1. This study examined the relationship between prenatal cocaine exposure, respiratory sinus arrhythmia measurements from infancy to kindergarten, and behavioral problems at age 7 using a longitudinal data set of 153 mother-child dyads. 2. The results showed that gender moderated the relationship between prenatal cocaine exposure and behavioral problems, with exposed girls having significantly higher internalizing, externalizing, and total behavioral problems compared to other groups. Exposed boys had the lowest scores. 3. Additional factors like maternal sensitivity, parenting behaviors, and exposure to violence did not moderate the relationship between prenatal cocaine exposure and behavioral problems. The findings suggest girls may be more susceptible to behavioral effects of prenatal cocaine exposure.

1. INTRODUCTION
Prenatal Cocaine Exposure, Respiratory Sinus Arrhythmia, and
Subsequent Behavioral Problems by Age 7
Vanessa McNeill
Department of Psychology
METHODS
ACKNOWLEDGMENTS
DISCUSSION
Advisor: Dr. Brent Finger, Professor of Psychology, MSU-Billings
Thank you to Dr. Rina Eiden at the Research Institute on Addictions, Buffalo,
NY. for providing this dataset!
A sample of mother-child dyads (n=153) participated in a longitudinal
study of prenatal cocaine exposure. The sample consisted of 81
cocaine exposed children and 72 carefully matched comparison
subjects. Respiratory Sinus Arrhythmias taken at six epochs between
infancy and kindergarten indicated a correlation with baseline RSAs
and cocaine exposure. Correlations were also found between prenatal
cocaine exposure, base RSAs between infancy and kindergarten, and
behavior problems at age seven. Using multivariate analyses, the
Child Behavior Checklist scale for total behavior problems showed
only child gender moderated the relation between cocaine exposure
and behavior problems, (F (3, 149) = 10.86, p = .001). Cocaine
exposed girls were the highest group in the cohort for internalizing,
externalizing, and total behavior problems, while cocaine exposed
boys displayed the lowest internalizing, externalizing, and total
behavior problem scores. Maternal sensitivity, parenting behaviors,
paternal involvement, and exposure to violence were not found to
moderate the relation between cocaine exposure and behavior
problems. Findings suggest that girls may be more susceptible to the
behavioral effects of prenatal cocaine exposure.
RESULTS
This study examined a longitudinal data-set collected by the Research
Institute on Addictions in Buffalo, New York.
Data Analytic Approach
• Multivariate analysis was conducted with SPSS to examine
previously collected data (from birth to kindergarten) and
compared with behavior outcome variables collected in second
grade.
• The Child Behavior Checklist (CBCL) was used to assess
behavior problems. Analyses focused on internalizing,
externalizing, and total behavior problem scores.
• Two-factor ANOVAs were used to assess variables that may
moderate the relationship between PCE and BP.
• Moderating variables included gender, maternal sensitivity, foster
home placement, discipline, father involvement, and exposure to
violence.
• All variables were dichotomized by mean scores for the purpose of
data analysis except for cocaine exposure which was
trichotomized to identify differences between light vs. heavy
exposure.
• RSA measures were compared by controls, light cocaine exposure
(PCE Light) and heavy cocaine exposure (PCE Heavy).
CBCL scores were analyzed using two-way ANOVAs to examine
behavior problems by group status and by gender. Internalizing and
externalizing behavior problems as the dependent measures indicated
an association between PCE, gender, and behavior problems. PCE
girls had significantly higher scores, indicating more behavior
problems. Using the total score from the Child Behavior Checklist
ratings produced a statistically significant interactive effect of cocaine
exposure by gender, (F (3, 149) = 10.86, p = .001). Cocaine exposed
girls were higher for internalizing (F (3, 149) = 13.08, p = .000) and
externalizing (F (3, 149) = 7.21, p = .008), than the rest of the cohort,
while cocaine exposed boys displayed lower internalizing,
externalizing, and total behavior problems than the cohort.
