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Reactivity and Regulation in Children Prenatally Exposed to
Cocaine
Tracy Dennis
Hunter College of the City University of New York
Margaret Bendersky, Douglas Ramsay, and
Michael Lewis
University of Medicine and Dentistry of New Jersey—Robert
Wood Johnson Medical School
Children prenatally exposed to cocaine may be at elevated risk
for adjustment problems in early
development because of greater reactivity and reduced
regulation during challenging tasks. Few studies
have examined whether cocaine-exposed children show such
difficulties during the preschool years, a
period marked by increased social and cognitive demands and
by rapid changes in reactivity and
regulation. The authors addressed this question by examining
frustration reactivity and regulation of
behavior during a problem-solving task in cocaine-exposed and
-unexposed preschoolers. Participants
were 174 4.5-year-olds (M age � 4.55 years, SD � 0.09).
Frustration reactivity was measured as latency
to show frustration and number of disruptive behaviors, whereas
regulation was measured as latency to
approach and attempt the problem-solving task and number of
problem-solving behaviors. Results
indicated that cocaine-exposed children took longer to attempt
the problem-solving task but that
cocaine-exposed boys showed the most difficulties: They were
quicker to express frustration and were
more disruptive. Effect sizes were relatively small, suggesting
both resilience and vulnerabilities.
Keywords: reactivity, regulation, prenatal cocaine exposure
Regulation is the ability to initiate behavioral changes that meet
goals and manage emotional and physiological reactivity and is
among the most critical and rapidly developing capacities of
early
childhood. Individual differences in how children react to and
regulate behavior during challenges and frustrations are an
impor-
tant aspect of child adjustment and temperament (Derryberry &
Rothbart, 1997; Goldsmith et al., 1987; Rothbart & Bates, 1998;
Rothbart & Derryberry, 1981; Thomas & Chess, 1977).
Reactivity
and regulation are closely related but distinct dimensions of be-
havior and emotion (Derryberry & Rothbart, 1997; Ramsay &
Lewis, 2003), although there is continuing debate about their
independence (Campos, Frankel, & Camras, 2004). Reactivity is
marked by the dynamics of emotional responses, such as
latency,
intensity, and frequency of emotion; regulation is marked by
adaptive attempts to cope with challenges (Cole, Martin, &
Den-
nis, 2004; Thompson, 1994). Flexible and effective regulation
characterizes mental health, and deficits in this core capacity
are
involved in a range of psychological disorders (Barkley, 1997;
Saarni, 1999). Although regulation often refers to the regulation
of
affect, it also refers to effortful control, the intentional control
and
inhibition of behavior and attention (Derryberry & Rothbart,
1997;
Eisenberg et al., 2005; Kochanska, 1997). In the present study,
we
observed reactivity and regulation during a frustrating problem-
solving task. Reactivity was measured as emotional frustration,
oppositionality, and aggression, whereas regulation was
measured
as the ability to approach the task and effectively solve the
prob-
lem despite the frustration.
Over the past two decades, there has been growing concern that
prenatal exposure to cocaine, through its actions on the central
nervous system, increases risk for problems related to reactivity
and regulation in infancy and childhood (Bendersky, Gambini,
Lastella, Bennett, & Lewis, 2003; Bendersky & Lewis, 1998;
Bennett, Bendersky, & Lewis, 2002; Chasnoff, Burns, Schnoll,
&
Burns, 1985; Chasnoff & Griffith, 1989; Delaney-Black et al.,
2000, 2004; Dow-Edwards, Mayes, Spear, & Hurd, 1999;
Harvey
& Kosofsky, 1998; Napiorkowski & Lester, 1996). Cocaine-
exposed newborns show impaired neurobehavioral functioning
(Bingol, Fuchs, Diaz, Stone, & Gromisch, 1987; Griffith,
Azuma,
& Chasnoff, 1994; Lutiger, Graham, Einarson, & Koren, 1991;
Martin, Barr, Martin, & Streissguth, 1996; Richardson, 1998;
Singer et al., 2002; for a review, see Mayes, 1999a), and
specific
neural effects have been documented in brain systems
associated
with reactivity, regulation, and problem-solving capacities (e.g.,
the mesolimbic and midprefrontal cortices and the
monoaminergic
neurotransmitter system; Karmel, Gardner, & Freedland, 1996;
Jones, Field, Davalos, & Hart, 2004; Mayes, 1994; Wang,
Yeung,
& Friedman, 1995; J. R. Woods, Plessinger, & Clark, 1987).
Exposed toddlers and preschoolers show decreased reactivity
mod-
ulation and inhibitory control (Bendersky et al., 2003;
Bendersky
& Lewis, 1998; Hawley, Halle, Drasin, & Thomas, 1995;
Mayes,
Bornstein, Chawarska, Haynes, & Granger, 1996), greater atten-
tional impulsivity (Mayes, Grillon, Granger, & Schottenfeld,
1998), greater risk for specific cognitive impairments (Singer et
al., 2004), and greater teacher-reported disruptive behavior
(Delaney-Black et al., 2000, 2004). Older children prenatally
ex-
posed to cocaine may be slower to initiate the mental processes
Tracy Dennis, Department of Psychology, Hunter College of the
City
University of New York; Margaret Bendersky, Douglas Ramsay,
and
Michael Lewis, Institute for the Study of Child Development,
University of
Medicine and Dentistry of New Jersey—Robert Wood Johnson
Medical
School.
This research was supported by the National Institute on Drug
Abuse
Grant R01 DA07109.
Correspondence concerning this article should be addressed to
Tracy
Dennis, 695 Park Avenue, Department of Psychology, Hunter
College,
City University of New York, New York, NY 10021. E-mail:
[email protected]
Developmental Psychology Copyright 2006 by the American
Psychological Association
2006, Vol. 42, No. 4, 688 – 697 0012-1649/06/$12.00 DOI:
10.1037/0012-1649.42.4.688
688
needed to solve a problem (Bandstra, Morrow, Anthony, Accor-
nero, & Fried, 2001; Bandstra, Vogel, Morrow, Xue, &
Anthony,
2004; Schroder, Snyder, Sielski, & Mayes, 2004; Singer et al.,
2004).
However, other studies show significant resilience among
cocaine-exposed children and fail to document vulnerabilities,
such as neurotoxicity and withdrawal in infants (e.g., Eyler et
al.,
2001), child behavior problems (e.g., Accornero, Morrow,
Band-
stra, Johnson, & Anthony, 2002), and deficits in school
readiness
and IQ (e.g., Chasnoff et al., 1998; Pulsifer, Radonovich,
Belcher,
& Butz, 2004). In many of these studies, factors such as home
environment and parenting characteristics rather than cocaine
ex-
posure predicted or mediated behavioral and cognitive
outcomes.
Given these mixed results and given the difficulty of conducting
prospective longitudinal studies, relatively little is known about
the
effect of cocaine exposure on reactivity and regulation during
early
childhood. Although some research on prenatal cocaine
exposure
has focused on social– emotional development (e.g., Accornero
et
al., 2002; Beeghly, Frank, Rose-Jacobs, Cabral, & Tronick,
2003;
Bendersky, Alessandri, & Lewis, 1996; Jones et al., 2004), most
studies have focused on cognitive and attentional development
(e.g., Mayes et al., 1998; Pulsifer et al., 2004), and relatively
few
if any studies have specifically examined the effects of prenatal
cocaine exposure on reactivity and regulation during frustrating
problem-solving tasks. Such research is needed during the pre-
school years, which are marked by rapid maturation of the
frontal
lobes and associated improvements in executive control,
reactivity
modulation, and regulation of behavior (Bender, Word, Di-
Clemente, & Crittenden, 1995; Diamond, 2002; Mayes, 1994).
There is a need for research that uses observational assessment
and
seminaturalistic conditions rather than computer-based tasks
and
measures that are susceptible to reporter bias, such as maternal
and
teacher reports.
Prenatal cocaine exposure may have subtle but important effects
on children that are not evident until more complex abilities are
measured (Lester, 2000; Lester, Lagasse, & Seifer, 1998; Singer
et
al., 2004). For example, cocaine-exposed children may show
small
decrements in cognitive or emotional abilities that have increas-
ingly disruptive effects as development proceeds (Cicchetti,
Gani-
ban, & Barnett, 1991). Moreover, even in conjunction with
signif-
icant signs of resilience, small problems with emotional
reactivity
and regulation, such as lower threshold for frustration and diffi-
culty regulating behavior under emotional circumstances, may
compromise a child’s ability to negotiate challenging tasks
(Leech,
Richardson, Goldschmidt, & Day, 1999; Mayes et al., 1996).
Children who are relatively more reactive to challenges and/or
have difficulty regulating may be predisposed to greater stress,
which could further exacerbate vulnerabilities (Mayes et al.,
1998).
Thus, reactivity and regulation during cognitive and emotional
challenges are critically relevant to academic achievement and
social adjustment during early childhood (Denham, 1998; Mayes
et al., 1998; Richardson, 1998).
Various factors may interact with exposure in determining the
effect of cocaine on the development of reactivity and
regulation.
Gender might be one such factor. Recent findings indicate that
verbal reasoning and problem solving may be impaired in
cocaine-
exposed boys but not in cocaine-exposed girls (Bennett et al.,
2002). Further, in studies of school-age children, teachers
reported
that boys but not girls exposed to cocaine were more likely to
have
clinically significant disruptive behavior problems, suggesting
dif-
ficulties related to frustration reactivity and regulation,
compared
with cocaine-unexposed children (Delaney-Black et al., 2000,
2004). This is consistent with findings in animal research:
Cocaine-exposed male rats have been found to perform more
poorly than cocaine-exposed female rats on tasks assessing cog-
nitive and motor development (Markowski, Cox, & Weiss, 1998;
Spear, 1995).
To accurately evaluate the effect of prenatal exposure to
cocaine
on child reactivity and regulation, one must take potentially
con-
founding factors into account, including neonatal risk factors
such
as prenatal exposure to other drugs, environmental risk factors,
and
intelligence. Women who use cocaine tend to drink more
alcohol,
smoke more cigarettes, and use more marijuana than those who
do
not use cocaine (Bendersky, Alessandri, Gilbert, & Lewis, 1996;
N. S. Woods, Behnke, Eyler, Conlon, & Wobie, 1995). Prenatal
exposure to these substances may have a unique impact on reac-
tivity and regulation. Environmental risk factors such as
poverty,
high life stress, and maternal social isolation also are likely to
have
a negative impact on developmental outcomes and are generally
more prevalent in children exposed to cocaine (Bendersky, All-
esandri, Sullivan, & Lewis, 1995; Bendersky et al., 2003).
Given
the mixed support for effects of cocaine exposure on IQ, the
effect
of IQ was examined in this study to ensure that it did not
interact
with exposure in determining reactivity and regulation (Bennett
et
al., 2002; Pulsifer et al., 2004; Singer et al., 2004).
In summary, children, especially boys, prenatally exposed to
cocaine may well be at risk for frustration reactivity and
difficul-
ties in regulating behavior during a frustrating and cognitively
demanding problem-solving task. However, relatively little re-
search has involved directly observing these effects during the
preschool years, when the ability to modulate reactivity and
reg-
ulate behavior is developing. Even fewer studies have assessed
reactivity and regulation during problem solving, which is an
important activity during early childhood (Melnick & Hinshaw,
2000). In this study, we assessed frustration reactivity and regu-
latory behaviors in cocaine-exposed versus -unexposed boys and
girls during a frustrating problem-solving task when the
children
were 4.5 years old. Although we anticipated significant
resiliency
on the part of cocaine-exposed children, we hypothesized that
prenatal exposure to cocaine would be associated with greater
frustration reactivity (shorter latencies to show frustration,
more
numerous disruptive behaviors) and greater difficulty regulating
behavior (longer latencies to approach and attempt the problem-
solving task, fewer problem-solving behaviors), and, given
previ-
ous findings on gender differences, we expected that these
effects
would be strongest for cocaine-exposed boys. The effects of po-
tentially associated factors—including IQ; neonatal medical
risk;
environmental risk; and prenatal exposure to cigarettes, alcohol,
and marijuana—were evaluated.
