Pasadena City College Psychology Essay

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While the field of psychology is about how we behave, think and feel, and so might seem like common sense, it is in fact a science.  Sharing information about scientific ideas is done mainly through peer reviewed scholarly articles published in academic journals.  The purpose of these reading assignments is to familiarize you with scientific writing – being able to read and understand what a scholarly article is.  There are different kinds of articles – empirical or literature review – and then different parts of each kind. 
In this first assignment, I have provided you with an article, and you need to identify what type of article it is, then answer the questions pertaining to that type of article in our assignment.  Make sure that you are answering every question in detail (you can see how many points each is worth by clicking on the three dots on the top of this assignment to reveal the rubric I use).
For the article on Teratology Download Teratologyplease answer the following questions in complete sentences.  It is best that you answer completely in your own words.  You may quote the authors’ exact words, but if you do so, remember to put the information in quotation marks.  This assignment is due inside canvas on Sept 26.
For all articles:
What is the article about in general?  (Look at the title, abstract and, of course, the entire paper)
Is this article an empirical study or a literature review?
For empirical studies
What is the hypothesis?
What is the research design? 
Is it an experimental, quasi experimental, or correlational design?
If it is a developmental question, is it longitudinal, cross sectional or sequential design?
What were the methods used? How was the study performed? With whom?
What are the findings of the study?
What are the limitations?

For literature review
What did you know about this topic from the text/lecture/course information to begin with?

What is the main purpose of the review?
What did they find?
For all articles

How does all of this fit with your knowledge of the course?  Does it enhance what you know?  Does it conflict? Is it tangential (meaning not really/only marginally related)?Journal of Child Psychology and Psychiatry 48:8 (2007), pp 773–784
doi:10.1111/j.1469-7610.2007.01745.x
The contribution of fetal drug exposure
to temperament: potential teratogenic effects
on neuropsychiatric risk
Sandra J. Weiss,1 Mary St. Jonn-Seed,2 and Carolyn Harris-Muchell1
1
Department of Community Health Systems, University of California, San Francisco, USA; 2Department
of Community and Mental Health Nursing, University of San Francisco, USA
Background: Preliminary evidence indicates that fetal drug exposure may be associated with alterations in temperament. However, studies often do not dissociate the potential effects of drug exposure
from other perinatal or environmental factors that could influence temperament phenotypes.
Methods: High risk children (n ¼ 120) were followed from birth to 6 months of age to determine the
effects of fetal drug exposure on temperament, after controlling for the child’s gender, gestational age,
medical morbidity, ethnicity, and maltreatment as well as the mother’s stress, income adequacy, and
quality of caregiving. Methods included medical chart review, questionnaires, and videotapes of mother–
child interaction. Results: Preliminary analyses indicated that fetal drug exposure was associated with
both distractibility and intensity of children’s responses to the environment at 6 months of age. After
adjusting for potentially confounding variables, drug exposure accounted for 12% of the variance in
distractibility but was not a significant predictor in the regression model for intensity. Conclusions: Findings suggest that drug-exposed children may experience difficulty sustaining
their focus of attention and be more easily distracted by environmental stimuli than non-drug-exposed
children. Results converge with previous research to implicate cortical hyperarousal, stemming from
teratogenic effects on the dopaminergic system during fetal development. Keywords: Fetal drug
exposure, temperament, arousal regulation, distractibility.
There is a high incidence of psychiatric problems
among children who are exposed to drugs in utero
(Chasnoff et al., 1998; Delaney-Black et al., 2000;
Linares et al., 2006). One of the earliest markers of
later psychiatric risk may be the nature of the child’s
temperament during the first year of life (Frick,
2004; Saudino, 2005). There is evidence of the link
between childhood temperament and a variety of
internalizing and externalizing disorders (Crockenberg & Leerkes, 2006; Fox, Henderson, Marshall,
Nichols, & Ghera, 2005; Leve, Kim, & Pears, 2005:
Mervielde, De Clercq, De Fruyt, & Van Leeuwen,
2005; Neal & Edelmann, 2003; Rubin et al., 2003) as
well as cognitive outcomes (Blair, 2002; Robinson &
Acevedo, 2001).
Studies indicate that drug-exposed children may
differ from non-drug-exposed children in temperament. Poor self- and emotional regulation, higher
arousal, over-reactivity, and excitability have all
been identified in cocaine–exposed infants (Bard et
al., 2000; Keller & Snyder-Keller, 2000; Lester et al.,
2002; Moliter, Mayes, & Ward, 2003; Schuler & Nair,
1999). Prenatal exposure to cocaine has been related
to problems with sustained attention and distractibility during early childhood years (Bandstra,
Morrow, Anthony, Accornero, & Fried, 2001; Heffelfinger
Conflict of interest statement: No conflicts declared.
et al., 2002; Savage et al., 2005), with continuing
evidence of deficits in the ability to sustain attention
for school aged children of mothers reporting light to
moderate cocaine use during pregnancy (Richardson, Conroy, & Day, 1996).
Although the effects of opiate exposure have received less attention, research has demonstrated
higher levels of arousal, greater stress reactivity, and
poorer consolability in opiate–exposed infants than
for infants not exposed (Hans, 1992; Lester et al.,
2002). School aged children with prenatal opiate
exposure have shown attention problems and
impulsivity (Suess, Newlin, & Porges, 1997).
Toddlers who were exposed to marijuana in utero
appear less socially engaged and more fearful than
non-exposed toddlers (Faden & Graubard, 2000).
Studies also suggest that these children have greater
inattention and impulsivity at 6 years of age (Leech
et al., 1999) as well as diminished attention span
and poor impulse control as adolescents (Fried &
Watkinson, 2001). In addition, deficits in attention,
impulse control, and distractibility have been found
for children prenatally exposed to alcohol (Chiriboga,
2003; Riley & McGee, 2005). Alcohol exposure also
predicts problems in affect regulation at 7 months of
age (Eiden, Lewis, Croff, & Young, 2002).
Studies of infants with polydrug exposure have
identified both greater reactivity and lower levels of
Ó 2007 The Authors
Journal compilation Ó 2007 Association for Child and Adolescent Mental Health.
Published by Blackwell Publishing, 9600 Garsington Road, Oxford OX4 2DQ, UK and 350 Main Street, Malden, MA 02148, USA
774
Sandra J. Weiss, Mary St. Jonn-Seed, and Carolyn Harris-Muchell
reactivity than for non-drug-exposed infants (Lewis
& Weiss, 2003). Lester and colleagues (2002) noted
similar profiles for cocaine-exposed infants, whereby
some infants were excitable and highly aroused
while others were lethargic and ‘depressed’. Other
research with polydrug-exposed infants has found
that fetal exposure more commonly predicts greater
reactivity, as evidenced by increased fussiness,
irritability, inconsolability, problems regulating state
changes, startle responses, increased heart rate and
respiration, and hyperactivity (Brown et al., 1998;
Higley & Morin, 2004; Weiss & Wilson, 2006). In a
large study that examined differential effects of
substances, investigators found that increased
reactivity to stimuli was present in one-month-old
infants exposed to a variety of distinct substances,
including cocaine, opiates, alcohol, and marijuana
(Lester et al., 2002).
Confounding much of previous research has been
a lack of control for factors that may influence infant
temperament. One such factor is the infant’s medical
risk. Drug exposure is often associated with premature birth and low birth weight (Datta-Bhutada,
Johnson, & Rosen, 1998; Lester et al., 2002). As a
result, it is difficult to distinguish the teratogenic
effects of drug exposure from those that may be
associated with medical problems experienced by
other high risk infants. Researchers have found
temperament differences in preterm and full term
infants, indicating that gestational age, lower birth
weight and more extensive perinatal complications
may result in infants being less adaptable, responsive, active and predictable and more distractible
(Honjo et al., 2002; Hughes, Shults, McGrath, &
Medoff-Cooper, 2002; Larroque, N’Guyen, Guedency,
Marchard, & Burguet, 2005; Weiss, St. Jonn-Seed, &
Wilson, 2004).