A second analysis was then done using trichotomized PCE status
(heavy exposure (N= 41, M=25.23), light exposure (N=40, M=31.14),
and no exposure (N =72, M=27.50) to isolate whether levels of cocaine
exposure effected CBCL outcomes. Girls exposed prenatally to
cocaine had statistically significant behavior problems in the CBCL
total (M=29.60, sd=20.90), externalizing (M=10.60, sd=7.75), and
internalizing (M=10.59, sd=7.87) scores. Conversely, boys exposed
prenatally to cocaine had the lowest CBCL total (M=26.81, sd=21.45),
externalizing (M=10.60, sd=8.47), and internalizing scores (M=7.19,
sd=7.01).
Prenatal Cocaine Exposure
Extensive research has examined prenatal cocaine exposure (PCE)
and how this exposure is moderated by multiple variables which effect
behavioral outcomes including internalizing and externalizing
behavior problems. (Mayes & Bornstein, 1995; Schuetze, Eiden, &
Danielewicz, 2009).
Respiratory Sinus Arrhythmia
Respiratory Sinus Arrhythmia (RSA) is a widely discussed
physiological regulation index within the developmental literature. RSA
is a measure of variability in heart rate that occurs at the frequency of
respiration and is believed to provide an index of parasympathetic
influence on cardiac output.
RSA withdrawal during periods of environmental challenges is believed
to reflect one’s ability to appropriately engage or disengage with the
environment (Bornstein & Suess, 2000; Porges, 1996). Thus, the
measurement of change in RSA from baseline to challenging situation
is an important index of parasympathetic regulation.
Behavior Problems
A well-known distinction in the field of child psychology and psychiatry
is the distinction between “externalizing” and “internalizing” disorders
(Achenbach, 1978). The construct of externalizing behavior problems
refers to a grouping of behavior problems that are manifested in
children’s outward behavior and reflect the child negatively acting on
the external environment (Campbell, Shaw, & Gilliom, 2000; Eisenberg
et al., 2001).
Demographics Control Group
(n=72)
Cocaine Group
(n=81)
M SD M SD
Cocaine per
week
0 0 .70 1.38
Cigarettes per
week
8.92 19.18 38.70 44.17
Standard drinks
per week
.14 .65 5.37 13.72
Binge drinking
episodes per
week
.02 .10 .48 1.39
Joints per week 1.13 6.24 1.08 2.69
Primary Caregiver
demographics by 2nd Grade
Caregiver Age
Cocaine per
week
0 0 3.34 .70
Cigarettes per
week
18.23 31.1
6
31.09 40.02
Standard drinks
per week
.72 1.34 2.68 9.84
Binge drinking
episodes per
week
2.91 11.0
8
1.35 6.74
Table 1 Maternal demographic characteristics by cocaine status.
1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11
.
1. Group
status
2. Gender -.039
3. BRSA 7M -.222** .060
4. BRSA 36M -.090 .067 -.041
5. BRSA 60M .168* .039 .082 .512**
6. RSA-F 7M .184* -.217* -.395** -.091 -.104
7. RSA-F 36M -.002 .050 .037 .549** .259* -.054
8. RSA-F 60M .119 .048 .153 .351** .781** -.071 .127
9. RSA-R 7M -.070 .089 .542** .159 .120 .087 .061 .251**
10. RSA-R
36M
-.007 .103 .165 .574** .241* .224* .886** .191 .430**
11. RSA-R
60M
.088 .100 .225* .254* .633** -.041 .157 .897** .357** .402**
Table 2. Correlations among RSA, PCE group status, and gender.
1. 2. 3. 4. 5. 6. 7. 8.
1. Group
status
2. Gender -.015
3. BRSA 1M -.239** .012
4. BRSA 13M -.197* -.062 .020
5. BRSA
36M
-.107 .111 .267* .152
6. BRSA
60M
.169 .042 .100 .026 .523**
7. CBCL
Internalizing
.040 .146 .013 .159 -.011 -074
8. CBCL
Externalizing
.020 .000 .099 .195* .106 -.039 .710**
9. CBCL Total
score
.015 .066 .055 .213* .054 -.088 .921** .902**
Table 3. Correlations between group status, gender, BRSA, and behavior problem.
In contrast, children may develop internalizing behavior problems such
as withdrawn, anxious, inhibited, and depressed behaviors, problems
that more centrally affect the child’s internal psychological environment
rather than the external world.