Method
Participants
Participants were 191 mothers and their children (95 boys, 88
girls), who
were 4.5 years old (M � 4.55 years, SD � 0.09; ages ranged
from 4.3 to
4.9 years), participating in a longitudinal study of
developmental conse-
quences of prenatal cocaine exposure. Children were
predominantly Afri-
can American (86%), with 11% of the children being European
American
and 3% Hispanic or Asian American. The racial composition did
not differ
between mothers who used or did not use cocaine during
pregnancy.
689REACTIVITY AND REGULATION
Complete data were available for 174 children. Sixty-five were
exposed to
cocaine during pregnancy, and 109 were unexposed. Maternal
education
level ranged from 8th grade through post– high school training,
with 54%
being high school graduates. At the time of the study, 32% were
receiving
public assistance. Maternal education and public assistance did
not differ
between cocaine users and nonusers. Participation was
voluntary, and
incentives were provided in the form of vouchers for use at
local stores.
Recruiters approached pregnant women attending participating
hospital-
based prenatal clinics and/or obstetric services in Trenton, New
Jersey, or
Philadelphia, Pennsylvania, between February 1993 and
December 1995.
Of these, 82% (n � 384) agreed to participate. Children were
excluded
from the study if they were born prior to 32 weeks of gestation,
required
special care or oxygen therapy for more than 24 hours,
exhibited congenital
anomalies, were exposed to opiates or phencyclidine in utero,
were born to
mothers less than 15 years of age, or were infected with HIV (n
� 63). Of
these 321 children invited to participate, 258 children
participated in the
first lab visit at 4 months of age. Of the children lost to the
study, 18
participants were placed in foster care on discharge and these
families
refused to participate, 27 families could not be contacted, and
18 chose not
to continue.
At the 4.5-year visit, 191 mothers participated (60% of those
who were
invited to participate and 74% of those who participated in the
first lab
visit). Of the 67 families not seen at 4.5 years, 15 moved out of
the area,
15 declined to participate at this age, 28 could not be contacted
for this age
point, 1 child and 2 mothers died, and 6 went to foster parents
who refused
to participate. There were no significant differences in the
distributions of
cocaine exposure, gender, perinatal medical risk, or
environmental risk
between participants who participated and those who refused to
continue or
were lost to the study from the neonatal period through 4.5
years of age.
Among children participating in the study, 23 children were in
foster care,
20 of whom had been prenatally exposed to cocaine. Foster care
was not
associated with any differences in risk or outcome variables,
except for
maternal use of alcohol during pregnancy, p � .001.1
Procedures and Measures
For the 4.5-year visit, mothers and children arrived at the
research
laboratory and were escorted into a playroom by a female
experimenter. A
set of toys was arranged on the floor to encourage child play.
The
experimenter described the study and obtained informed consent
from the
mother. Several tasks followed, including a frustration task. The
tasks were
administered to all participants in the same order. For the
present study,
only child behaviors during the frustration task (the impossible
pulley task)
were examined for measures of reactivity and regulation.
The impossible pulley task was a 3-min problem-solving task
designed
to elicit high levels of frustration. The task materials consisted
of a basket
and a pulley with a rope anchored with a knot tied to a hook in
the wall.
While the child was watching, the experimenter placed an
attractive toy or
food in the basket out of reach. The child was encouraged for 2
min to
obtain the prize. This required figuring out that he or she had to
untie the
knot to release the rope from the hook in the wall and allow the
basket to
fall into reach. If the task was not solved after 1 min, the
examiner drew the
child’s attention to the pulley (e.g., pointed to the pulley, the
rope attached
to it, and the hook in the wall), and the child was then allowed
an additional
1 min to solve the problem.
To identify differences in reactivity and regulation, we coded
frequency
counts of the following six behaviors: (a) carrying out
instrumental actions
to obtain the prize without using force, such as untying the knot
and
reaching for the basket; (b) using items in the room to try to
solve the
problem, such as reaching for the basket with another toy; (c)
making
demands of adults, such as asking that the experimenter solve
the task; (d)
complaining to adults about the task; (e) showing aggression
toward
objects, such as banging the pulley or hitting the basket; and (f)
showing
aggression toward people, such as hitting or kicking the
experimenter. An
instrumental behavior composite score was created by summing
frequency
counts of instrumental actions and use of items in room. A
disruptive
behavior composite score also was created by summing counts
of demands,
complaints, and aggression toward objects and people.
Proportion scores
for the composites were calculated as the proportion of children
showing
instrumental behaviors (low or high levels were determined on
the basis of
a median split) and the proportion of children showing
disruptive behaviors
(proportions were for no, low, or high levels of disruptive
behavior, and
low or high levels were determined on the basis of a median
split of the
nonzero frequency counts).
Three latency scores were coded: latency to first evidence of
frustration
(including all behaviors composing the disruptive behavior
composite
score as well as signs of emotional collapse, such as crying),
latency to
approach the task, and latency to first attempt to untie the knot.
Scores also
were calculated for the proportion of children approaching the
task imme-
diately (approaching immediately vs. waiting) and attempting
the knot
(attempting vs. not attempting).
Composite scores, proportion scores, and latency scores were
used in
subsequent analyses as dependent variables indexing frustration
reactivity
and regulation. Frustration reactivity was measured as latency
to first
evidence of frustration and the disruptive behavior composite.
Regulation
was measured as the latency and proportion scores for
approaching and
attempting the task and the instrumental behavior composite.
Interrater agreement. A team of coders reviewed videotaped
record-
ings of the sessions to generate data for analyses. Before
coding, all coders
achieved adequate interrater agreement. Interrater reliability for
latency
and frequency scores was calculated on the basis of 25% of the
videotapes
(45 tapes), which were randomly chosen. The average weighted
Cohen’s
kappa coefficient for latency scores was .94 (ranging from .92
to .96) and
for frequency scores was .91 (ranging from .80 to 1.00). Both
coefficients
reflected excellent agreement (Bartko, 1991; Fleiss, 1981). The
average
upper bound intraclass correlation for latency scores was .97
(ranging from
.96 to .98) and for frequency scores was .95 (ranging from .89
to 1.00).
Coders were blind to the exposure status of the participants and
hypotheses
of the study.
Neonatal medical risk score. On the basis of hospital records,
prenatal
and neonatal medical data were used to complete a neonatal
medical risk
scale consisting of 35 possible complications (Hobel,
Hyvarinen, Okada, &
Oh, 1973). Variables included general factors (e.g., low birth
weight, fetal
anomalies), respiratory complications (e.g., congenital
pneumonia, apnea),
metabolic disorders (e.g., hypoglycemia, failure to gain weight),
cardiac
problems (e.g., murmur, cardiac anomalies), and central nervous
system
(CNS) problems (e.g., CNS depression, seizures). Variables
were weighted
and summed to obtain the risk score, which ranged from 0 � no
risk to
13 � high risk.
Environmental risk score. Demographic and lifestyle
information was
obtained through structured interviews administered to the
mother during
the 4.5-year laboratory visit. These interviews included
questions about the
mother’s race, the mother’s educational achievement, household
compo-
sition, sources of income, maternal history of substance abuse,
the number
of caregivers, the regularity of the child’s schedule, social
support (deter-
mined by using the Norbeck Social Support Questionnaire;
Norbeck,
Lindsey, & Carrieri, 1981), and maternal life stressors
(determined by
using the Social Environment Inventory; Orr, James, & Casper,
1992). The
variables were standardized, reverse coded if necessary so that
higher
values indicated greater risk, and summed. This cumulative risk
score was
then rescaled as a t score with a mean of 50 (see Bendersky &
Lewis, 1998,
Bendersky et al., 2003). Scores ranged from 24 to 81.
Cumulative envi-
ronmental risk measures have been found to explain more
variance in
children’s outcomes than do single factors, including
socioeconomic status
(Hurt, Malmud, Betancourt, Brodsky, & Giannetta, 2001).
Prenatal substance exposure. Prenatal substance exposure
information
was obtained through a semistructured interview administered
to the
1 When analyses were rerun without children in foster care,
patterns of
effects remained the same.
690 DENNIS, BENDERSKY, RAMSAY, AND LEWIS
mother by trained interviewers within 2 weeks of the infant’s
birth. The
interview contained questions about the frequency, amount, and
trimester
of the mother’s use of cocaine, alcohol, cigarettes, marijuana,
opiates, PCP,
tranquilizers, amphetamines, and barbiturates. Ratings were on
an 8-point
scale, from 0 � no use to 7 � daily use. For those children
prenatally
exposed to cocaine, average exposure was 0.60 g/day (SD �
0.91). Co-
caine use was confirmed by results of analysis of newborns’
meconium,
which was screened with radioimmunoassay followed by
confirmatory gas
chromatography–mass spectrometry for the presence of benzoyl
ecgonine
(cocaine metabolite), cannabinoids, opiates, amphetamines, and
PCP.
Mothers showed no signs of PCP, heroin, or methadone use as
determined
by assay and by self-report in repeated interviews. Children
were consid-
ered exposed to cocaine if positive by maternal report or
meconium assay.
They were considered unexposed to cocaine if negative by both
report and
assay. For the current study, we also examined the effects of
prenatal
exposure to alcohol (number of drinks per day), cigarettes
(number per
day), and marijuana (number of joints per day).
IQ. When the children were 4 years old (M � 4.12, SD � 0.23),
the
Stanford–Binet Intelligence Scale, Fourth Edition (Thorndike,
Hagen, &
Sattler, 1986) was administered. The composite score was used.
This
measure has extensive standardization data and satisfactory
reliability,
including with African American children (Krohn & Lamp,
1999;
Thorndike et al., 1986).
Results
Table 1 presents means and standard deviations for neonatal and
environmental risk scores and amount of in utero exposure to
alcohol, cigarettes, marijuana, and cocaine. Cocaine-exposed
ver-
sus -unexposed children had significantly greater neonatal com-
plications, F(1, 169) � 9.14, p � .01, and were exposed in utero
to greater amounts of alcohol, F(1, 165) � 32.31, p � .001;
cigarettes, F(1, 165) � 54.10, p � .001; and marijuana, F(1,
164) � 4.96, p � .05. However, environmental risk did not
differ
between cocaine-exposed and -unexposed children, and there
were
no gender or Gender � Exposure differences in the risk factors.
These risk factors were not significantly correlated with the de-
pendent variables (reactivity and regulation variables;
correlations
between �.13 and .14). We examined correlations between risk
factors and outcomes separately for cocaine-exposed versus
-unexposed children, and associations remained nonsignificant.
Next, because child IQ might be associated with problem-
solving
ability, correlations between child IQ and outcome variables
were
examined (child IQ M � 84.14, SD � 11.47, range � 54 –111).
There were no significant correlations. Finally, all analyses of
variance (ANOVAs) reported below were initially conducted us-
ing neonatal and environmental risk scores and child IQ as
covari-
ates, including their interactions with exposure group and
gender.
Results did not differ from those analyses without covariates.
Thus, analyses without risk factors and IQ as covariates are re-
ported below.