There is also evidence of the effects of other biologically driven factors such as gender of the child
and race/ethnicity. A recent meta-analysis of temperament in children from 3 to 13 years of age found
that girls were more likely to have greater inhibitory
control and perceptual sensitivity while boys were
more active and showed more high intensity pleasure (Else-Quest, Hyde, Goldsmith, & Van Hulle,
2006). In their first year of life, research has noted
that girls are more withdrawn, have less positive
mood, and are less active than boys (Kivijarvi, Raiha,
Virtanen, Lertola, & Piha, 2004). However, more
challenging temperament profiles have been noted
for boys than for girls at school age, including
characteristics such as low adaptability, intensity
and negative mood (McClowry, 2002). An early crosscultural study found differences among toddlers
from ethnic groups of various countries (Oberklaid,
Prior, Sanson, Sewell, & Kyrios, 1990). More recently, 6-month-old infants of Euro-American heritage were reported to be less intense and more
persistent than infants from other cultural groups
(Weiss et al., 2004). An additional study found that
Hispanic school aged children exhibited more challenging temperaments than children from other
cultural groups (McClowry, 2002).
The child’s evolving temperament may also be
influenced by factors in the environment (Gorman,
Lourie, & Choudhury, 2001). In a recent review,
Saudino (2005) noted that environmental variance in
temperament includes those influences that are
shared by family members such as parent education
and family socioeconomic status (SES) and those
that are specific to a child such as unique parental
treatment. Her analysis indicates little evidence of
any effect by shared environmental factors such as
SES but a strong effect of those factors specific to the
individual. However, some studies have found specific effects of factors such as parental education and
income on child temperament (McClowry, 2002;
Zimmermann & Stansbury, 2003).
During the first year of life, the infant–mother
relationship is a primary medium through which
environmental effects may occur. There is a considerable body of research suggesting that children with
fetal drug exposure receive less optimal care
(Blackwell, Kirkhart, Schmitt, & Kaiser, 1998;
Donohue, 2004; Singer, Hawkins, Huang, Davillier,
& Baley, 2001; Quinlivan & Evans, 2005) and are
more likely to require oversight of child protective
services due to neglect or abuse (Byrd, Neistadt,
Howard, Brownstein-Evans, & Weitzman, 1999;
Smith & Test, 2002). Maltreatment and maternal
hostility have been linked to more challenging temperaments in children (Bagley & Mallick, 2000;
Harrington, Black, Starr, & Dubowitz, 1998; St.
Jonn-Seed & Weiss, 2002). In contrast, there is evidence that maternal responsiveness is associated
with decreased reactivity and less challenging temperaments in children (Black et al., 2004; Jahromi,
Putnam, & Stifter, 2004; Kochanska, Friesenborg,
Lange, Martel, & Kochanska, 2004). Maternal sensitivity appears also to predict less activity, withdrawal, negative emotionality and stress reactivity in
infants (Hane & Fox, 2006; Kivijarvi et al., 2005;
Pauli-Pott, Mertesacker, & Beckmann, 2004). Lastly,
maternal stress has been related to greater irritability, reactivity, attention deficits, negative affect
and distress to limitations in children (de Weerth,
van Hees, & Buitelaar, 2003; Huizink, de Medina,
Mulder, Visser, & Buitelaar, 2002; Sheinkopf et al.,
2006; Wadhwa, Sandman, & Garite, 2001).
The purpose of this study was to understand the
effects of drug exposure on a child’s temperament by
differentiating its effects from potentially confounding infant and environmental variables. We asked
the following research question: To what degree does
fetal drug exposure contribute to a child’s temperament at 6 months of age, after controlling for infant
variables of perinatal risk, ethnicity, and gender and
environmental variables of maltreatment, quality of
maternal caregiving, maternal stress, and socioeconomic status? Temperament was conceptualized
Ó 2007 The Authors
Journal compilation Ó 2007 Association for Child and Adolescent Mental Health.
Fetal drug exposure and temperament
as the child’s predisposition on 9 dimensions:
activity, rhythmicity, readiness to approach or engage, adaptability, intensity, mood, persistence,
distractibility, and sensory threshold.
Methods
Sample
The convenience sample included 120 infants and their
mothers who were part of a study on infants born prematurely. All infants were born prior to 37 weeks gestation and had a birth weight of 2500 grams or less. All
mothers whose infants met study criteria were approached for participation unless it was expected that
the infant would not survive, the infant had fragile X or
Down syndrome, or the mother was cognitively impaired. Families were recruited over a three-year period.
There was a 90% success rate in enrollment of those
recruited. From the original sample of 185, data pertinent to this secondary analysis were available from
142 families. From this group, two sets of infants were
selected. The first set consisted of infants whose
mothers had a negative toxicology screen and reported
no drug use of any kind during pregnancy, including
alcohol. The second set consisted of infants whose
mothers reported use of cocaine or opiates during
pregnancy or whose toxicology screen showed evidence
of these drugs. In the resulting sample (n ¼ 120), 75%
of the infants were not exposed to any substance (n ¼
90) and 25% were exposed to cocaine or opiates (n ¼
30). However, mothers who had used one or more of
these 2 drugs also used alcohol, marijuana, or other
drugs, exposing the infants to a variety of substances.
No infant was exposed to only one substance. Table 1
provides data on the percent of infants in the final
sample who were exposed to different substances.
Procedures
All study procedures were approved by the Committee
on Human Research Protection at University of California, San Francisco (UCSF). As part of the larger
study protocol, families were recruited during the infants’ first few weeks of life from the Neonatal Intensive
Care Units (NICUs) of 3 major teaching hospitals affiliated with UCSF. Two of the NICUs were sites of referral
from throughout northern California. The third NICU
was at a community hospital in the San Francisco Bay
Area. All hospitals followed a similar neurodevelopmental approach to care.
Table 1 Percent of mothers using specific classes of drugs
during their pregnancy
Alcohol
Amphetamines
Barbiturates
Cocaine
Marijuana
Methamphetamine
Opiates
N
%
23
12
11
20
12
7
10
76
40
36
66
40
23
33
Note: All mothers used more than 1 class of drug.
775
At recruitment, an informed consent was acquired
and the mother was given a demographic questionnaire
and a stress scale to complete. Medical records were
reviewed by a clinical nurse specialist to identify drug
exposure, gestational age, birth weight, and data related to the infant’s neonatal morbidity. When the child
was 3 months old (corrected for gestational age), a
home visit was made to collect data regarding the
quality of maternal caregiving. At this time, a research
assistant (RA) videotaped the mother and child during a
typical feeding. The videotapes of the feedings were
analyzed later for caregiving behavior, using a standardized protocol. The RA made a second home visit
when the infant was 6 months of age. The mother
completed two questionnaires during this visit: one to
measure dimensions of her child’s temperament and
another to assess potential child maltreatment.
Measures
Demographics. A demographic questionnaire provided data on infant gender and ethnicity, maternal
education, adequacy of family income and other descriptive information. Adequacy of income was measured by a score combining three items on the
questionnaire. The first item asked the degree to which
the family’s income was enough to cover the family’s
needs. This item was a five-point scale including 5) not
enough, 4) barely enough, 3) adequate but no extra to
spend, 2) adequate with some extra to spend, and 1)
more than adequate. The second and third items
acquired a yes or no response as to whether the
family had an income below the poverty level and was
homeless. The sum score for these three items was used
as the final score for adequacy of income.
Drug exposure. Drug exposure was determined by
chart review to identify evidence of a positive toxicology
screen as well as by maternal report. Part of the
standard protocol for a preterm delivery at each of the
hospitals was a urine toxicology screen. Some mothers
and infants had additional blood or meconium screens
if they reported drug use at admission. As part of the
intake process, mothers were asked whether they had
used alcohol or any other drugs during their pregnancy
and the type of substance. No information was available
on the time, amount or duration of use.
Infants were placed in the non-drug-exposed group if
mothers denied any drug use, including alcohol, and
had a negative screen for drug metabolites. Infants were
placed in the drug-exposed group if there was evidence
of a positive toxicology screen for opiates and/or cocaine or if mothers indicated they had used either of
these substances during their pregnancy. Infants
whose mothers reported only alcohol, amphetamines,
barbiturates, and/or marijuana use during pregnancy
or whose toxicology screen showed evidence only of
these drugs were not included in either group unless
they also used opiates and/or cocaine, in which case
they were placed in the drug-exposed group.
