low SES was related to all non-optimal caretaking and environment scores (all p's<.001). Caretakers of EXP infants had lower self esteem (p<.001), higher child abuse potential (p<.05), and lower SES (p<.01) scores than caretakers of COMP infants. These differences were maintained after adjustment for covariates (regression analysis). Previous studies have shown subtle differences in child outcome related to prenatal drug exposure. The present study indicates that the child rearing environment of drug exposed infants may include parenting risk factors in addition to poverty that could mediate these differences.