The dependent variables are located in the left-hand column of
Table 2. Correlational analyses were used to evaluate the
relations
among these measures. The pattern of correlations was
comparable
across the four Exposure � Gender groups. Significant intercor-
relations indicated that the greater the number of instrumental
behaviors, the shorter the latency to approach the task, r �
�.29,
p � .001, but the longer the latency to attempt to untie the knot,
r � .34, p � .001. This was perhaps because children using
instrumental behaviors also used other problem-solving
strategies
before attempting the knot. The number of instrumental
behaviors
also was correlated positively with disruptive behaviors, r �
.15, T
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50
N
o.
of
ci
ga
re
tt
es
/d
ay
(n
�
16
6)
3.
32
6.
77
5.
53
9.
46
4.
36
8.
19
1.
50
4.
97
1.
21
3.
44
1.
38
4.
37
7.
66
8.
44
11
.7
4
11
.7
3
9.
91
10
.5
0
N
o.
of
m
ar
ij
ua
na
jo
in
ts
/d
ay
(n
�
16
5)
0.
05
0.
24
0.
07
0.
28
0.
06
0.
26
0.
04
0.
26
0.
01
0.
03
0.
02
0.
19
0.
07
0.
20
0.
15
0.
42
0.
12
0.
34
A
ve
ra
ge
gr
am
s
of
co
ca
in
e/
da
y
(n
�
65
)
0.
14
0.
55
0.
24
0.
61
0.
19
0.
58
0.
55
0.
98
0.
64
0.
87
0.
60
0.
91
N
o
te
.
T
he
en
vi
ro
nm
en
ta
l
ri
sk
sc
or
e
is
a
t
sc
or
e
ba
se
d
on
th
e
su
m
of
z
sc
or
es
fr
om
10
ri
sk
va
ri
ab
le
s.
691REACTIVITY AND REGULATION
T
ab
le
2
D
es
cr
ip
ti
ve
S
ta
ti
st
ic
s
fo
r
O
u
tc
o
m
e
V
a
ri
a
b
le
s
D
ep
en
de
nt
va
ri
ab
le
T
ot
al
sa
m
pl
e
N
o
co
ca
in
e
C
oc
ai
ne
B
oy
s
(n
�
91
)
G
ir
ls
(n
�
83
)
T
ot
al
(n
�
17
4)
B
oy
s
(n
�
62
)
G
ir
ls
(n
�
47
)
T
ot
al
(n
�
10
9)
B
oy
s
(n
�
29
)
G
ir
ls
(n
�
36
)
T
ot
al
(n
�
65
)
M
S
D
%
M
S
D
%
M
S
D
%
M
S
D
%
M
S
D
%
M
S
D
%
M
S
D
%
M
S
D
%
M
S
D
%
L
at
en
cy
to
ap
pr
oa
ch
th
e
ta
sk
10
.0
7
17
.6
9
14
.1
3
30
.0
1
12
.0
1
24
.3
7
8.
85
12
.6
3
16
.9
8
35
.3
4
12
.3
5
25
.2
7
12
.6
9
25
.4
5
10
.4
0
21
.0
5
11
.4
2
22
.9
6
A
pp
ro
ac
he
d
im
m
ed
ia
te
ly
41
.1
33
.8
37
.6
37
.7
26
.1
32
.7
48
.3
44
.1
46
.0
L
at
en
cy
to
fi
rs
t
at
te
m
pt
to
un
ti
e
th
e
kn
ot
10
5.
90
74
.9
0
13
2.
23
76
.9
6
11
8.
46
76
.8
1
94
.0
8
65
.7
9
12
7.
49
79
.4
0
10
8.
49
73
.5
2
13
1.
17
87
.3
7
13
8.
42
74
.3
2
13
5.
18
79
.8
3
A
tt
em
pt
ed
kn
ot
81
.3
69
.9
75
.9
88
.7
70
.2
80
.7
65
.5
69
.4
67
.7
L
at
en
cy
to
fi
rs
t
ev
id
en
ce
of
fr
us
tr
at
io
n
13
3.
57
10
5.
21
15
3.
29
10
5.
34
14
2.
98
10
5.
43
15
1.
08
99
.6
4
14
9.
47
10
5.
48
15
0.
39
10
1.
72
96
.1
4
10
8.
72
15
8.
28
10
6.
45
13
0.
55
11
1.
07
S
ho
w
ed
fr
us
tr
at
io
n
54
.9
43
.4
49
.4
50
.0
46
.8
48
.6
65
.5
38
.9
50
.8
N
o.
of
in
st
ru
m
en
ta
l
be
ha
vi
or
s
11
.6
2
9.
10
15
.1
2
11
.6
0
13
.2
9
10
.4
8
11
.5
6
8.
79
16
.3
2
13
.1
1
13
.6
1
11
.0
7
11
.7
2
9.
89
13
.5
6
9.
21
12
.7
4
9.
49
N
o.
of
di
sr
up
ti
ve
be
ha
vi
or
s
1.
68
2.
80
1.
76
3.
52
1.
72
3.
16
1.
32
2.
25
2.
28
4.
19
1.
74
3.
25
2.
45
3.
64
1.
08
2.
27
1.
69
3.
02
N
ot
di
sr
up
ti
ve
48
.4
62
.6
55
.2
51
.6
55
.3
53
.2
41
.4
72
.2
58
.4
L
ow
di
sr
up
ti
ve
36
.3
18
.1
27
.6
37
.1
21
.3
30
.3
34
.5
13
.9
23
.1
H
ig
h
di
sr
up
ti
ve
15
.3
19
.3
17
.2
11
.3
23
.4
16
.5
24
.1
13
.9
18
.5
N
o
te
.
V
al
ue
s
fo
r
la
te
nc
ie
s
ar
e
in
se
co
nd
s.
692 DENNIS, BENDERSKY, RAMSAY, AND LEWIS
p � .05, perhaps reflecting the general level of activity. Finally,
as
might be expected, the greater the number of disruptive
behaviors,
the shorter the latency to express frustration, r � �.62, p �
.001.
These correlations suggest that reactivity and regulation scores
were largely independent. However, to further explore the inde-
pendence of these constructs, we examined whether children
who
expressed frustration relatively quickly or slowly (reactivity)
dif-
fered in their problem-solving behavior during the task (regula-
tion). Of the 174 children in this study, 88 children never
showed
frustration. For the remaining 86, we created two groups based
on
a median split (50th percentile � 19 s). These groups did not
differ
on our measures of regulation (latency to approach the task and
latency to first attempt to untie the knot, number of
instrumental
behaviors). This further suggests that reactivity and regulation
are
independent dimensions.
Table 2 presents the means, standard deviations, and proportion
scores for the dependent variables. To examine cocaine
exposure
and gender differences in child reactivity and regulation, we
con-
ducted a separate univariate ANOVA for each of the five depen-
dent variables: latency to first evidence of frustration, number
of
disruptive behaviors, latency to approach the task, latency to
first
attempt to untie the knot, and number of instrumental behaviors.
Substance exposure group and gender were the between-subjects
factors. A high proportion of children did not receive scores for
one or more of the behavioral codes. For example, 24.1% of
children did not attempt the knot and 50.6% did not show
frustra-
tion and thus did not have latency scores. Therefore, each
ANOVA
was followed by a chi-square analysis to examine cocaine expo-
sure and gender group differences in the proportion of children
who (a) showed frustration; (b) showed no, low, or high levels
of
disruptive behavior; (c) approached the task immediately; (d)
attempted the knot; and (e) showed low versus high levels of
instrumental behavior.
The ANOVA for latency to express frustration revealed a sig-
nificant interaction between exposure and gender, F(1, 173) �
3.76, p � .05, �2 � 2%. Cocaine-exposed boys showed a
signif-
icantly shorter latency to express frustration than did cocaine-
unexposed boys, t(89) � 2.38, p � .05; cocaine-exposed girls,
t(63) � 2.32, p � .05; and cocaine-unexposed girls, t(74) �
2.12,
p � .05. There were no differences in frustration latency among
cocaine-exposed girls and -unexposed girls and boys. Chi-
square
analyses further indicated that a greater proportion of cocaine-
exposed boys versus cocaine-exposed girls showed frustration,
�2(1, N � 174) � 4.56, p � .05. Differences among cocaine-
exposed boys, cocaine-unexposed boys, and cocaine-unexposed
girls were not significant.
For the disruptive behaviors composite, the interaction between
cocaine exposure and gender also was significant, F(1, 173) �
5.50, p � .05, �2 � 3%. Follow-up tests revealed trends for
cocaine-exposed boys to evidence more disruptive behaviors
than
cocaine-unexposed boys, t(89) � 1.81, p � .07, and cocaine-
exposed girls, t(63) � 1.85, p � .07, but they did not differ
from
cocaine-unexposed girls. Chi-square analyses confirmed these
trends, revealing significant Exposure � Gender group
differences
in the proportion of children showing no, low, or high levels of
disruptive behaviors, �2(2, N � 174) � 6.48, p � .05. Follow-
up
chi square analyses for each level of disruptive behavior found
that
only the proportion of children showing no disruptive behavior
differed significantly among groups, �2(1, N � 174) � 5.15, p
�
.05. A smaller proportion of cocaine-exposed boys showed no
disruptive behavior compared with cocaine-exposed girls,
cocaine-
unexposed boys, and cocaine-unexposed girls. The differences
among cocaine-exposed girls, cocaine-unexposed boys, and
cocaine-unexposed girls were not significant. Also, the
differences
between cocaine-exposed and -unexposed children and between
boys and girls for low or high levels of disruptive behaviors
were
not significant.
Analyses of latency to approach the task did not reach signifi-
cance, but analyses of latency to first attempt to untie the knot
revealed a significant main effect of cocaine exposure. Cocaine-
exposed children took longer to attempt to untie the knot than
did
cocaine-unexposed children, F(1, 173) � 4.09, p � .05, �2 �
3%.
The interaction between cocaine exposure and gender did not
reach significance. However, a chi-square analysis examining
the
proportion of children who attempted the knot yielded a
significant
Exposure � Gender interaction, �2(1, N � 174) � 4.44, p �
.05.
A larger proportion of cocaine-unexposed boys attempted the
knot
compared with cocaine-unexposed girls, cocaine-exposed boys,
and cocaine-exposed girls. The differences among cocaine-
unexposed girls, cocaine-exposed boys, and cocaine-exposed
girls
for latency to first attempt to untie the knot were not
significant,
and group differences for latency to approach the task also were
not significant.
The ANOVA for the instrumental behaviors composite yielded
a main effect of gender, F(1, 173) � 4.04, p � .05, �2 � 3%,
showing that girls evidenced more instrumental behaviors than
did
boys. Chi-square analyses for instrumental behavior did not
reach
significance.
Discussion
During the preschool years, children are often faced with
problem-solving challenges that test their cognitive and
emotional
capacities. By maintaining emotional equilibrium and
effectively
exploring problems, children build a foundation for current and
future success in academic and social domains. The results of
the
present study supported our hypothesis that prenatal exposure to
cocaine increases the risk for problems related to frustration
reac-
tivity and regulation of problem-solving behavior in early child-
hood. However, evidence of significant resiliency also emerged,
and effect sizes of these differences were relatively small.
Indeed,
prenatal cocaine exposure has been used as a model of the
complex
interplay between risk and vulnerability in young children
(Mayes,
1999b). However, these early deviations in developmental
trajec-
tories may have an impact at later developmental stages. To our
knowledge, this is the first study that observed reactivity and
regulation in cocaine-exposed and -unexposed preschoolers
during
a challenging problem-solving task rather than relying on adult
report of child behavior. Although these two constructs are
inter-
related, they also are distinct, as demonstrated by our results
and as
conceptualized by a rich literature on child temperament (e.g.,
Derryberry & Rothbart, 1997). Few studies of prenatal cocaine
exposure have integrated these concepts from temperament re-
search into the study of developmental trajectories of cocaine-
exposed versus -unexposed children.