Neonatal morbidity. The Postnatal Complications
Scale (Littman & Parmelee, 1978) was used to measure
neonatal morbidity. A summary score was based on the
Ó 2007 The Authors
Journal compilation Ó 2007 Association for Child and Adolescent Mental Health.
776
Sandra J. Weiss, Mary St. Jonn-Seed, and Carolyn Harris-Muchell
number of medical risk factors for each infant from
among 10 key conditions and treatments. Risk data
were acquired primarily from chart review during the
first month postnatal, with supplemental input from
the infant’s primary nurse. Reliability and validity have
been demonstrated previously for the scale (Scott,
Bauer, Kraemer, & Tyson, 1997; Weiss, Wilson, &
Morrison, 2004; Weiss & Wilson, 2006; White-Traut,
Nelson, Silvestri, Patel, & Kilgallon, 1993).
Maternal stress. An 8-item stress scale was used to
assess the degree of a mother’s perceived stress in her
life from factors such as work, discrimination, family,
the infant’s illness, and caregiving responsibilities
(Weiss & Chen, 2002). The measure was developed
using items specific to culturally diverse mothers with
high risk infants. Each item was rated by the mother on
a 4-point scale from no stress to very, very much stress.
The alpha coefficients for internal consistency of the
items were .88 in the original study and .90 in this
study. The validity of the scale has been supported by
its negative association with a mother’s satisfaction,
family cohesion, and overall mental health status, and
its positive association with severity of a mother’s psychological symptoms and expressed emotion with her
child (St. Jonn-Seed & Weiss, 2005; Weiss & Chen,
2002).
Quality of caregiving. The Nursing Child Assessment
Feeding Scales (NCAFS) were used to measure the
quality of maternal caregiving (Sumner & Spietz, 1994).
Four subscales measure sensitivity to cues, responsiveness to distress, socioemotional growth fostering,
and cognitive growth fostering as observed in mother–
child interaction. These subscales were combined to
yield the total caregiving score used in this study. The
NCAFS consists of binary items which are summed;
larger scores indicate more optimal caregiving. The
measure has established normative data and has
shown internal consistency and test–retest reliability as
well as construct, concurrent and predictive validity
(Kelly & Barnard, 2000; Shonkoff, Hauser-Cram,
Krauss, & Upshur, 1992; Sumner & Spietz, 1994). A
research assistant was trained and certified as reliable
in use of the NCAFS by the University of Washington
site where the scales were developed. This individual
coded the entire videotape of each feeding situation,
blind to any other information about the mother–child
pairs.
Maltreatment of the child. The Parental Acceptance–
Rejection Questionnaire (PARQ) was used to measure
the degree of a mother’s maltreatment of her child
(Rohner, 1991). This measure is a 60-item parental selfreport tool regarding specific behavior toward the child.
Four subscales contribute to a total rejection/maltreatment score: lack of warmth/affection, aggression/
hostility, neglect/indifference and undifferentiated
rejection. Reliability and validity have been established,
along with cross-cultural validity and lack of social
desirability effects (Gorman, Leifer, & Grossman, 1993;
McGuire & Earls, 1993; Rohner, 1991; Weiss &
St. Jonn-Seed, 2002).
Temperament. The Revised Infant Temperament
Questionnaire is a 95-item scale that assesses nine
dimensions of temperament: 1) amount of activity, 2)
rhythmicity (the regularity of behavioral and physiologic functions), 3) approach versus withdrawal, 4)
adaptability, 5) intensity or strength of expressiveness,
6) negative versus positive mood, 7) persistence with a
task or activity, 8) distractibility by external stimuli,
and 9) threshold for sensations such as touch or light
(Carey & McDevitt, 1997). The internal consistency as
well as construct and predictive validity of the measure
have been supported (Carey & McDevitt, 1995; ClarkeStewart, Fitzpatrick, Allhusen, & Goldberg, 2000;
Seifer, Sameroff, Barrett, & Krafchuk, 1994).
Data analysis
A power analysis for this sub-study indicated that,
using an alpha of .05, a sample size of 120 provided a
power of .90 to detect a moderate effect size (i.e., R2 ¼
.13 for the magnitude of the association between drug
exposure and temperament). The power to detect a
small effect size (i.e., R2 ¼ .02) was .60. These analyses
included all dependent variables for which regressions
were performed in order to account for the effects of
more than one outcome variable on power. Preliminary
t-tests were computed to determine potential differences between the drug-exposed and non-drug-exposed
groups in all predictors with continuous scores.
Chi-square tests were computed to examine group differences on categorical variables. Missing data were
minimal and were handled by replacing missing values
with the group mean value on that variable, that is, the
mean for the drug- or non-drug-exposed group. Tests
for normality, linearity and homoscedasticity were
performed and these assumptions were supported.
There were no differences between drug-exposed and
non-drug-exposed infants in the variance for any independent or dependent variable. Multicollinearity
among independent variables was also examined. Tolerance statistics indicated that the variables of infant
birth weight and maternal education were too highly
related to other variables in the analysis. Birth weight
had a tolerance of .38, with especially strong relationships to gestational age and neonatal morbidity. Education had a tolerance of .57, with significant
associations to adequacy of income and quality of
maternal caregiving. Thus, birth weight and education
were not included in the final regression models to
avoid any artificial inflation of the predicted variance.
The tolerance of all other variables ranged from .77 to
.98. The tolerance for drug exposure was .94, indicating
a high level of unique variance that was not shared with
other predictors in the model. Preliminary t-tests were
calculated to determine any differences between drugand non-drug-exposed children on any of the 9 temperament dimensions. A regression model was then
computed for each temperament variable that showed a
significant difference between groups at p < .05. The final analysis employed a hierarchical approach for each regression model that was tested, whereby scores for gender, ethnicity, gestational age, and neonatal morbidity were entered at the first step. Quality of caregiving, inadequacy of income, maternal stress, and maltreatment of the infant were entered at the second Ó 2007 The Authors Journal compilation Ó 2007 Association for Child and Adolescent Mental Health. Fetal drug exposure and temperament step and group status for drug exposure was entered at the third and final step. In this way, the variance contributed by infant characteristics was extracted first and then the variance for environmental factors before testing the effects of drug exposure. Results As shown in Table 2, there were no differences between drug- and non-drug-exposed dyads in their mean scores for any continuous predictor variable. Half of the families in each group were living below the poverty level. The gender profile of infants in the two groups was also identical, with 44% female and 56% male. However, ethnicity did show a significant difference between groups (v2 ¼ 13.87, p < .02). There were more African-American infants and fewer Hispanic-American infants in the drug-exposed group (Table 3). There were differences between the means of the drug- and non-drug-exposed groups on two of the temperament variables. As shown in Table 2, drug-exposed infants had higher means for the intensity of their expressivity, t (118) ¼ 2.38, p ¼ .02 and for distractibility, t (118) ¼ 2.55, p ¼ .01. Based on these preliminary analyses, regression equations 777 were computed for the temperament variables of distractibility and intensity. The regression model for distractibility was significant (F(9,110) ¼ 2.14, p < .03), with the variables in Step 1 accounting for 2% of the variance, those in Step 2 accounting for 4% of the variance, and drug exposure contributing 12% to the variance in distractibility. As shown by the beta coefficients in Table 4, maltreatment was a significant predictor of the likelihood of greater distractibility in children. However, fetal drug exposure accounted for most of the identified variance in distractibility, with drugexposed children more likely to be distracted by objects or events in the environment. The regression model for intensity of a child’s behavior and feelings was not significant (F(9,110) ¼ 1.75, p < .09). The beta coefficients in Table 5 indicate that ethnicity was the only significant predictor of intensity. Post hoc contrasts using Tukey’s HSD test indicated that Euro-American infants (M ¼ 3.87) were significantly less likely to react to their environments with an impassioned, uninhibited manner of expression than were African-American infants (M ¼ 4.23, p < .05). Drug exposure accounted for 2% of the variance in an infant’s intensity of expression but was not a significant predictor. Table 2 Group means for scores on study variables Drug-exposed M SD Non-drug-exposed M Table 4 Results of hierarchical