Published online June 9, 2008
PEDIATRICS Vol. 122 No. 1 July 2008, pp. e83-e91 (doi:10.1542/peds.2007-2826)
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ARTICLE

Effects of Prenatal Cocaine Exposure on Special Education in School-Aged Children

Todd P. Levine, MDa, Jing Liu, PhDa, Abhik Das, PhDb, Barry Lester, PhDa, Linda Lagasse, PhDa, Seetha Shankaran, MDc, Henrietta S. Bada, MDd, Charles R. Bauer, MDe and Rosemary Higgins, MDf

a Department of Pediatrics, Warren Alpert Medical School, Brown University, Providence, Rhode Island
b Research Triangle Institute International, Research Triangle Park, North Carolina
c Department of Pediatrics, Wayne State University School of Medicine, Detroit, Michigan
d Department of Pediatrics, University of Kentucky College of Medicine, Lexington, Kentucky
e Department of Pediatrics, University of Miami School of Medicine, Miami, Florida
f National Institute of Child Health and Human Development, Bethesda, Maryland

OBJECTIVE. The objective of this study was to evaluate the effects of prenatal cocaine exposure on special education at age 7 with adjustment for covariates.

METHODS. As part of the prospective, longitudinal, multisite study of children with prenatal cocaine exposure (Maternal Lifestyle Study), school records were reviewed for 943 children at 7 years to determine involvement in special education outcomes: (1) individualized education plan; (2) special education conditions; (3) support services; (4) special education classes; and (5) speech and language services. Logistic regression was used to examine the effect of prenatal cocaine exposure on these outcomes with environmental, maternal, and infant medical variables as covariates, as well as with and without low child IQ.

RESULTS. Complete data for each analysis model were available for 737 to 916 children. When controlling for covariates including low child IQ, prenatal cocaine exposure had a significant effect on individualized education plan. When low child IQ was not included in the model, prenatal cocaine exposure had a significant effect on support services. Male gender, low birth weight, white race, and low child IQ also predicted individualized education plan. Low birth weight and low child IQ were significant in all models. White race was also significant in speech and language services. Other covariate effects were model specific. When included in the models, low child IQ accounted for more of the variance and changed the significance of other covariates.

CONCLUSIONS. Prenatal cocaine exposure increased the likelihood of receiving an individualized education plan and support services, with adjustment for covariates. Low birth weight and low child IQ increased the likelihood of all outcomes. The finding that white children were more likely to get an individualized education plan and speech and language services could indicate a greater advantage in getting educational resources for this population.

Key Words: prenatal exposure • cocaine • education • schools

Abbreviations: PCE—prenatal cocaine exposure • SES—socioeconomic status • MISU—Maternal Interview of Substance Use • HOME—Home Observation for Measurement of the Environment • IEP—individualized education plan • SE—special education conditions • SEC—special education classes • SS—support services • SLS—speech and language services • LBW—low birth weight

Accepted Feb 20, 2008.