Overall, cocaine exposure appeared to have an effect on prob-
lem solving: Cocaine-exposed versus -unexposed children took
longer to engage in the problem-solving task. Thus, it appeared
that they were slower in defining and working on the problem at
hand. Whether this was due to the cocaine-exposed children
being
693REACTIVITY AND REGULATION
less engaged in the problem and/or less able to solve the
problem
remains unclear. Both possibilities are likely given that cocaine-
exposed children are at risk for specific neurological deficits
and
problems associated with motivation, executive functions,
reason-
ing, and problem solving (Bender et al., 1995; Davis et al.,
1992;
Mayes, 1994; Singer, Farkas, & Kliegman, 1992; Singer et al.,
2004).
In this sample, prenatal exposure to alcohol, cigarettes, and
marijuana differed between cocaine-exposed and -unexposed
chil-
dren but did not appear to be related to outcomes. Neonatal and
environmental risk factors and IQ also failed to influence
outcome
measures beyond the effect of cocaine exposure. Thus, these
findings strengthen the inference that prenatal exposure to
cocaine
was related specifically to the decrements in frustration
reactivity
and regulation detected in this study.
Consistent with previous research (Delaney-Black et al., 2000,
2004; Bendersky et al., 2003; Bendersky & Lewis, 1998;
Bennett
et al., 2002), we found that cocaine-exposed boys showed the
most
difficulties, as evidenced by shorter latencies to express
frustration
and a larger number of disruptive behaviors as compared with
the
cocaine-unexposed children and cocaine-exposed girls. This
sug-
gests that cocaine-exposed boys showed greater reactivity and
less
effective regulation. They appeared to have somewhat shorter
fuses; that is, they became more quickly frustrated and more
often
acted out that frustration through complaints and aggression.
How-
ever, Exposure � Gender differences were not found for all
measures, and there were notable similarities between cocaine-
exposed and -unexposed children. Cocaine-exposed boys were
equally quick to approach the challenge and maintained the
adap-
tive ability to generate instrumental and constructive problem-
solving behaviors during the frustrating task. Moreover,
cocaine-
exposed girls showed almost none of the decrements evidenced
by
cocaine-exposed boys, and girls overall responded to the
challeng-
ing task with significantly more instrumental behaviors than did
boys. This resilience on the part of cocaine-exposed girls is in-
triguing and suggests the presence of gender-sensitive etiologies
and trajectories in the development of psychopathology (Crick
&
Zahn-Waxler, 2003). These findings underscore the importance
of
acknowledging and seeking out examples of effective
adjustment
in cocaine-exposed children rather than emphasizing potential
deficits. A number of studies document resilience in cocaine-
exposed children, particularly those who receive adequate
caregiv-
ing (Bennett et al., 2002; Brown, Bakeman, Coles, Platzman, &
Lynch, 2004; Pulsifer et al., 2004; Singer et al., 2004).
Related to this, some children in our sample were living in
foster
care (23 children, 13%), 87% of whom were exposed to cocaine.
Foster care was not associated with any differences in risk or
outcome variables, except for greater maternal use of alcohol
during pregnancy, p � .001. Yet, the quality of foster care is
likely
to have an impact on developmental outcomes. High-quality
foster
care could operate over time as a protective factor for cocaine-
exposed children. However, foster care could be associated with
a
range of disruptions (e.g., loss of an attachment figure,
instability
due to multiple changes in foster care placement, little contact
with
biological caregiver or other kin) that could have a negative
impact
on adjustment. The complexity of this issue is not fully
reflected in
our environmental risk score. However, this score is based on
assessment of the current caregiver (including foster caregiver)
and does include factors such as stability of the environment.
Future research would benefit from a careful assessment of
foster
care quality and stability.
Difficulties with the modulation of frustration and problem
solving often have a reciprocal influence on each other (Dennis
&
Miller-Brotman, 2003; Derryberry & Rothbart, 1997; Rothbart
&
Bates, 1998). High levels of frustration likely have a negative
impact on child persistence and problem solving during
challeng-
ing tasks, whereas deficits in basic regulatory capacities, such
as
executive functions and cognitive control, are associated with
increased frustration and aggression. These effects might have
been compounded by cognitive decrements found in cocaine-
exposed preschoolers, such as lower levels of visual-spatial
skills,
short-term memory, and general knowledge (Bennett et al.,
2002;
Singer et al., 2004).
This reciprocal influence between reactivity and regulation
raises questions about their independence as constructs (Campos
et
al., 2004; Cole et al., 2004). It is difficult to distinguish
behaviors
associated with emotion from subsequent attempts to regulate
emotion. For example, behaviors associated with frustration in-
clude increased persistence and working to overcome obstacles.
These behaviors also serve to regulate frustration. Yet, there are
important distinctions between emotional reactivity and regula-
tion: Reactivity increases the probability of behavior but does
not
force the initiation of regulatory actions, and different
regulation
strategies have distinct implications for adjustment independent
of
emotional reactivity (e.g., Gross, 2002). Moreover, there is evi-
dence that reactivity and regulation are distinct processes and
that
the balance between reactivity and regulation, rather than the
strength of each alone, is a fundamental determinant of positive
adjustment (Derryberry & Rothbart, 1997).
Although the results of this study were statistically significant,
effect sizes were small (ranging from 2% to 3%). However,
relatively small effects of cocaine exposure on reactivity and
regulation may contribute to larger effects at older ages in this
and
other domains (Lester, 2000; Lester et al., 1998). This is
consistent
with an organizational perspective on development, which sug-
gests that deficits in the negotiation of stage-salient tasks can
have
a strong impact on future development, even if initial problems
are
relatively small (Cicchetti et al., 1991). This occurs because the
successful development of one competency increases the likeli-
hood of successful development of subsequent competencies.
Early capacities and abilities are thus carried forward, as are
early
vulnerabilities. This developmental principle may be
particularly
relevant to measures of reactivity and regulation. Reactivity and
regulation can be thought of as gating mechanisms that direct
and
optimize attention, information processing, learning, and
memory
(Mayes et al., 1998). Moreover, chronically high reactivity or
reduced regulation may be associated with increased activity of
the
stress response system, thus increasing child vulnerability for
poor
physical and mental health outcomes, particularly if children are
exposed to stressful environments. Animal models also suggest
that subtle behavioral and neuronal effects can have a powerful
impact on the development of basic learning processes (e.g.,
Little
& Teyler, 1996). For example, although cocaine-exposed rabbits
react normally to standard learning stimuli, reducing the
duration
of stimuli by as little as several hundred milliseconds abolishes
normal neuronal responding and impairs behavioral learning
(Gab-
riel & Taylor, 1998).
Two aspects of this study may limit the generalizability of our
findings. First, we examined frustration reactivity and
regulation
694 DENNIS, BENDERSKY, RAMSAY, AND LEWIS
during one task. It would have been optimal to assess children
across multiple tasks during this assessment phase to obtain the
most reliable measures of each construct. However, because the
larger study focused on a broad array of functional skills, we
only
sampled this one behavior at 4.5 years. Replication using this
and
similar tasks would be necessary to confirm findings. Second,
the
retention rate was lower than desired by the 4.5-year
assessment.
Although this is a concern, participants did not significantly
differ
from those who refused to continue or who did not take part in
this
specific assessment in terms of cocaine exposure, environment
and
perinatal risk, or gender. This issue reflects the challenges
inherent
in working with families that experience multiple risk factors.
In addition, our measurements of cocaine exposure could have
limited the specificity of our findings. Prenatal drug exposure
information was collected retrospectively at the end of
pregnancy
and up to 2 weeks postpartum. A prospective design might have
improved accuracy and reduced reporting biases. However, be-
cause poor, drug-using women often do not obtain early or con-
sistent prenatal care, limiting the sample to women who had
prenatal care throughout pregnancy would have resulted in an
inadequate representation of the highest risk group. In addition,
the
cocaine-exposure variable was a dichotomous variable (used or
did
not use at any time during pregnancy). Details about cocaine
exposure, such as the timing and amount of exposure, are absent
from this variable. It is acknowledged to be very difficult at this
juncture to obtain reliable information about timing and amount
of
exposure, as these variables are usually based on self-report and
were entirely based on self-report in this study. Knowing if a
woman used any cocaine during pregnancy from self-report and
meconium analysis seems to be a more reliable although
possibly
less sensitive measure of cocaine use. Research conducted when
more reliable methods of determining timing and amount of ex-
posure become available should investigate whether such
param-
eters of cocaine exposure influence patterns of effects.
The strengths of this prospective longitudinal study of prenatal
cocaine exposure included observational assessment techniques,
a
focus on child competencies, and a theoretical framework rarely
applied to studies of prenatal cocaine exposure: temperamental
reactivity and regulation as they relate to the development of
adjustment and maladjustment. Results illustrate remarkable
resil-
iency but hint at the presence of vulnerability points,
particularly
in cocaine-exposed boys: greater frustration reactivity and
greater
difficulty in regulating behavior during problem solving. These
results have implications for intervention and prevention,
suggest-
ing that treatment of children prenatally exposed to cocaine
should
anticipate specific problems related to reactivity, regulation,
and
problem solving while capitalizing on significant strengths and
signs of positive adjustment. It is critical to conduct further lon-
gitudinal studies of prenatal cocaine exposure to delineate
devel-
opmental trajectories toward risk and resilience.
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Cole, P. M., Martin, S. E., & Dennis, T. A. (2004). Emotion
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Crick, N. R., & Zahn-Waxler, C. (2003). The development of
psychopa-
695REACTIVITY AND REGULATION
thology in females and males: Current progress and future
challenges.
Development and Psychopathology, 15, 719 –742.
Davis, E., Fennoy, I., Laraque, D., Kanem, N., Brown, G., &
Mitchell, J.
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with peri-
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Delaney-Black, V., Covington, C., Nordstrom, B., Ager, J.,
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Hannigan, J. H., et al. (2004). Prenatal cocaine: Quantity of
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diatrics, 25, 254 –263.
Delaney-Black, V., Covington, C., Templin, T., Ager, J.,
Nordstrom-Klee,
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children
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York: Guilford Press.
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Received November 12, 2004
Revision received December 21, 2005
Accepted January 31, 2006 �
Call for Papers:
Special Section on Sexual Orientation Across the Life Span
Developmental Psychology invites manuscripts for a special
section on Sexual Orientation Across
the Life Span, to be compiled by Guest Editors Charlotte J.
Patterson and Ritch C. Savin-Williams,
working together with journal Associate Editor Suniya S.
Luthar. The goal of the special section is
to highlight high-quality recent research on the role of sexual
orientation in human development.
Topics might include, but are not limited to, (a) development of
sexual orientation; (b) sexual
orientation and parenting; (c) sexual orientation in biological,
social, and cultural contexts; and (d)
the impact of sexual orientation on personal, social, familial,
occupational, and other aspects of lives
over time. Especially welcomed are papers that report the
results of longitudinal research, studies
that involve participants with multiple minority identities (e.g.,
minority ethnic, racial, or religious
identities, as well as minority sexual identities), and research on
understudied groups such as those
with bisexual or transgendered identities. The submission of
recently completed doctoral disserta-
tions is also encouraged.
The submission deadline is September 1, 2006. The main text of
each manuscript, exclusive of
figures, tables, references, and/or appendices, should not exceed
20 double-spaced pages (approx-
imately 5,000 words). Initial inquiries regarding the special
section may be sent to Charlotte J.
