Cocaine-Exposed Toddler-Caregiver Dyads During Free Play At 24 Months

Some women continue to use cocaine during pregnancy, placing their fetus at risk for developmental problems. While gross problems are not evident after controlling for experimental flaws, subtle effects continue to be found. Social interactions of cocaine-exposed and nonexposed toddlers and their caregivers were assessed during a Free Play test to determine if psychobehavioral deficits were clinically observable. Risk factors were evaluated to assess whether the child's socioemotional-behavioral behaviors were related to exposure and/or interactions with caregivers or the environment. Twenty-four-month-old cocaine-exposed and nonexposed toddlers were evaluated with the Child Behavior Check List while they played with their caregivers. Caregivers' vocalizations were scored as contingent pairs if they occurred within 3 seconds of the child's. The proportion of pairs was compared by group. Quality of caregivers' vocalizations was rated as positive or negative based on approval, encouragement, and criticism. General linear model analyses indicate that cocaine-exposed children showed more dysfunctional behaviors than noncocaine-exposed children. Deficits increased when income and number of dependents were included. Caregivers in the drug group emitted fewer vocalizations during play before receiving a toy, indicating fewer opportunities for learning. No effect of quality of caregiver communication or gender by cocaine exposure interaction emerged. Cocaine exposure predicts poor developmental outcomes, but the toddler-caregiver relationship and reduced access to resources are additional risks that had previously been attributed to cocaine exposure. Early intervention services are needed to reduce the impact of low income, increase preschool readiness, and optimize functioning of these fragile families.