regression analysis for the child’s distractibility SD Beta Child temperament Highly active 4.48 .51 4.31 .56 Arrythmic 3.88 .88 3.87 .58 Withdrawn 3.64 .49 3.43 .70 Nonadaptive 3.80 .71 3.61 .67 Negative in mood 3.92 .81 3.87 .62 Intense 4.36* .86 4.00* .65 Non persistent 3.96 .61 3.90 .82 Distractible 4.24** .60 3.87** .67 Low in threshold 3.92 .64 3.72 .61 Infant perinatal risk Gestational age 31.4 3.84 31.9 3.50 Birth weight (g) 1612 599 1690 538 Neonatal morbidity 3.90 2.06 4.26 2.34 Environmental factors Maternal education 11.75 3.57 12.06 4.07 Income adequacy 2.29 .98 2.86 .95 Quality of care 42.48 4.25 43.19 4.56 Maltreatment 85.28 11.29 84.18 10.58 Step 1 – Infant characteristics Gestational age .06 Gender ).16 Neonatal morbidity .04 Ethnicity .00 Step 2 – Environmental factors Quality of caregiving .15 Maltreatment of the child .21* Maternal stress ).01 Adequacy of income .08 Step 3 – Fetal drug exposure .36** African-American Asian-American Euro-American Hispanic-American Native-American Non-drug-exposed (n ¼ 90) 50 3 34 13 0 15 6 39 36 4 F .02 .13 .03 .14 .02 .39 .02 .01 .02 .06 .17 .06 .66 .18 2.14 Table 5 Results of hierarchical regression analysis for the child’s intensity of behavior and emotional expression Beta Drug-exposed (n ¼ 30) R2 Note: *p < .05; **p < .001. Note: *p < .05; **p < .01. Table 3 Percent of drug- and non-drug-exposed children in each ethnic group SE Step 1– Infant characteristics Gestational age ).11 Gender .00 Neonatal morbidity .07 Ethnicity .35* Step 2 – Environmental factors Quality of caregiving .18 Maltreatment of the child .02 Maternal stress .04 Adequacy of family income .05 Step 3 – Fetal drug exposure .15 Note: *p < .01. Ó 2007 The Authors Journal compilation Ó 2007 Association for Child and Adolescent Mental Health. SE R2 F .02 .13 .03 .15 .10 2.68 .02 .01 .02 .06 .18 .13 1.67 .15 1.75 778 Sandra J. Weiss, Mary St. Jonn-Seed, and Carolyn Harris-Muchell Discussion Overall, our results suggest that fetal drug exposure had a very circumscribed effect on a child’s temperament at 6 months of age. Drug exposure was associated only with a child’s distractibility, but accounted for a notable, moderate effect size as defined by Cohen (1987). This dimension of temperament has received strong support from previous studies in which increased distractibility and deficits in the ability to sustain attention have been found for infants, preschool and young school aged children exposed to cocaine prenatally (Bandstra et al., 2001; Coles et al., 1999; Garavan et al., 2000; Heffelfinger et al., 2002; Karmel & Gardner, 1996; Leech et al., 1999; Mayes, Grillon, Granger, & Schottenfeld, 1998; Noland et al., 2005; Nulman et al., 2001; Richardson et al., 1996; Savage et al., 2005; Singer et al., 2004). Similar difficulties with distractibility and attention have been noted for children exposed to marijuana (Fried & Smith, 2001; Fried & Watkinson, 2001; Goldschmidt et al., 2000; Leech et al., 1999; Noland et al, 2005), to opiates (Suess, Newlin & Porges, 1997), to alcohol (Burden, Jacobson, Sokol, & Jacobson, 2005; Kable & Coles, 2004; Lee, Mattson, & Riley, 2004), and to polydrug use (Butz, Pulsifer, Leppert, Rimrodt, & Belcher, 2003). Animal research provides additional evidence of attention deficits, increased reactivity, and a persistent hyperattentive response to novel stimuli in offspring who have prenatal exposure to cocaine and alcohol (Foltz et al., 2004; He, Bai, Champoux, Suomi, & Lidow, 2004; Schneider et al., 2002), with enduring effects into adulthood (Gendle et al., 2003, 2004; Hausknecht et al., 2005; Mactutus, 1999; Morgan et al., 2002). Results of these various studies suggest that distractibility and problems sustaining attention may occur from exposure to cocaine, opiates, alcohol or marijuana rather than being unique effects of any one type of substance. with diminished inhibition and augmented excitation of the nervous system. The frontal striatal system of the brain has primary responsibility for inhibitory control of stimuli and regulation of attention (Botvinick et al., 2001; Casey, Giedd, & Thomas, 2002; Noland et al., 2005; Roberts et al., 2004). Previous research suggests that the striatal system is altered as a result of cocaine exposure (Garavan et al., 2000; Gendle et al., 2004). In a meta analysis, Glatt and colleagues (2000) noted that prenatal cocaine exposure appeared primarily to produce a down-regulation of the nigrostriatal dopamine system, including decreased dopamine receptors in both infants and adults and an overall decrease in striatal dopamine levels. Dopamine acts on its receptors to modulate excitatory and inhibitory processes that play an important regulatory role in attention (Silvers et al., 2006). This regulatory role is central to information processing by adjusting the signal to noise ratio across sensory systems (Gilman & Newman, 2003). Substantial evidence for both cocaine and alcohol suggests that they alter dopamine neurotransmitter levels during gestation which then affects structural organization of the brain during development (Choi et al., 1998; Lester et al., 2003; Lidow, 2003; Mayes, 2002, 2003; Stanwood & Levitt, 2004; Zhou, Sari, & Powrozek, 2005). Research using animal models indicates that an increase in extracellular dopamine levels during sensitive growth periods during gestation may decrease neuronal proliferation, axonal arborization, transporter levels, and synaptic connectivity in the dopaminergic system (Glatt et al., 2004; Silvers et al., 2006). Thus, abnormalities in distractibility and attention observed in children exposed to alcohol, marijuana, opiates, and cocaine may be influenced by long-lasting changes in the function of dopamine neurons (Singer et al., 2002), including alterations in transporter protein levels and signaling in the striatum (Choong & Shen, 2004; Fang & Ronnekleiv, 1999; Salvatore et al., 2004). Potential mechanisms underlying distractibility Higher distractibility in drug-exposed children may be a behavioral indicator of difficulties with the cortical regulation of arousal and excitation in response to stimulation. Mayes (2002) views arousal regulation as a gating mechanism that serves to enhance orientation and attention to the environment but also to protect the brain from excessive environmental stimulation. Under optimal conditions, development results in effective regulation of arousal, with a balance of inhibitory and excitatory processes that help the child modulate responses to the environment (Crowell et al., 2004; Strelau, 1995). High levels of distractibility in children have been associated with a pattern of brain activity that indicates involuntary shifting of attention to novel stimuli (Gumenyuk et al., 2001). Such a predisposition may imply ineffective regulation of arousal, Other factors influencing temperament Results of regression testing in this research indicate few relationships between the predictors studied and either intensity or distractibility at 6 months. Other studies also have found that environmental risk factors, including socioeconomic status, education, maternal behavior, and maternal stress, have no significant effect on child temperament (Austin, Hadzi-Pavlovic, Leader, Saint, & Parker, 2005; Larroque et al., 2005; Noland et al., 2005). Similarly, gender (Larroque et al., 2005; Weiss et al., 2004) and perinatal biological risks (Austin et al., 2005; Eckerman et al., 1999; Weiss et al., 2004) have shown minimal effects on temperament in some studies. However, replication with a larger sample of drugexposed children is essential to determine the stability of our findings. In addition, some of the Ó 2007 The Authors Journal compilation Ó 2007 Association for Child and Adolescent Mental Health. Fetal drug exposure and temperament factors we examined may be delayed in their effect and expressed later in development. Still, our findings suggest that factors we did not examine may be more critical in determining a child’s temperament. The genetic basis of temperament was not examined in this study and there is growing evidence of the influence of specific polymorphisms on temperament (Gonda et al., 2006; Kim, Kim, Lee, Kim, & Kim, 2006). Of relevance to distractibility are studies that have found significant associations between a dopamine transporter gene and childhood attention deficit hyperactivity disorder (ADHD; Brookes et al. 2006; Kahn, Khoury, Nichols, & Lanphear, 2003). These researches also have identified interactions of this gene with maternal substance use during pregnancy in predicting childhood risk for ADHD in children. Because we didn’t control for genetic factors in the study reported here, it is possible that our measure of drug exposure reflects some aspect of a genetic contribution. Clearly, the links between genetic profiles and specific temperament traits are an important area of future inquiry. Other medical factors such as the child’s status regarding HIV exposure, infant malnourishment, or intrauterine growth restriction also must be considered. Lastly, the nature of the family’s dynamics, including domestic violence, ongoing drug use by parents, or other characteristics of the home environment will likely play a role. Our results did show a significant contribution of maltreatment to distractibility in children. Maltreated children could become more vigilant and responsive to stimuli in their environments because of concerns regarding their emotional or physical well being. Increased attention to environmental cues may serve as a successful strategy for selfprotection but with detrimental effects on their ability to sustain attention to ongoing tasks that are important for adaptation in general. Conclusions After controlling for a number of important confounds, drug exposure accounted for 12% of the variance in a child’s likelihood of distractibility at 6 months of age. Research suggests that problems sustaining attention and focus in the first year of life are predictive of later cognitive deficits as well as hyperactivity and impulsivity through the preschool years (Lawson & Ruff, 2004). Distractibility has been associated with a number of psychiatric disorders, particularly ADHD (American Psychiatric Association, 1994; De Quiros & Kinsbourne, 2001). The dopamine deficiencies noted in drug-exposed children (Slotkin, Seidler, & Yanai, 2003) have been found in ADHD as well (Himelstein, Newcorn, & Halperin, 2000; Swanson et al., 2000), suggesting the potential for a common underlying mechanism. 