Patterson at [email protected] or to Ritch C. Savin-Williams at
[email protected] Manuscripts
must be submitted electronically through the Manuscript
Submission Portal of Developmental
Psychology at http://www.apa.org/journals/dev.html and a hard
copy sent to Cynthia Garcı́a Coll,
Editor, Developmental Psychology, Center for the Study of
Human Development, Brown Univer-
sity, Box 1831, Providence RI 02912. Please be sure to specify
in the cover letter that your
submission is intended for the special section. For instructions
to authors and other detailed
submission information, see the journal Web site at
http://www.apa.org/journals/dev.html
697REACTIVITY AND REGULATION
TABLE 5.2 | Categories of Marginally Ethical Negotiating
Tactics
Category Example
Traditional competitive Not disclosing your
walkaway; making an inflated opening offer bargaining
Emotional manipulation Faking anger, fear,
disappointment; faking elation, satisfaction
Misrepresentation Distorting information or
negotiation events in describing them to others
Misrepresentation to Corrupting your opponent’s
reputation with his or her peers
opponent’s networks
Inappropriate information Bribery, infiltration,
spying, etc.
gathering
Bluffing Insincere threats or promises
Exercise
23
SALARY
NEGOTIATIONS
NEGOTIATION
7e
LEWICKI
▪
BARRY
▪
SAUNDERS
Confidential
Role
Information
for
Employer
Position
3A
You
are
the
Marketing
Vice
President
of
the
Rapid
Golf
Equipment
Company,
and
have
held
this
position
for
the
past
four
years.
One
of
the
people
working
for
you
is
the
Director
of
Mail
Order
Sales.
This
person
has
been
in
the
position
for
the
past
two
years,
and
over
that
time,
the
Director
has
done
an
excellent
job.
This
is
indicated
by
the
improved
response
in
the
campaigns
of
the
Slingshot,
Fireball
and
Thunderhead
lines
of
golf
balls,
golf
gloves,
golf
bags
and
other
equipment.
The
Director
designed
and
executed
several
new
marketing/sales
campaigns
that
have
done
well.
You
are
quite
pleased
with
the
progress
on
these
lines.
There
has
been
one
problem
area.
One
of
the
objectives
for
this
past
year
was
to
get
more
action
in
the
Phoenix
line
(Rapid's
most
expensive
line
of
golf
equipment).
The
sales
units
on
this
year's
Phoenix
line
have
been
quite
poor—but
then
again,
Phoenix
has
never
been
a
really
successful
line.
The
current
director
has
been
unable
to
change
the
sales
performance
results
of
this
line
in
the
past
few
quarters,
and
you
have
no
indication
that
anything
in
the
program
has
changed.
It
is
currently
salary
review
time,
and
while
the
Director
has
had
excellent
results
in
the
other
lower
priced
lines,
the
failure
to
get
Phoenix
moving
is
the
reason
you
expect
to
give
only
a
nominal
raise
for
this
year.
If
new
achievements
in
the
Phoenix
line
can
be
shown,
then
you
could
see
your
way
clear
to
a
larger
raise.
The
director's
current
salary
is
$75,000
base
pay.
You
feel
that
a
raise
of
$4,000
(just
over
5
percent)
is
a
fair
raise
for
this
year's
efforts
(normal
raises
are
usually
in
the
6
-­‐
8
percent
range).
You
are
not
constrained
in
granting
a
raise
of
more
than
$4,000,
but
you
want
some
justifiable
evidence
why
the
Director
should
get
more.
You
consider
yourself
a
firm
but
fair
negotiator.
Take
a
few
minutes
to
review
these
facts
and
devise
discussion
with
your
Director
about
a
pay
raise.
Exercise
23
SALARY
NEGOTIATIONS
NEGOTIATION
7e
LEWICKI
▪
BARRY
▪
SAUNDERS
Confidential
Role
Information
for
Employee
Position
3B
You
are
the
Director
of
Mail
Order
Sales
for
the
Rapid
Golf
Equipment
Company,
and
have
held
that
job
for
two
years.
On
the
whole,
you
believe
that
you
have
done
a
satisfactory
job.
When
you
took
the
job
of
Director,
you
had
several
talks
with
your
boss
(the
Marketing
Vice
President).
The
two
of
you
were
able
to
work
out
an
informal
set
of
job
objectives
for
the
coming
year,
and
have
been
able
to
produce
a
good
record
against
each
of
these
criteria
-­‐
with
one
exception.
The
exception
is
a
major
one,
and
it
looms
as
the
biggest
stumbling
block
to
your
raise.
The
projects
that
you
have
been
working
on
have
been
Slingshot,
Fireball,
and
Thunderhead—all
different
lines
of
golf
balls,
gloves,
golf
bags
and
other
equipment.
These
projects
have
been
excellent
successes
and
have
exceeded
their
projected
growth
targets.
However,
one
of
your
other
objectives
was
to
develop
a
new
approach
for
selling
Rapid's
Phoenix
line
(the
company's
most
expensive
line
of
golf
equipment).
Phoenix
has
never
been
done
successfully
in
the
past,
so
you
pretty
much
had
to
start
over
from
scratch.
You
have
worked
hard
on
ways
to
improve
sales
in
the
Phoenix
line:
you
experimented
with
different
mailing
lists,
tried
discount
coupons,
free
shipping,
promotional
contests
that
featured
trips
to
Rapid's
manufacturing
plants,
golf
package
weekends,
and
still
the
results
were
relatively
insignificant.
In
the
past
months
you
have
been
working
very
hard
on
Phoenix.
One
particular
new
appeal,
using
demonstrations
at
the
nation’s
top
golf
courses,
has
produced
better
results
than
most.
It's
too
early
to
come
to
a
definite
conclusion
about
the
real
impact
on
Phoenix
sales;
further
testing
will
be
required,
but
the
signs
are
good
enough
to
be
optimistic.
You
know
your
boss
is
a
hard
negotiator
at
raise
time.
You
also
know
that
failure
to
achieve
a
breakthrough
on
Phoenix
will
make
it
easy
for
your
boss
to
deny
you
anything
but
the
most
nominal
raise.
But
you
have
not
told
your
boss
of
the
recent
results
with
the
new
list;
you
plan
to
use
the
result
of
the
new
promotion
to
counter
any
argument
raised
about
your
lack
of
performance
in
the
Phoenix
line.
You
plan
on
asking
for
a
$10,000
raise
(normally,
your
raises
have
been
5
-­‐
8
percent).
Your
current
compensation
has
a
base
salary
of
$75,000
Take
a
few
minutes
to
review
these
facts
and
then
devise
a
strategy
to
approach
your
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Reactivity and Regulation in Children Prenatally Exposed to Co.docx

  • 1. Reactivity and Regulation in Children Prenatally Exposed to Cocaine Tracy Dennis Hunter College of the City University of New York Margaret Bendersky, Douglas Ramsay, and Michael Lewis University of Medicine and Dentistry of New Jersey—Robert Wood Johnson Medical School Children prenatally exposed to cocaine may be at elevated risk for adjustment problems in early development because of greater reactivity and reduced regulation during challenging tasks. Few studies have examined whether cocaine-exposed children show such difficulties during the preschool years, a period marked by increased social and cognitive demands and by rapid changes in reactivity and regulation. The authors addressed this question by examining frustration reactivity and regulation of behavior during a problem-solving task in cocaine-exposed and -unexposed preschoolers. Participants were 174 4.5-year-olds (M age � 4.55 years, SD � 0.09). Frustration reactivity was measured as latency to show frustration and number of disruptive behaviors, whereas regulation was measured as latency to approach and attempt the problem-solving task and number of problem-solving behaviors. Results indicated that cocaine-exposed children took longer to attempt the problem-solving task but that
  • 2. cocaine-exposed boys showed the most difficulties: They were quicker to express frustration and were more disruptive. Effect sizes were relatively small, suggesting both resilience and vulnerabilities. Keywords: reactivity, regulation, prenatal cocaine exposure Regulation is the ability to initiate behavioral changes that meet goals and manage emotional and physiological reactivity and is among the most critical and rapidly developing capacities of early childhood. Individual differences in how children react to and regulate behavior during challenges and frustrations are an impor- tant aspect of child adjustment and temperament (Derryberry & Rothbart, 1997; Goldsmith et al., 1987; Rothbart & Bates, 1998; Rothbart & Derryberry, 1981; Thomas & Chess, 1977). Reactivity and regulation are closely related but distinct dimensions of be- havior and emotion (Derryberry & Rothbart, 1997; Ramsay & Lewis, 2003), although there is continuing debate about their independence (Campos, Frankel, & Camras, 2004). Reactivity is marked by the dynamics of emotional responses, such as latency, intensity, and frequency of emotion; regulation is marked by adaptive attempts to cope with challenges (Cole, Martin, & Den- nis, 2004; Thompson, 1994). Flexible and effective regulation characterizes mental health, and deficits in this core capacity are involved in a range of psychological disorders (Barkley, 1997; Saarni, 1999). Although regulation often refers to the regulation of affect, it also refers to effortful control, the intentional control and inhibition of behavior and attention (Derryberry & Rothbart,
  • 3. 1997; Eisenberg et al., 2005; Kochanska, 1997). In the present study, we observed reactivity and regulation during a frustrating problem- solving task. Reactivity was measured as emotional frustration, oppositionality, and aggression, whereas regulation was measured as the ability to approach the task and effectively solve the prob- lem despite the frustration. Over the past two decades, there has been growing concern that prenatal exposure to cocaine, through its actions on the central nervous system, increases risk for problems related to reactivity and regulation in infancy and childhood (Bendersky, Gambini, Lastella, Bennett, & Lewis, 2003; Bendersky & Lewis, 1998; Bennett, Bendersky, & Lewis, 2002; Chasnoff, Burns, Schnoll, & Burns, 1985; Chasnoff & Griffith, 1989; Delaney-Black et al., 2000, 2004; Dow-Edwards, Mayes, Spear, & Hurd, 1999; Harvey & Kosofsky, 1998; Napiorkowski & Lester, 1996). Cocaine- exposed newborns show impaired neurobehavioral functioning (Bingol, Fuchs, Diaz, Stone, & Gromisch, 1987; Griffith, Azuma, & Chasnoff, 1994; Lutiger, Graham, Einarson, & Koren, 1991; Martin, Barr, Martin, & Streissguth, 1996; Richardson, 1998; Singer et al., 2002; for a review, see Mayes, 1999a), and specific neural effects have been documented in brain systems associated with reactivity, regulation, and problem-solving capacities (e.g., the mesolimbic and midprefrontal cortices and the monoaminergic neurotransmitter system; Karmel, Gardner, & Freedland, 1996;
  • 4. Jones, Field, Davalos, & Hart, 2004; Mayes, 1994; Wang, Yeung, & Friedman, 1995; J. R. Woods, Plessinger, & Clark, 1987). Exposed toddlers and preschoolers show decreased reactivity mod- ulation and inhibitory control (Bendersky et al., 2003; Bendersky & Lewis, 1998; Hawley, Halle, Drasin, & Thomas, 1995; Mayes, Bornstein, Chawarska, Haynes, & Granger, 1996), greater atten- tional impulsivity (Mayes, Grillon, Granger, & Schottenfeld, 1998), greater risk for specific cognitive impairments (Singer et al., 2004), and greater teacher-reported disruptive behavior (Delaney-Black et al., 2000, 2004). Older children prenatally ex- posed to cocaine may be slower to initiate the mental processes Tracy Dennis, Department of Psychology, Hunter College of the City University of New York; Margaret Bendersky, Douglas Ramsay, and Michael Lewis, Institute for the Study of Child Development, University of Medicine and Dentistry of New Jersey—Robert Wood Johnson Medical School. This research was supported by the National Institute on Drug Abuse Grant R01 DA07109. Correspondence concerning this article should be addressed to Tracy Dennis, 695 Park Avenue, Department of Psychology, Hunter College, City University of New York, New York, NY 10021. E-mail:
  • 5. [email protected] Developmental Psychology Copyright 2006 by the American Psychological Association 2006, Vol. 42, No. 4, 688 – 697 0012-1649/06/$12.00 DOI: 10.1037/0012-1649.42.4.688 688 needed to solve a problem (Bandstra, Morrow, Anthony, Accor- nero, & Fried, 2001; Bandstra, Vogel, Morrow, Xue, & Anthony, 2004; Schroder, Snyder, Sielski, & Mayes, 2004; Singer et al., 2004). However, other studies show significant resilience among cocaine-exposed children and fail to document vulnerabilities, such as neurotoxicity and withdrawal in infants (e.g., Eyler et al., 2001), child behavior problems (e.g., Accornero, Morrow, Band- stra, Johnson, & Anthony, 2002), and deficits in school readiness and IQ (e.g., Chasnoff et al., 1998; Pulsifer, Radonovich, Belcher, & Butz, 2004). In many of these studies, factors such as home environment and parenting characteristics rather than cocaine ex- posure predicted or mediated behavioral and cognitive outcomes. Given these mixed results and given the difficulty of conducting prospective longitudinal studies, relatively little is known about the effect of cocaine exposure on reactivity and regulation during
