Expressive and Receptive Language Functioning in Preschool Children With Prenatal Cocaine Exposure

Abstract

Objective To estimate the relationship between severity of prenatal cocaine exposure and expressive and receptive language skills in full-term, African American children at age 3 years. Methods Language was assessed at age 3 using the Clinical Evaluation of Language Fundamentals–Preschool (CELF-P). The sample included 424 children (226 cocaine exposed, 198 non–cocaine exposed) who received preschool language assessments at age 3, drawn from a cohort of 476 children enrolled prospectively at birth. Results Structural equation modeling was used to regress expressive and receptive language as intercorrelated response variables on level of prenatal cocaine exposure, measured by a latent construct including maternal self-report of cocaine use and maternal/infant urine toxicology assays and infant meconium. Results indicated a .168 SD decrease in expressive language functioning for every unit increase in exposure level (95% CI = –.320, –.015; p = .031) after consideration for fetal growth and gestational age as correlated response variables. Receptive language was more modestly related to prenatal cocaine exposure and was not statistically significant. Results for expressive language remained stable with inclusion of the McCarthy general cognitive index as a response variable (expressive language β = –.173, 95% CI = –.330, –.016; p = .031), and with adjustment for maternal age and prenatal exposures to alcohol, tobacco, and marijuana (expressive language β = –.175, 95% CI = –.347, –.003; p = .046). Additional child and caregiver environmental variables assessed at age 3 were also evaluated in varying statistical models with similar results. Conclusion The evidence from this study supports a gradient relationship between increased level of prenatal cocaine exposure and decreased expressive language functioning in preschool-aged cocaine-exposed children.