779 However, we cannot assume that our measure of drug exposure reflects a neurobiological effect of the substance. It could instead be a proxy for environmental factors associated with parental drug taking or other variables in the homes and communities where drugs are used. Alternatively, it might represent a familial genetic vulnerability possessed by mother and child that predisposes them more generally to behavioral challenges such as substance use or distractibility. Our findings did not differentiate effects of various teratogens and it would require a larger sample to detect these differences. The sample consisted of polydrug users so there may be interactions among various substances that influence drug effects. This issue challenges all ongoing human studies of drug exposure because of the major difficulty in finding drug-exposed children who are not exposed to multiple substances (Carmichael Olson & Toth, 1999; Lester et al., 2002). Also, we had no data on frequency, amount, or timing of drug use. These variables could have significant moderating effects and, although difficult to acquire in human studies, should be addressed in future research to the degree possible. A detailed calendar of retrospective drug use has been employed in a few studies and could be one approach to acquiring these data. A prospective study that collects weekly or monthly drug information during pregnancy could also be useful. Both of these approaches require effective strategies for addressing issues of subject burden, trust and concerns regarding social desirability. It is possible that some mothers in our study did not report drug use that occurred earlier in pregnancy. Mothers could have denied use if they believed that the infant’s early birth or medical problems were caused by drug use or if they feared consequences of honest reporting. Knowledge of previous exposure was dependent on the validity of maternal report since our toxicology data only identified current use. Thus, some exposed infants could have been assigned mistakenly to the non-drug-exposed group. A multi-system approach to studying temperament of drug-exposed children is needed, using measures that assess behavior, emotion, cognition, and neurobiology concurrently. In this way, there can be a more integrative understanding of the effects of prenatal exposure to drugs on regulation of arousal and its relationship to distractibility. It seems particularly important to continue studying dopamine abnormalities associated with drug exposure, and how they may influence behavioral, emotional and cognitive features of temperament in different or similar ways. Prospective, longitudinal research can identify the changing effects of drugs on temperament during development and how these effects may influence the child’s mental health over time. Little is known about the long-term implications of prenatal drug exposure and whether early temperament traits related to Ó 2007 The Authors Journal compilation Ó 2007 Association for Child and Adolescent Mental Health. 780 Sandra J. Weiss, Mary St. Jonn-Seed, and Carolyn Harris-Muchell exposure may endure and be markers for later psychiatric disorder. We also need to consider how traits such as distractibility could serve to enhance the child’s psychosocial functioning. For instance, children who are distractible may be more skilled in surveying and monitoring nuances in the environment. The ultimate effects of any temperament trait will be determined by the ways in which it interacts with the child’s other personal attributes and particular environmental context. Understanding this complex interplay is essential if we are to identify appropriate interventions for drug-exposed children and enhance their potential for optimal mental health. Acknowledgements Funding for this research was made possible by the U.S. National Institutes of Health, NINR, Grant R01 NR02698 and the Delphine Wentland Eschbach and Robert Eschbach Endowment. Correspondence to Sandra J. 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Interactions between maternal characteristics Ó 2007 The Authors Journal compilation Ó 2007 Association for Child and Adolescent Mental Health. 784 Sandra J. Weiss, Mary St. Jonn-Seed, and Carolyn Harris-Muchell and neonatal behavior in the prediction of parenting stress and perception of infant temperament. Journal of Pediatric Psychology, 31, 27–40. Shonkoff, J., Hauser-Cram, P., Krauss, M., & Upshur, C. (1992). Development of infants with disabilities and their families. Monographs of the Society for Research in Child Development, 7(6, Serial No. 230). Silvers, J., Wallace, D., Harrod, S., Mactutus, C., & Booze, R. (2006). Prenatal cocaine alters dopamine and sigma receptor binding in nucleus accumbens and striatum in dams and adolescent offspring. Neurotoxicology and Teratology, 28, 173–180. Singer, L., Arendt, R., Minnes, S., Farkas, K., Salvator, A., Kirchner, H., & Kliegman, R. (2002). Cognitive and motor outcomes of cocaine-exposed infants. 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Motivation, sustained attention, and autonomic regulation in school age boys exposed in utero to opiates and alcohol. Experimental and Clinical Psychopharmacology, 5, 375–387. Sumner, G., & Spietz, A. (1994). NCAST caregiver/ parent–child interaction feeding manual. Seattle: NCAST Publications, University of Washington. Swanson, J., Flodman, P., Kennedy, J., Spence, M., Moyzis, R., Schuck, S., Murias, M., Moriarity, J., Barr, C., Smith, M., & Posner, M. (2000). Dopamine genes and ADHD. Neuroscience and Biobehavioral Review, 24, 21–25. Wadhwa, P., Sandman, C., & Garite, T. (2001). The neurobiology of stress in human pregnancy: Implications for prematurity and development of the fetal central nervous system. Progress in Brain Research, 133, 131–142. Weiss, S., & Chen, J. (2002). Factors influencing maternal mental health and family functioning during the low birth weight infant’s first year of life. Journal of Pediatric Nursing, 17, 114–125. Weiss, S., & St. Jonn-Seed, M. (2002). Precursors of mental health problems for low birth weight children: The salience of family environment during the first year of life. Child Psychiatry and Human Development, 33, 3–27. Weiss, S., St. Jonn-Seed, M., & Wilson, P. (2004). The temperament of pre-term, low birth weight infants and its potential biological substrates. Research in Nursing and Health, 27, 392–402. Weiss, S., & Wilson, P. (2006). Origins of tactile vulnerability in high risk infants. Advances in Neonatal Care, 6, 25–36. Weiss, S., Wilson, P., & Morrison, D. (2004). Maternal tactile stimulation and the neurodevelopment of low birth weight infants. Infancy, 5, 85–107. White-Traut, R., Nelson, M., Silvestri, P., Patel, M., & Kilgallon, D. (1993). Patterns of physiologic and behavioral response of intermediate care preterm infants to intervention. Pediatric Nursing, 19, 625– 629. Zhou, F., Sari, Y., & Powrozek, T. (2005). Fetal alcohol exposure reduces serotonin innervation and compromises development of the forebrain along the serotonergic pathway. Alcoholism, Clinical and Experimental Research, 29, 141–149. Zimmermann, L., & Stansbury, K. (2003). The influence of temperamental reactivity and situational context on the emotion-regulatory abilities of 3 year old children. Journal of Genetic Psychology, 164, 389–409. Manuscript accepted 23 January 2007 Ó 2007 The Authors Journal compilation Ó 2007 Association for Child and Adolescent Mental Health. Purchase answer to see full attachment