  • 6. early childhood. Although some research on prenatal cocaine exposure has focused on social– emotional development (e.g., Accornero et al., 2002; Beeghly, Frank, Rose-Jacobs, Cabral, & Tronick, 2003; Bendersky, Alessandri, & Lewis, 1996; Jones et al., 2004), most studies have focused on cognitive and attentional development (e.g., Mayes et al., 1998; Pulsifer et al., 2004), and relatively few if any studies have specifically examined the effects of prenatal cocaine exposure on reactivity and regulation during frustrating problem-solving tasks. Such research is needed during the pre- school years, which are marked by rapid maturation of the frontal lobes and associated improvements in executive control, reactivity modulation, and regulation of behavior (Bender, Word, Di- Clemente, & Crittenden, 1995; Diamond, 2002; Mayes, 1994). There is a need for research that uses observational assessment and seminaturalistic conditions rather than computer-based tasks and measures that are susceptible to reporter bias, such as maternal and teacher reports. Prenatal cocaine exposure may have subtle but important effects on children that are not evident until more complex abilities are measured (Lester, 2000; Lester, Lagasse, & Seifer, 1998; Singer et al., 2004). For example, cocaine-exposed children may show small decrements in cognitive or emotional abilities that have increas- ingly disruptive effects as development proceeds (Cicchetti,
  • 7. Gani- ban, & Barnett, 1991). Moreover, even in conjunction with signif- icant signs of resilience, small problems with emotional reactivity and regulation, such as lower threshold for frustration and diffi- culty regulating behavior under emotional circumstances, may compromise a child’s ability to negotiate challenging tasks (Leech, Richardson, Goldschmidt, & Day, 1999; Mayes et al., 1996). Children who are relatively more reactive to challenges and/or have difficulty regulating may be predisposed to greater stress, which could further exacerbate vulnerabilities (Mayes et al., 1998). Thus, reactivity and regulation during cognitive and emotional challenges are critically relevant to academic achievement and social adjustment during early childhood (Denham, 1998; Mayes et al., 1998; Richardson, 1998). Various factors may interact with exposure in determining the effect of cocaine on the development of reactivity and regulation. Gender might be one such factor. Recent findings indicate that verbal reasoning and problem solving may be impaired in cocaine- exposed boys but not in cocaine-exposed girls (Bennett et al., 2002). Further, in studies of school-age children, teachers reported that boys but not girls exposed to cocaine were more likely to have clinically significant disruptive behavior problems, suggesting dif- ficulties related to frustration reactivity and regulation, compared with cocaine-unexposed children (Delaney-Black et al., 2000,
  • 8. 2004). This is consistent with findings in animal research: Cocaine-exposed male rats have been found to perform more poorly than cocaine-exposed female rats on tasks assessing cog- nitive and motor development (Markowski, Cox, & Weiss, 1998; Spear, 1995). To accurately evaluate the effect of prenatal exposure to cocaine on child reactivity and regulation, one must take potentially con- founding factors into account, including neonatal risk factors such as prenatal exposure to other drugs, environmental risk factors, and intelligence. Women who use cocaine tend to drink more alcohol, smoke more cigarettes, and use more marijuana than those who do not use cocaine (Bendersky, Alessandri, Gilbert, & Lewis, 1996; N. S. Woods, Behnke, Eyler, Conlon, & Wobie, 1995). Prenatal exposure to these substances may have a unique impact on reac- tivity and regulation. Environmental risk factors such as poverty, high life stress, and maternal social isolation also are likely to have a negative impact on developmental outcomes and are generally more prevalent in children exposed to cocaine (Bendersky, All- esandri, Sullivan, & Lewis, 1995; Bendersky et al., 2003). Given the mixed support for effects of cocaine exposure on IQ, the effect of IQ was examined in this study to ensure that it did not interact with exposure in determining reactivity and regulation (Bennett et al., 2002; Pulsifer et al., 2004; Singer et al., 2004).
  • 9. In summary, children, especially boys, prenatally exposed to cocaine may well be at risk for frustration reactivity and difficul- ties in regulating behavior during a frustrating and cognitively demanding problem-solving task. However, relatively little re- search has involved directly observing these effects during the preschool years, when the ability to modulate reactivity and reg- ulate behavior is developing. Even fewer studies have assessed reactivity and regulation during problem solving, which is an important activity during early childhood (Melnick & Hinshaw, 2000). In this study, we assessed frustration reactivity and regu- latory behaviors in cocaine-exposed versus -unexposed boys and girls during a frustrating problem-solving task when the children were 4.5 years old. Although we anticipated significant resiliency on the part of cocaine-exposed children, we hypothesized that prenatal exposure to cocaine would be associated with greater frustration reactivity (shorter latencies to show frustration, more numerous disruptive behaviors) and greater difficulty regulating behavior (longer latencies to approach and attempt the problem- solving task, fewer problem-solving behaviors), and, given previ- ous findings on gender differences, we expected that these effects would be strongest for cocaine-exposed boys. The effects of po- tentially associated factors—including IQ; neonatal medical risk; environmental risk; and prenatal exposure to cigarettes, alcohol, and marijuana—were evaluated. Method
  • 10. Participants Participants were 191 mothers and their children (95 boys, 88 girls), who were 4.5 years old (M � 4.55 years, SD � 0.09; ages ranged from 4.3 to 4.9 years), participating in a longitudinal study of developmental conse- quences of prenatal cocaine exposure. Children were predominantly Afri- can American (86%), with 11% of the children being European American and 3% Hispanic or Asian American. The racial composition did not differ between mothers who used or did not use cocaine during pregnancy. 689REACTIVITY AND REGULATION Complete data were available for 174 children. Sixty-five were exposed to cocaine during pregnancy, and 109 were unexposed. Maternal education level ranged from 8th grade through post– high school training, with 54% being high school graduates. At the time of the study, 32% were receiving public assistance. Maternal education and public assistance did not differ between cocaine users and nonusers. Participation was voluntary, and incentives were provided in the form of vouchers for use at local stores.
  • 11. Recruiters approached pregnant women attending participating hospital- based prenatal clinics and/or obstetric services in Trenton, New Jersey, or Philadelphia, Pennsylvania, between February 1993 and December 1995. Of these, 82% (n � 384) agreed to participate. Children were excluded from the study if they were born prior to 32 weeks of gestation, required special care or oxygen therapy for more than 24 hours, exhibited congenital anomalies, were exposed to opiates or phencyclidine in utero, were born to mothers less than 15 years of age, or were infected with HIV (n � 63). Of these 321 children invited to participate, 258 children participated in the first lab visit at 4 months of age. Of the children lost to the study, 18 participants were placed in foster care on discharge and these families refused to participate, 27 families could not be contacted, and 18 chose not to continue. At the 4.5-year visit, 191 mothers participated (60% of those who were invited to participate and 74% of those who participated in the first lab visit). Of the 67 families not seen at 4.5 years, 15 moved out of the area, 15 declined to participate at this age, 28 could not be contacted for this age point, 1 child and 2 mothers died, and 6 went to foster parents who refused
  • 12. to participate. There were no significant differences in the distributions of cocaine exposure, gender, perinatal medical risk, or environmental risk between participants who participated and those who refused to continue or were lost to the study from the neonatal period through 4.5 years of age. Among children participating in the study, 23 children were in foster care, 20 of whom had been prenatally exposed to cocaine. Foster care was not associated with any differences in risk or outcome variables, except for maternal use of alcohol during pregnancy, p � .001.1 Procedures and Measures For the 4.5-year visit, mothers and children arrived at the research laboratory and were escorted into a playroom by a female experimenter. A set of toys was arranged on the floor to encourage child play. The experimenter described the study and obtained informed consent from the mother. Several tasks followed, including a frustration task. The tasks were administered to all participants in the same order. For the present study, only child behaviors during the frustration task (the impossible pulley task) were examined for measures of reactivity and regulation. The impossible pulley task was a 3-min problem-solving task designed
  • 13. to elicit high levels of frustration. The task materials consisted of a basket and a pulley with a rope anchored with a knot tied to a hook in the wall. While the child was watching, the experimenter placed an attractive toy or food in the basket out of reach. The child was encouraged for 2 min to obtain the prize. This required figuring out that he or she had to untie the knot to release the rope from the hook in the wall and allow the basket to fall into reach. If the task was not solved after 1 min, the examiner drew the child’s attention to the pulley (e.g., pointed to the pulley, the rope attached to it, and the hook in the wall), and the child was then allowed an additional 1 min to solve the problem. To identify differences in reactivity and regulation, we coded frequency counts of the following six behaviors: (a) carrying out instrumental actions to obtain the prize without using force, such as untying the knot and reaching for the basket; (b) using items in the room to try to solve the problem, such as reaching for the basket with another toy; (c) making demands of adults, such as asking that the experimenter solve the task; (d) complaining to adults about the task; (e) showing aggression toward objects, such as banging the pulley or hitting the basket; and (f) showing
  • 14. aggression toward people, such as hitting or kicking the experimenter. An instrumental behavior composite score was created by summing frequency counts of instrumental actions and use of items in room. A disruptive behavior composite score also was created by summing counts of demands, complaints, and aggression toward objects and people. Proportion scores for the composites were calculated as the proportion of children showing instrumental behaviors (low or high levels were determined on the basis of a median split) and the proportion of children showing disruptive behaviors (proportions were for no, low, or high levels of disruptive behavior, and low or high levels were determined on the basis of a median split of the nonzero frequency counts). Three latency scores were coded: latency to first evidence of frustration (including all behaviors composing the disruptive behavior composite score as well as signs of emotional collapse, such as crying), latency to approach the task, and latency to first attempt to untie the knot. Scores also were calculated for the proportion of children approaching the task imme- diately (approaching immediately vs. waiting) and attempting the knot (attempting vs. not attempting).
