Expressive and receptive language functioning in preschool children with prenatal cocaine exposure

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