Description While the field of psychology is about how we behave, think and feel, and so might seem like common sense, it is in fact a science.  Sharing information about scientific ideas is done mainly through peer reviewed scholarly articles published in academic journals.  The purpose of these reading assignments is to familiarize you with scientific writing – being able to read and understand what a scholarly article is.  There are different kinds of articles – empirical or literature review – and then different parts of each kind.  In this first assignment, I have provided you with an article, and you need to identify what type of article it is, then answer the questions pertaining to that type of article in our assignment.  Make sure that you are answering every question in detail (you can see how many points each is worth by clicking on the three dots on the top of this assignment to reveal the rubric I use). For the article on Teratology Download Teratologyplease answer the following questions in complete sentences.  It is best that you answer completely in your own words.  You may quote the authors’ exact words, but if you do so, remember to put the information in quotation marks.  This assignment is due inside canvas on Sept 26. For all articles: What is the article about in general?  (Look at the title, abstract and, of course, the entire paper) Is this article an empirical study or a literature review? For empirical studies What is the hypothesis? What is the research design?  Is it an experimental, quasi experimental, or correlational design? If it is a developmental question, is it longitudinal, cross sectional or sequential design? What were the methods used? How was the study performed? With whom? What are the findings of the study? What are the limitations? For literature review What did you know about this topic from the text/lecture/course information to begin with? What is the main purpose of the review? What did they find? For all articles How does all of this fit with your knowledge of the course?  Does it enhance what you know?  Does it conflict? Is it tangential (meaning not really/only marginally related)?Journal of Child Psychology and Psychiatry 48:8 (2007), pp 773–784 doi:10.1111/j.1469-7610.2007.01745.x The contribution of fetal drug exposure to temperament: potential teratogenic effects on neuropsychiatric risk Sandra J. Weiss,1 Mary St. Jonn-Seed,2 and Carolyn Harris-Muchell1 1 Department of Community Health Systems, University of California, San Francisco, USA; 2Department of Community and Mental Health Nursing, University of San Francisco, USA Background: Preliminary evidence indicates that fetal drug exposure may be associated with alterations in temperament. However, studies often do not dissociate the potential effects of drug exposure from other perinatal or environmental factors that could influence temperament phenotypes. Methods: High risk children (n ¼ 120) were followed from birth to 6 months of age to determine the effects of fetal drug exposure on temperament, after controlling for the child’s gender, gestational age, medical morbidity, ethnicity, and maltreatment as well as the mother’s stress, income adequacy, and quality of caregiving. Methods included medical chart review, questionnaires, and videotapes of mother– child interaction. Results: Preliminary analyses indicated that fetal drug exposure was associated with both distractibility and intensity of children’s responses to the environment at 6 months of age. After adjusting for potentially confounding variables, drug exposure accounted for 12% of the variance in distractibility but was not a significant predictor in the regression model for intensity. Conclusions: Findings suggest that drug-exposed children may experience difficulty sustaining their focus of attention and be more easily distracted by environmental stimuli than non-drug-exposed children. Results converge with previous research to implicate cortical hyperarousal, stemming from teratogenic effects on the dopaminergic system during fetal development. Keywords: Fetal drug exposure, temperament, arousal regulation, distractibility. There is a high incidence of psychiatric problems among children who are exposed to drugs in utero (Chasnoff et al., 1998; Delaney-Black et al., 2000; Linares et al., 2006). One of the earliest markers of later psychiatric risk may be the nature of the child’s temperament during the first year of life (Frick, 2004; Saudino, 2005). There is evidence of the link between childhood temperament and a variety of internalizing and externalizing disorders (Crockenberg & Leerkes, 2006; Fox, Henderson, Marshall, Nichols, & Ghera, 2005; Leve, Kim, & Pears, 2005: Mervielde, De Clercq, De Fruyt, & Van Leeuwen, 2005; Neal & Edelmann, 2003; Rubin et al., 2003) as well as cognitive outcomes (Blair, 2002; Robinson & Acevedo, 2001). Studies indicate that drug-exposed children may differ from non-drug-exposed children in temperament. Poor self- and emotional regulation, higher arousal, over-reactivity, and excitability have all been identified in cocaine–exposed infants (Bard et al., 2000; Keller & Snyder-Keller, 2000; Lester et al., 2002; Moliter, Mayes, & Ward, 2003; Schuler & Nair, 1999). Prenatal exposure to cocaine has been related to problems with sustained attention and distractibility during early childhood years (Bandstra, Morrow, Anthony, Accornero, & Fried, 2001; Heffelfinger Conflict of interest statement: No conflicts declared. et al., 2002; Savage et al., 2005), with continuing evidence of deficits in the ability to sustain attention for school aged children of mothers reporting light to moderate cocaine use during pregnancy (Richardson, Conroy, & Day, 1996). Although the effects of opiate exposure have received less attention, research has demonstrated higher levels of arousal, greater stress reactivity, and poorer consolability in opiate–exposed infants than for infants not exposed (Hans, 1992; Lester et al., 2002). School aged children with prenatal opiate exposure have shown attention problems and impulsivity (Suess, Newlin, & Porges, 1997). Toddlers who were exposed to marijuana in utero appear less socially engaged and more fearful than non-exposed toddlers (Faden & Graubard, 2000). Studies also suggest that these children have greater inattention and impulsivity at 6 years of age (Leech et al., 1999) as well as diminished attention span and poor impulse control as adolescents (Fried & Watkinson, 2001). In addition, deficits in attention, impulse control, and distractibility have been found for children prenatally exposed to alcohol (Chiriboga, 2003; Riley & McGee, 2005). Alcohol exposure also predicts problems in affect regulation at 7 months of age (Eiden, Lewis, Croff, & Young, 2002). Studies of infants with polydrug exposure have identified both greater reactivity and lower levels of Ó 2007 The Authors Journal compilation Ó 2007 Association for Child and Adolescent Mental Health. Published by Blackwell Publishing, 9600 Garsington Road, Oxford OX4 2DQ, UK and 350 Main Street, Malden, MA 02148, USA 774 Sandra J. Weiss, Mary St. Jonn-Seed, and Carolyn Harris-Muchell reactivity than for non-drug-exposed infants (Lewis & Weiss, 2003). Lester and colleagues (2002) noted similar profiles for cocaine-exposed infants, whereby some infants were excitable and highly aroused while others were lethargic and ‘depressed’. Other research with polydrug-exposed infants has found that fetal exposure more commonly predicts greater reactivity, as evidenced by increased fussiness, irritability, inconsolability, problems regulating state changes, startle responses, increased heart rate and respiration, and hyperactivity (Brown et al., 1998; Higley & Morin, 2004; Weiss & Wilson, 2006). In a large study that examined differential effects of substances, investigators found that increased reactivity to stimuli was present in one-month-old infants exposed to a variety of distinct substances, including cocaine, opiates, alcohol, and marijuana (Lester et al., 2002). Confounding much of previous research has been a lack of control for factors that may influence infant temperament. One such factor is the infant’s medical risk. Drug exposure is often associated with premature birth and low birth weight (Datta-Bhutada, Johnson, & Rosen, 1998; Lester et al., 2002). As a result, it is difficult to distinguish the teratogenic effects of drug exposure from those that may be associated with medical problems experienced by other high risk infants. Researchers have found temperament differences in preterm and full term infants, indicating that gestational age, lower birth weight and more extensive perinatal complications may result in infants being less adaptable, responsive, active and predictable and more distractible (Honjo et al., 2002; Hughes, Shults, McGrath, & Medoff-Cooper, 2002; Larroque, N’Guyen, Guedency, Marchard, & Burguet, 2005; Weiss, St. Jonn-Seed, & Wilson, 2004). There is also evidence of the effects of other biologically driven factors such as gender of the child and race/ethnicity. A recent meta-analysis of temperament in children from 3 to 13 years of age found that girls were more likely to have greater inhibitory control and perceptual sensitivity while boys were more active and showed more high intensity pleasure (Else-Quest, Hyde, Goldsmith, & Van Hulle, 2006). In their first year of life, research has noted that girls are more withdrawn, have less positive mood, and are less active than boys (Kivijarvi, Raiha, Virtanen, Lertola, & Piha, 2004). However, more challenging temperament profiles have been noted for boys than for girls at school age, including characteristics such as low adaptability, intensity and negative mood (McClowry, 2002). An early crosscultural study found differences among toddlers from ethnic groups of various countries (Oberklaid, Prior, Sanson, Sewell, & Kyrios, 1990). More recently, 