  • 15. Composite scores, proportion scores, and latency scores were used in subsequent analyses as dependent variables indexing frustration reactivity and regulation. Frustration reactivity was measured as latency to first evidence of frustration and the disruptive behavior composite. Regulation was measured as the latency and proportion scores for approaching and attempting the task and the instrumental behavior composite. Interrater agreement. A team of coders reviewed videotaped record- ings of the sessions to generate data for analyses. Before coding, all coders achieved adequate interrater agreement. Interrater reliability for latency and frequency scores was calculated on the basis of 25% of the videotapes (45 tapes), which were randomly chosen. The average weighted Cohen’s kappa coefficient for latency scores was .94 (ranging from .92 to .96) and for frequency scores was .91 (ranging from .80 to 1.00). Both coefficients reflected excellent agreement (Bartko, 1991; Fleiss, 1981). The average upper bound intraclass correlation for latency scores was .97 (ranging from .96 to .98) and for frequency scores was .95 (ranging from .89 to 1.00). Coders were blind to the exposure status of the participants and hypotheses of the study.
  • 16. Neonatal medical risk score. On the basis of hospital records, prenatal and neonatal medical data were used to complete a neonatal medical risk scale consisting of 35 possible complications (Hobel, Hyvarinen, Okada, & Oh, 1973). Variables included general factors (e.g., low birth weight, fetal anomalies), respiratory complications (e.g., congenital pneumonia, apnea), metabolic disorders (e.g., hypoglycemia, failure to gain weight), cardiac problems (e.g., murmur, cardiac anomalies), and central nervous system (CNS) problems (e.g., CNS depression, seizures). Variables were weighted and summed to obtain the risk score, which ranged from 0 � no risk to 13 � high risk. Environmental risk score. Demographic and lifestyle information was obtained through structured interviews administered to the mother during the 4.5-year laboratory visit. These interviews included questions about the mother’s race, the mother’s educational achievement, household compo- sition, sources of income, maternal history of substance abuse, the number of caregivers, the regularity of the child’s schedule, social support (deter- mined by using the Norbeck Social Support Questionnaire; Norbeck, Lindsey, & Carrieri, 1981), and maternal life stressors
  • 17. (determined by using the Social Environment Inventory; Orr, James, & Casper, 1992). The variables were standardized, reverse coded if necessary so that higher values indicated greater risk, and summed. This cumulative risk score was then rescaled as a t score with a mean of 50 (see Bendersky & Lewis, 1998, Bendersky et al., 2003). Scores ranged from 24 to 81. Cumulative envi- ronmental risk measures have been found to explain more variance in children’s outcomes than do single factors, including socioeconomic status (Hurt, Malmud, Betancourt, Brodsky, & Giannetta, 2001). Prenatal substance exposure. Prenatal substance exposure information was obtained through a semistructured interview administered to the 1 When analyses were rerun without children in foster care, patterns of effects remained the same. 690 DENNIS, BENDERSKY, RAMSAY, AND LEWIS mother by trained interviewers within 2 weeks of the infant’s birth. The interview contained questions about the frequency, amount, and trimester of the mother’s use of cocaine, alcohol, cigarettes, marijuana, opiates, PCP,
  • 18. tranquilizers, amphetamines, and barbiturates. Ratings were on an 8-point scale, from 0 � no use to 7 � daily use. For those children prenatally exposed to cocaine, average exposure was 0.60 g/day (SD � 0.91). Co- caine use was confirmed by results of analysis of newborns’ meconium, which was screened with radioimmunoassay followed by confirmatory gas chromatography–mass spectrometry for the presence of benzoyl ecgonine (cocaine metabolite), cannabinoids, opiates, amphetamines, and PCP. Mothers showed no signs of PCP, heroin, or methadone use as determined by assay and by self-report in repeated interviews. Children were consid- ered exposed to cocaine if positive by maternal report or meconium assay. They were considered unexposed to cocaine if negative by both report and assay. For the current study, we also examined the effects of prenatal exposure to alcohol (number of drinks per day), cigarettes (number per day), and marijuana (number of joints per day). IQ. When the children were 4 years old (M � 4.12, SD � 0.23), the Stanford–Binet Intelligence Scale, Fourth Edition (Thorndike, Hagen, & Sattler, 1986) was administered. The composite score was used. This measure has extensive standardization data and satisfactory reliability,
  • 19. including with African American children (Krohn & Lamp, 1999; Thorndike et al., 1986). Results Table 1 presents means and standard deviations for neonatal and environmental risk scores and amount of in utero exposure to alcohol, cigarettes, marijuana, and cocaine. Cocaine-exposed ver- sus -unexposed children had significantly greater neonatal com- plications, F(1, 169) � 9.14, p � .01, and were exposed in utero to greater amounts of alcohol, F(1, 165) � 32.31, p � .001; cigarettes, F(1, 165) � 54.10, p � .001; and marijuana, F(1, 164) � 4.96, p � .05. However, environmental risk did not differ between cocaine-exposed and -unexposed children, and there were no gender or Gender � Exposure differences in the risk factors. These risk factors were not significantly correlated with the de- pendent variables (reactivity and regulation variables; correlations between �.13 and .14). We examined correlations between risk factors and outcomes separately for cocaine-exposed versus -unexposed children, and associations remained nonsignificant. Next, because child IQ might be associated with problem- solving ability, correlations between child IQ and outcome variables were examined (child IQ M � 84.14, SD � 11.47, range � 54 –111). There were no significant correlations. Finally, all analyses of variance (ANOVAs) reported below were initially conducted us- ing neonatal and environmental risk scores and child IQ as covari- ates, including their interactions with exposure group and gender.
  • 20. Results did not differ from those analyses without covariates. Thus, analyses without risk factors and IQ as covariates are re- ported below. The dependent variables are located in the left-hand column of Table 2. Correlational analyses were used to evaluate the relations among these measures. The pattern of correlations was comparable across the four Exposure � Gender groups. Significant intercor- relations indicated that the greater the number of instrumental behaviors, the shorter the latency to approach the task, r � �.29, p � .001, but the longer the latency to attempt to untie the knot, r � .34, p � .001. This was perhaps because children using instrumental behaviors also used other problem-solving strategies before attempting the knot. The number of instrumental behaviors also was correlated positively with disruptive behaviors, r � .15, T ab le 1 D es cr ip ti ve S
  • 71. te nc ie s ar e in se co nd s. 692 DENNIS, BENDERSKY, RAMSAY, AND LEWIS p � .05, perhaps reflecting the general level of activity. Finally, as might be expected, the greater the number of disruptive behaviors, the shorter the latency to express frustration, r � �.62, p � .001. These correlations suggest that reactivity and regulation scores were largely independent. However, to further explore the inde- pendence of these constructs, we examined whether children who expressed frustration relatively quickly or slowly (reactivity) dif- fered in their problem-solving behavior during the task (regula-
  • 72. tion). Of the 174 children in this study, 88 children never showed frustration. For the remaining 86, we created two groups based on a median split (50th percentile � 19 s). These groups did not differ on our measures of regulation (latency to approach the task and latency to first attempt to untie the knot, number of instrumental behaviors). This further suggests that reactivity and regulation are independent dimensions. Table 2 presents the means, standard deviations, and proportion scores for the dependent variables. To examine cocaine exposure and gender differences in child reactivity and regulation, we con- ducted a separate univariate ANOVA for each of the five depen- dent variables: latency to first evidence of frustration, number of disruptive behaviors, latency to approach the task, latency to first attempt to untie the knot, and number of instrumental behaviors. Substance exposure group and gender were the between-subjects factors. A high proportion of children did not receive scores for one or more of the behavioral codes. For example, 24.1% of children did not attempt the knot and 50.6% did not show frustra- tion and thus did not have latency scores. Therefore, each ANOVA was followed by a chi-square analysis to examine cocaine expo- sure and gender group differences in the proportion of children who (a) showed frustration; (b) showed no, low, or high levels of disruptive behavior; (c) approached the task immediately; (d)
  • 73. attempted the knot; and (e) showed low versus high levels of instrumental behavior. The ANOVA for latency to express frustration revealed a sig- nificant interaction between exposure and gender, F(1, 173) � 3.76, p � .05, �2 � 2%. Cocaine-exposed boys showed a signif- icantly shorter latency to express frustration than did cocaine- unexposed boys, t(89) � 2.38, p � .05; cocaine-exposed girls, t(63) � 2.32, p � .05; and cocaine-unexposed girls, t(74) � 2.12, p � .05. There were no differences in frustration latency among cocaine-exposed girls and -unexposed girls and boys. Chi- square analyses further indicated that a greater proportion of cocaine- exposed boys versus cocaine-exposed girls showed frustration, �2(1, N � 174) � 4.56, p � .05. Differences among cocaine- exposed boys, cocaine-unexposed boys, and cocaine-unexposed girls were not significant. For the disruptive behaviors composite, the interaction between cocaine exposure and gender also was significant, F(1, 173) � 5.50, p � .05, �2 � 3%. Follow-up tests revealed trends for cocaine-exposed boys to evidence more disruptive behaviors than cocaine-unexposed boys, t(89) � 1.81, p � .07, and cocaine- exposed girls, t(63) � 1.85, p � .07, but they did not differ from cocaine-unexposed girls. Chi-square analyses confirmed these trends, revealing significant Exposure � Gender group differences in the proportion of children showing no, low, or high levels of disruptive behaviors, �2(2, N � 174) � 6.48, p � .05. Follow- up chi square analyses for each level of disruptive behavior found that
  • 74. only the proportion of children showing no disruptive behavior differed significantly among groups, �2(1, N � 174) � 5.15, p � .05. A smaller proportion of cocaine-exposed boys showed no disruptive behavior compared with cocaine-exposed girls, cocaine- unexposed boys, and cocaine-unexposed girls. The differences among cocaine-exposed girls, cocaine-unexposed boys, and cocaine-unexposed girls were not significant. Also, the differences between cocaine-exposed and -unexposed children and between boys and girls for low or high levels of disruptive behaviors were not significant. Analyses of latency to approach the task did not reach signifi- cance, but analyses of latency to first attempt to untie the knot revealed a significant main effect of cocaine exposure. Cocaine- exposed children took longer to attempt to untie the knot than did cocaine-unexposed children, F(1, 173) � 4.09, p � .05, �2 � 3%. The interaction between cocaine exposure and gender did not reach significance. However, a chi-square analysis examining the proportion of children who attempted the knot yielded a significant Exposure � Gender interaction, �2(1, N � 174) � 4.44, p � .05. A larger proportion of cocaine-unexposed boys attempted the knot compared with cocaine-unexposed girls, cocaine-exposed boys, and cocaine-exposed girls. The differences among cocaine- unexposed girls, cocaine-exposed boys, and cocaine-exposed girls
  • 75. for latency to first attempt to untie the knot were not significant, and group differences for latency to approach the task also were not significant. The ANOVA for the instrumental behaviors composite yielded a main effect of gender, F(1, 173) � 4.04, p � .05, �2 � 3%, showing that girls evidenced more instrumental behaviors than did boys. Chi-square analyses for instrumental behavior did not reach significance. Discussion During the preschool years, children are often faced with problem-solving challenges that test their cognitive and emotional capacities. By maintaining emotional equilibrium and effectively exploring problems, children build a foundation for current and future success in academic and social domains. The results of the present study supported our hypothesis that prenatal exposure to cocaine increases the risk for problems related to frustration reac- tivity and regulation of problem-solving behavior in early child- hood. However, evidence of significant resiliency also emerged, and effect sizes of these differences were relatively small. Indeed, prenatal cocaine exposure has been used as a model of the complex interplay between risk and vulnerability in young children (Mayes, 1999b). However, these early deviations in developmental trajec-