“It is a grave mistake to believe that children with emotional disorders that result primarily in internalizing behaviors have only
mild and transient problems. The severe anxiety and mood disorders experienced by some children not only cause pervasive
impairments in their educational performance—they also threaten their very existence. Indeed, without identification and effective
treatment, the extreme emotional disorders of some children can lead to self-inflicted injury or even death from substance abuse,
starvation, or suicidal behavior.”
http://www.education.com/reference/article/children-emotional-behavioral-disorders/
Our results indicate that gender moderates the association between
prenatal cocaine exposure and behavior problems among school-age
children such that prenatally exposed girls are particularly vulnerable to
such problems. Additional variables including maternal sensitivity,
foster home placement, discipline, paternal involvement, and exposure
to violence were not found to moderate the relationship between
exposure and behavior problems by second grade.
Strong correlations across time demonstrate a pattern of consistency in the
RSA scores over time. There are significant correlations between group status
(PCE v. Controls) and RSA (See Table 2 and Table 3), and one significant
correlation between RSA and gender (See Table 2).
Longitudinal RSA - Prenatal Cocaine Exposure v. Controls
0
0.02
0.04
0.06
0.08
0.1
0.12
0.14
1M 7M 13M 36M 48M 60M
BRSA Longitudinal Comparison
PCE BRSA CTRL BRSA
0
0.02
0.04
0.06
0.08
0.1
0.12
0.14
1M 7M 13M 36M 48M 60M
RSA-Frustration Longitudinal
Comparison
PCE RSA-F CTRL RSA-F
-0.02
0
0.02
0.04
0.06
0.08
0.1
0.12
1M 7M 13M 36M 48M 60M
RSA-Recovery/Regulation
Longitudinal Comparison
PCE RSA-R CTRL RSA-R
Longitudinal RSA - by Gender
0
0.02
0.04
0.06
0.08
0.1
0.12
0.14
1M 7M 13M 36M 48M 60M
Baseline RSA
PCE Girls PCE Boys
0
0.02
0.04
0.06
0.08
0.1
0.12
1M 7M 13M 36M 48M 60M
RSA-Frustration
PCE Girls PCE Boys
-0.02
0
0.02
0.04
0.06
0.08
0.1
0.12
1M 7M 13M 36M 48M 60M
RSA-Recovery/Regulation
PCE Girls PCE Boys
Moderators
Parental conflict. Parents play a critical role in helping children
manage their arousal by reading their child’s emotional signals and
responding appropriately (Schuetze, Molnar, & Eiden, 2012). Children
respond to marital conflict with emotional and behavioral dysregulation
rather than imitation. (Cummings, Iannoti, & Zahn-Waxler, 1985). They
experience intense distress in the absence of adequate parental
responsiveness (Finger, Hans, Bernstein, & Cox, 2009). There has
been some evidence suggesting that mothers have greater influence
on children’s internalizing behavior, whereas fathers’ influence is
greater for externalizing behavior (Cowan, Cowan, Schulz, & Heming,
1994) . Regardless, marital discord increases distress in children. In
extremes, parental conflict has the capacity to expose children to a
disorganizing effect of “fright without solution” (Finger, Hans, Bernstein,
& Cox, 2009).
Maternal negative affect. Cocaine using mothers reportedly have
higher negative affect (Schuetze, Molnar, & Eiden, 2012). For the first
36 months, the cohort in this study demonstrated that high maternal
negative affect significantly moderated the association between high
BRSA and behavior problems, but not maternal sensitivity nor maternal
warmth (Finger, Scheutze, & Eiden, 2014); though, high maternal
sensitivity and maternal warmth did buffer the association between
violence exposure and behavior problems whereas high maternal
harshness exacerbated this association. (Veira, et al., 2014)
Exposure to violence. Aggressive behavior has been predicted in 5-
to 8-year-old as well as 9- to 12-year-old children based on levels of
exposure to community violence (Guerra, Huesmann, & Spindler, 2003)
By kindergarten, the cohort in this study demonstrated that exposure to
violence in kindergarten was significantly associated with higher
behavior problems.
The mean age of the primary
caregivers by 2nd grade was
30.87 (SD=8.73), they were
predominantly African
American (72%), and single
(82.2%).
* p < .05. ** p < .01.
* p < .05. ** p < .01. p < .001