6-month-old infants of Euro-American heritage were reported to be less intense and more persistent than infants from other cultural groups (Weiss et al., 2004). An additional study found that Hispanic school aged children exhibited more challenging temperaments than children from other cultural groups (McClowry, 2002). The child’s evolving temperament may also be influenced by factors in the environment (Gorman, Lourie, & Choudhury, 2001). In a recent review, Saudino (2005) noted that environmental variance in temperament includes those influences that are shared by family members such as parent education and family socioeconomic status (SES) and those that are specific to a child such as unique parental treatment. Her analysis indicates little evidence of any effect by shared environmental factors such as SES but a strong effect of those factors specific to the individual. However, some studies have found specific effects of factors such as parental education and income on child temperament (McClowry, 2002; Zimmermann & Stansbury, 2003). During the first year of life, the infant–mother relationship is a primary medium through which environmental effects may occur. There is a considerable body of research suggesting that children with fetal drug exposure receive less optimal care (Blackwell, Kirkhart, Schmitt, & Kaiser, 1998; Donohue, 2004; Singer, Hawkins, Huang, Davillier, & Baley, 2001; Quinlivan & Evans, 2005) and are more likely to require oversight of child protective services due to neglect or abuse (Byrd, Neistadt, Howard, Brownstein-Evans, & Weitzman, 1999; Smith & Test, 2002). Maltreatment and maternal hostility have been linked to more challenging temperaments in children (Bagley & Mallick, 2000; Harrington, Black, Starr, & Dubowitz, 1998; St. Jonn-Seed & Weiss, 2002). In contrast, there is evidence that maternal responsiveness is associated with decreased reactivity and less challenging temperaments in children (Black et al., 2004; Jahromi, Putnam, & Stifter, 2004; Kochanska, Friesenborg, Lange, Martel, & Kochanska, 2004). Maternal sensitivity appears also to predict less activity, withdrawal, negative emotionality and stress reactivity in infants (Hane & Fox, 2006; Kivijarvi et al., 2005; Pauli-Pott, Mertesacker, & Beckmann, 2004). Lastly, maternal stress has been related to greater irritability, reactivity, attention deficits, negative affect and distress to limitations in children (de Weerth, van Hees, & Buitelaar, 2003; Huizink, de Medina, Mulder, Visser, & Buitelaar, 2002; Sheinkopf et al., 2006; Wadhwa, Sandman, & Garite, 2001). The purpose of this study was to understand the effects of drug exposure on a child’s temperament by differentiating its effects from potentially confounding infant and environmental variables. We asked the following research question: To what degree does fetal drug exposure contribute to a child’s temperament at 6 months of age, after controlling for infant variables of perinatal risk, ethnicity, and gender and environmental variables of maltreatment, quality of maternal caregiving, maternal stress, and socioeconomic status? Temperament was conceptualized Ó 2007 The Authors Journal compilation Ó 2007 Association for Child and Adolescent Mental Health. Fetal drug exposure and temperament as the child’s predisposition on 9 dimensions: activity, rhythmicity, readiness to approach or engage, adaptability, intensity, mood, persistence, distractibility, and sensory threshold. Methods Sample The convenience sample included 120 infants and their mothers who were part of a study on infants born prematurely. All infants were born prior to 37 weeks gestation and had a birth weight of 2500 grams or less. All mothers whose infants met study criteria were approached for participation unless it was expected that the infant would not survive, the infant had fragile X or Down syndrome, or the mother was cognitively impaired. Families were recruited over a three-year period. There was a 90% success rate in enrollment of those recruited. From the original sample of 185, data pertinent to this secondary analysis were available from 142 families. From this group, two sets of infants were selected. The first set consisted of infants whose mothers had a negative toxicology screen and reported no drug use of any kind during pregnancy, including alcohol. The second set consisted of infants whose mothers reported use of cocaine or opiates during pregnancy or whose toxicology screen showed evidence of these drugs. In the resulting sample (n ¼ 120), 75% of the infants were not exposed to any substance (n ¼ 90) and 25% were exposed to cocaine or opiates (n ¼ 30). However, mothers who had used one or more of these 2 drugs also used alcohol, marijuana, or other drugs, exposing the infants to a variety of substances. No infant was exposed to only one substance. Table 1 provides data on the percent of infants in the final sample who were exposed to different substances. Procedures All study procedures were approved by the Committee on Human Research Protection at University of California, San Francisco (UCSF). As part of the larger study protocol, families were recruited during the infants’ first few weeks of life from the Neonatal Intensive Care Units (NICUs) of 3 major teaching hospitals affiliated with UCSF. Two of the NICUs were sites of referral from throughout northern California. The third NICU was at a community hospital in the San Francisco Bay Area. All hospitals followed a similar neurodevelopmental approach to care. Table 1 Percent of mothers using specific classes of drugs during their pregnancy Alcohol Amphetamines Barbiturates Cocaine Marijuana Methamphetamine Opiates N % 23 12 11 20 12 7 10 76 40 36 66 40 23 33 Note: All mothers used more than 1 class of drug. 775 At recruitment, an informed consent was acquired and the mother was given a demographic questionnaire and a stress scale to complete. Medical records were reviewed by a clinical nurse specialist to identify drug exposure, gestational age, birth weight, and data related to the infant’s neonatal morbidity. When the child was 3 months old (corrected for gestational age), a home visit was made to collect data regarding the quality of maternal caregiving. At this time, a research assistant (RA) videotaped the mother and child during a typical feeding. The videotapes of the feedings were analyzed later for caregiving behavior, using a standardized protocol. The RA made a second home visit when the infant was 6 months of age. The mother completed two questionnaires during this visit: one to measure dimensions of her child’s temperament and another to assess potential child maltreatment. Measures Demographics. A demographic questionnaire provided data on infant gender and ethnicity, maternal education, adequacy of family income and other descriptive information. Adequacy of income was measured by a score combining three items on the questionnaire. The first item asked the degree to which the family’s income was enough to cover the family’s needs. This item was a five-point scale including 5) not enough, 4) barely enough, 3) adequate but no extra to spend, 2) adequate with some extra to spend, and 1) more than adequate. The second and third items acquired a yes or no response as to whether the family had an income below the poverty level and was homeless. The sum score for these three items was used as the final score for adequacy of income. Drug exposure. Drug exposure was determined by chart review to identify evidence of a positive toxicology screen as well as by maternal report. Part of the standard protocol for a preterm delivery at each of the hospitals was a urine toxicology screen. Some mothers and infants had additional blood or meconium screens if they reported drug use at admission. As part of the intake process, mothers were asked whether they had used alcohol or any other drugs during their pregnancy and the type of substance. No information was available on the time, amount or duration of use. Infants were placed in the non-drug-exposed group if mothers denied any drug use, including alcohol, and had a negative screen for drug metabolites. Infants were placed in the drug-exposed group if there was evidence of a positive toxicology screen for opiates and/or cocaine or if mothers indicated they had used either of these substances during their pregnancy. Infants whose mothers reported only alcohol, amphetamines, barbiturates, and/or marijuana use during pregnancy or whose toxicology screen showed evidence only of these drugs were not included in either group unless they also used opiates and/or cocaine, in which case they were placed in the drug-exposed group. Neonatal morbidity. The Postnatal Complications Scale (Littman & Parmelee, 1978) was used to measure neonatal morbidity. A summary score was based on the Ó 2007 The Authors Journal compilation Ó 2007 Association for Child and Adolescent Mental Health. 