  • 76. tories may have an impact at later developmental stages. To our knowledge, this is the first study that observed reactivity and regulation in cocaine-exposed and -unexposed preschoolers during a challenging problem-solving task rather than relying on adult report of child behavior. Although these two constructs are inter- related, they also are distinct, as demonstrated by our results and as conceptualized by a rich literature on child temperament (e.g., Derryberry & Rothbart, 1997). Few studies of prenatal cocaine exposure have integrated these concepts from temperament re- search into the study of developmental trajectories of cocaine- exposed versus -unexposed children. Overall, cocaine exposure appeared to have an effect on prob- lem solving: Cocaine-exposed versus -unexposed children took longer to engage in the problem-solving task. Thus, it appeared that they were slower in defining and working on the problem at hand. Whether this was due to the cocaine-exposed children being 693REACTIVITY AND REGULATION less engaged in the problem and/or less able to solve the problem remains unclear. Both possibilities are likely given that cocaine- exposed children are at risk for specific neurological deficits and problems associated with motivation, executive functions, reason- ing, and problem solving (Bender et al., 1995; Davis et al., 1992; Mayes, 1994; Singer, Farkas, & Kliegman, 1992; Singer et al.,
  • 77. 2004). In this sample, prenatal exposure to alcohol, cigarettes, and marijuana differed between cocaine-exposed and -unexposed chil- dren but did not appear to be related to outcomes. Neonatal and environmental risk factors and IQ also failed to influence outcome measures beyond the effect of cocaine exposure. Thus, these findings strengthen the inference that prenatal exposure to cocaine was related specifically to the decrements in frustration reactivity and regulation detected in this study. Consistent with previous research (Delaney-Black et al., 2000, 2004; Bendersky et al., 2003; Bendersky & Lewis, 1998; Bennett et al., 2002), we found that cocaine-exposed boys showed the most difficulties, as evidenced by shorter latencies to express frustration and a larger number of disruptive behaviors as compared with the cocaine-unexposed children and cocaine-exposed girls. This sug- gests that cocaine-exposed boys showed greater reactivity and less effective regulation. They appeared to have somewhat shorter fuses; that is, they became more quickly frustrated and more often acted out that frustration through complaints and aggression. How- ever, Exposure � Gender differences were not found for all measures, and there were notable similarities between cocaine- exposed and -unexposed children. Cocaine-exposed boys were
  • 78. equally quick to approach the challenge and maintained the adap- tive ability to generate instrumental and constructive problem- solving behaviors during the frustrating task. Moreover, cocaine- exposed girls showed almost none of the decrements evidenced by cocaine-exposed boys, and girls overall responded to the challeng- ing task with significantly more instrumental behaviors than did boys. This resilience on the part of cocaine-exposed girls is in- triguing and suggests the presence of gender-sensitive etiologies and trajectories in the development of psychopathology (Crick & Zahn-Waxler, 2003). These findings underscore the importance of acknowledging and seeking out examples of effective adjustment in cocaine-exposed children rather than emphasizing potential deficits. A number of studies document resilience in cocaine- exposed children, particularly those who receive adequate caregiv- ing (Bennett et al., 2002; Brown, Bakeman, Coles, Platzman, & Lynch, 2004; Pulsifer et al., 2004; Singer et al., 2004). Related to this, some children in our sample were living in foster care (23 children, 13%), 87% of whom were exposed to cocaine. Foster care was not associated with any differences in risk or outcome variables, except for greater maternal use of alcohol during pregnancy, p � .001. Yet, the quality of foster care is likely to have an impact on developmental outcomes. High-quality foster care could operate over time as a protective factor for cocaine- exposed children. However, foster care could be associated with
  • 79. a range of disruptions (e.g., loss of an attachment figure, instability due to multiple changes in foster care placement, little contact with biological caregiver or other kin) that could have a negative impact on adjustment. The complexity of this issue is not fully reflected in our environmental risk score. However, this score is based on assessment of the current caregiver (including foster caregiver) and does include factors such as stability of the environment. Future research would benefit from a careful assessment of foster care quality and stability. Difficulties with the modulation of frustration and problem solving often have a reciprocal influence on each other (Dennis & Miller-Brotman, 2003; Derryberry & Rothbart, 1997; Rothbart & Bates, 1998). High levels of frustration likely have a negative impact on child persistence and problem solving during challeng- ing tasks, whereas deficits in basic regulatory capacities, such as executive functions and cognitive control, are associated with increased frustration and aggression. These effects might have been compounded by cognitive decrements found in cocaine- exposed preschoolers, such as lower levels of visual-spatial skills, short-term memory, and general knowledge (Bennett et al., 2002; Singer et al., 2004).
  • 80. This reciprocal influence between reactivity and regulation raises questions about their independence as constructs (Campos et al., 2004; Cole et al., 2004). It is difficult to distinguish behaviors associated with emotion from subsequent attempts to regulate emotion. For example, behaviors associated with frustration in- clude increased persistence and working to overcome obstacles. These behaviors also serve to regulate frustration. Yet, there are important distinctions between emotional reactivity and regula- tion: Reactivity increases the probability of behavior but does not force the initiation of regulatory actions, and different regulation strategies have distinct implications for adjustment independent of emotional reactivity (e.g., Gross, 2002). Moreover, there is evi- dence that reactivity and regulation are distinct processes and that the balance between reactivity and regulation, rather than the strength of each alone, is a fundamental determinant of positive adjustment (Derryberry & Rothbart, 1997). Although the results of this study were statistically significant, effect sizes were small (ranging from 2% to 3%). However, relatively small effects of cocaine exposure on reactivity and regulation may contribute to larger effects at older ages in this and other domains (Lester, 2000; Lester et al., 1998). This is consistent with an organizational perspective on development, which sug- gests that deficits in the negotiation of stage-salient tasks can have a strong impact on future development, even if initial problems are relatively small (Cicchetti et al., 1991). This occurs because the
  • 81. successful development of one competency increases the likeli- hood of successful development of subsequent competencies. Early capacities and abilities are thus carried forward, as are early vulnerabilities. This developmental principle may be particularly relevant to measures of reactivity and regulation. Reactivity and regulation can be thought of as gating mechanisms that direct and optimize attention, information processing, learning, and memory (Mayes et al., 1998). Moreover, chronically high reactivity or reduced regulation may be associated with increased activity of the stress response system, thus increasing child vulnerability for poor physical and mental health outcomes, particularly if children are exposed to stressful environments. Animal models also suggest that subtle behavioral and neuronal effects can have a powerful impact on the development of basic learning processes (e.g., Little & Teyler, 1996). For example, although cocaine-exposed rabbits react normally to standard learning stimuli, reducing the duration of stimuli by as little as several hundred milliseconds abolishes normal neuronal responding and impairs behavioral learning (Gab- riel & Taylor, 1998). Two aspects of this study may limit the generalizability of our findings. First, we examined frustration reactivity and regulation 694 DENNIS, BENDERSKY, RAMSAY, AND LEWIS
  • 82. during one task. It would have been optimal to assess children across multiple tasks during this assessment phase to obtain the most reliable measures of each construct. However, because the larger study focused on a broad array of functional skills, we only sampled this one behavior at 4.5 years. Replication using this and similar tasks would be necessary to confirm findings. Second, the retention rate was lower than desired by the 4.5-year assessment. Although this is a concern, participants did not significantly differ from those who refused to continue or who did not take part in this specific assessment in terms of cocaine exposure, environment and perinatal risk, or gender. This issue reflects the challenges inherent in working with families that experience multiple risk factors. In addition, our measurements of cocaine exposure could have limited the specificity of our findings. Prenatal drug exposure information was collected retrospectively at the end of pregnancy and up to 2 weeks postpartum. A prospective design might have improved accuracy and reduced reporting biases. However, be- cause poor, drug-using women often do not obtain early or con- sistent prenatal care, limiting the sample to women who had prenatal care throughout pregnancy would have resulted in an inadequate representation of the highest risk group. In addition, the cocaine-exposure variable was a dichotomous variable (used or did not use at any time during pregnancy). Details about cocaine
  • 83. exposure, such as the timing and amount of exposure, are absent from this variable. It is acknowledged to be very difficult at this juncture to obtain reliable information about timing and amount of exposure, as these variables are usually based on self-report and were entirely based on self-report in this study. Knowing if a woman used any cocaine during pregnancy from self-report and meconium analysis seems to be a more reliable although possibly less sensitive measure of cocaine use. Research conducted when more reliable methods of determining timing and amount of ex- posure become available should investigate whether such param- eters of cocaine exposure influence patterns of effects. The strengths of this prospective longitudinal study of prenatal cocaine exposure included observational assessment techniques, a focus on child competencies, and a theoretical framework rarely applied to studies of prenatal cocaine exposure: temperamental reactivity and regulation as they relate to the development of adjustment and maladjustment. Results illustrate remarkable resil- iency but hint at the presence of vulnerability points, particularly in cocaine-exposed boys: greater frustration reactivity and greater difficulty in regulating behavior during problem solving. These results have implications for intervention and prevention, suggest- ing that treatment of children prenatally exposed to cocaine should anticipate specific problems related to reactivity, regulation, and problem solving while capitalizing on significant strengths and signs of positive adjustment. It is critical to conduct further lon-
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  • 99. Hillsdale, NJ: Erlbaum. Received November 12, 2004 Revision received December 21, 2005 Accepted January 31, 2006 � Call for Papers: Special Section on Sexual Orientation Across the Life Span Developmental Psychology invites manuscripts for a special section on Sexual Orientation Across the Life Span, to be compiled by Guest Editors Charlotte J. Patterson and Ritch C. Savin-Williams, working together with journal Associate Editor Suniya S. Luthar. The goal of the special section is to highlight high-quality recent research on the role of sexual orientation in human development. Topics might include, but are not limited to, (a) development of sexual orientation; (b) sexual orientation and parenting; (c) sexual orientation in biological, social, and cultural contexts; and (d) the impact of sexual orientation on personal, social, familial, occupational, and other aspects of lives over time. Especially welcomed are papers that report the results of longitudinal research, studies that involve participants with multiple minority identities (e.g., minority ethnic, racial, or religious identities, as well as minority sexual identities), and research on understudied groups such as those with bisexual or transgendered identities. The submission of recently completed doctoral disserta- tions is also encouraged. The submission deadline is September 1, 2006. The main text of each manuscript, exclusive of
  • 100. figures, tables, references, and/or appendices, should not exceed 20 double-spaced pages (approx- imately 5,000 words). Initial inquiries regarding the special section may be sent to Charlotte J. Patterson at [email protected] or to Ritch C. Savin-Williams at [email protected] Manuscripts must be submitted electronically through the Manuscript Submission Portal of Developmental Psychology at http://www.apa.org/journals/dev.html and a hard copy sent to Cynthia Garcı́a Coll, Editor, Developmental Psychology, Center for the Study of Human Development, Brown Univer- sity, Box 1831, Providence RI 02912. Please be sure to specify in the cover letter that your submission is intended for the special section. For instructions to authors and other detailed submission information, see the journal Web site at http://www.apa.org/journals/dev.html 697REACTIVITY AND REGULATION TABLE 5.2 | Categories of Marginally Ethical Negotiating Tactics Category Example Traditional competitive Not disclosing your walkaway; making an inflated opening offer bargaining Emotional manipulation Faking anger, fear, disappointment; faking elation, satisfaction Misrepresentation Distorting information or
  • 101. negotiation events in describing them to others Misrepresentation to Corrupting your opponent’s reputation with his or her peers opponent’s networks Inappropriate information Bribery, infiltration, spying, etc. gathering Bluffing Insincere threats or promises Exercise 23 SALARY NEGOTIATIONS NEGOTIATION 7e LEWICKI ▪ BARRY ▪ SAUNDERS Confidential Role