776 Sandra J. Weiss, Mary St. Jonn-Seed, and Carolyn Harris-Muchell number of medical risk factors for each infant from among 10 key conditions and treatments. Risk data were acquired primarily from chart review during the first month postnatal, with supplemental input from the infant’s primary nurse. Reliability and validity have been demonstrated previously for the scale (Scott, Bauer, Kraemer, & Tyson, 1997; Weiss, Wilson, & Morrison, 2004; Weiss & Wilson, 2006; White-Traut, Nelson, Silvestri, Patel, & Kilgallon, 1993). Maternal stress. An 8-item stress scale was used to assess the degree of a mother’s perceived stress in her life from factors such as work, discrimination, family, the infant’s illness, and caregiving responsibilities (Weiss & Chen, 2002). The measure was developed using items specific to culturally diverse mothers with high risk infants. Each item was rated by the mother on a 4-point scale from no stress to very, very much stress. The alpha coefficients for internal consistency of the items were .88 in the original study and .90 in this study. The validity of the scale has been supported by its negative association with a mother’s satisfaction, family cohesion, and overall mental health status, and its positive association with severity of a mother’s psychological symptoms and expressed emotion with her child (St. Jonn-Seed & Weiss, 2005; Weiss & Chen, 2002). Quality of caregiving. The Nursing Child Assessment Feeding Scales (NCAFS) were used to measure the quality of maternal caregiving (Sumner & Spietz, 1994). Four subscales measure sensitivity to cues, responsiveness to distress, socioemotional growth fostering, and cognitive growth fostering as observed in mother– child interaction. These subscales were combined to yield the total caregiving score used in this study. The NCAFS consists of binary items which are summed; larger scores indicate more optimal caregiving. The measure has established normative data and has shown internal consistency and test–retest reliability as well as construct, concurrent and predictive validity (Kelly & Barnard, 2000; Shonkoff, Hauser-Cram, Krauss, & Upshur, 1992; Sumner & Spietz, 1994). A research assistant was trained and certified as reliable in use of the NCAFS by the University of Washington site where the scales were developed. This individual coded the entire videotape of each feeding situation, blind to any other information about the mother–child pairs. Maltreatment of the child. The Parental Acceptance– Rejection Questionnaire (PARQ) was used to measure the degree of a mother’s maltreatment of her child (Rohner, 1991). This measure is a 60-item parental selfreport tool regarding specific behavior toward the child. Four subscales contribute to a total rejection/maltreatment score: lack of warmth/affection, aggression/ hostility, neglect/indifference and undifferentiated rejection. Reliability and validity have been established, along with cross-cultural validity and lack of social desirability effects (Gorman, Leifer, & Grossman, 1993; McGuire & Earls, 1993; Rohner, 1991; Weiss & St. Jonn-Seed, 2002). Temperament. The Revised Infant Temperament Questionnaire is a 95-item scale that assesses nine dimensions of temperament: 1) amount of activity, 2) rhythmicity (the regularity of behavioral and physiologic functions), 3) approach versus withdrawal, 4) adaptability, 5) intensity or strength of expressiveness, 6) negative versus positive mood, 7) persistence with a task or activity, 8) distractibility by external stimuli, and 9) threshold for sensations such as touch or light (Carey & McDevitt, 1997). The internal consistency as well as construct and predictive validity of the measure have been supported (Carey & McDevitt, 1995; ClarkeStewart, Fitzpatrick, Allhusen, & Goldberg, 2000; Seifer, Sameroff, Barrett, & Krafchuk, 1994). Data analysis A power analysis for this sub-study indicated that, using an alpha of .05, a sample size of 120 provided a power of .90 to detect a moderate effect size (i.e., R2 ¼ .13 for the magnitude of the association between drug exposure and temperament). The power to detect a small effect size (i.e., R2 ¼ .02) was .60. These analyses included all dependent variables for which regressions were performed in order to account for the effects of more than one outcome variable on power. Preliminary t-tests were computed to determine potential differences between the drug-exposed and non-drug-exposed groups in all predictors with continuous scores. Chi-square tests were computed to examine group differences on categorical variables. Missing data were minimal and were handled by replacing missing values with the group mean value on that variable, that is, the mean for the drug- or non-drug-exposed group. Tests for normality, linearity and homoscedasticity were performed and these assumptions were supported. There were no differences between drug-exposed and non-drug-exposed infants in the variance for any independent or dependent variable. Multicollinearity among independent variables was also examined. Tolerance statistics indicated that the variables of infant birth weight and maternal education were too highly related to other variables in the analysis. Birth weight had a tolerance of .38, with especially strong relationships to gestational age and neonatal morbidity. Education had a tolerance of .57, with significant associations to adequacy of income and quality of maternal caregiving. Thus, birth weight and education were not included in the final regression models to avoid any artificial inflation of the predicted variance. The tolerance of all other variables ranged from .77 to .98. The tolerance for drug exposure was .94, indicating a high level of unique variance that was not shared with other predictors in the model. Preliminary t-tests were calculated to determine any differences between drugand non-drug-exposed children on any of the 9 temperament dimensions. A regression model was then computed for each temperament variable that showed a significant difference between groups at p < .05. The final analysis employed a hierarchical approach for each regression model that was tested, whereby scores for gender, ethnicity, gestational age, and neonatal morbidity were entered at the first step. Quality of caregiving, inadequacy of income, maternal stress, and maltreatment of the infant were entered at the second Ó 2007 The Authors Journal compilation Ó 2007 Association for Child and Adolescent Mental Health. Fetal drug exposure and temperament step and group status for drug exposure was entered at the third and final step. In this way, the variance contributed by infant characteristics was extracted first and then the variance for environmental factors before testing the effects of drug exposure. Results As shown in Table 2, there were no differences between drug- and non-drug-exposed dyads in their mean scores for any continuous predictor variable. Half of the families in each group were living below the poverty level. The gender profile of infants in the two groups was also identical, with 44% female and 56% male. However, ethnicity did show a significant difference between groups (v2 ¼ 13.87, p < .02). There were more African-American infants and fewer Hispanic-American infants in the drug-exposed group (Table 3). There were differences between the means of the drug- and non-drug-exposed groups on two of the temperament variables. As shown in Table 2, drug-exposed infants had higher means for the intensity of their expressivity, t (118) ¼ 2.38, p ¼ .02 and for distractibility, t (118) ¼ 2.55, p ¼ .01. Based on these preliminary analyses, regression equations 777 were computed for the temperament variables of distractibility and intensity. The regression model for distractibility was significant (F(9,110) ¼ 2.14, p < .03), with the variables in Step 1 accounting for 2% of the variance, those in Step 2 accounting for 4% of the variance, and drug exposure contributing 12% to the variance in distractibility. As shown by the beta coefficients in Table 4, maltreatment was a significant predictor of the likelihood of greater distractibility in children. However, fetal drug exposure accounted for most of the identified variance in distractibility, with drugexposed children more likely to be distracted by objects or events in the environment. The regression model for intensity of a child’s behavior and feelings was not significant (F(9,110) ¼ 1.75, p < .09). The beta coefficients in Table 5 indicate that ethnicity was the only significant predictor of intensity. Post hoc contrasts using Tukey’s HSD test indicated that Euro-American infants (M ¼ 3.87) were significantly less likely to react to their environments with an impassioned, uninhibited manner of expression than were African-American infants (M ¼ 4.23, p < .05). Drug exposure accounted for 2% of the variance in an infant’s intensity of expression but was not a significant predictor. Table 2 Group means for scores on study variables Drug-exposed M SD Non-drug-exposed M Table 4 Results of hierarchical regression analysis for the child’s distractibility SD Beta Child temperament Highly active 4.48 .51 4.31 .56 Arrythmic 3.88 .88 3.87 .58 Withdrawn 3.64 .49 3.43 .70 Nonadaptive 3.80 .71 3.61 .67 Negative in mood 3.92 .81 3.87 .62 Intense 4.36* .86 4.00* .65 Non persistent 3.96 .61 3.90 .82 Distractible 4.24** .60 3.87** .67 Low in threshold 3.92 .64 3.72 .61 Infant perinatal risk Gestational age 31.4 3.84 31.9 3.50 Birth weight (g) 1612 599 1690 538 Neonatal morbidity 3.90 2.06 4.26 2.34 Environmental factors Maternal education 11.75 3.57 12.06 4.07 Income adequacy 2.29 .98 2.86 .95 Quality of care 42.48 4.25 43.19 4.56 Maltreatment 85.28 11.29 84.18 10.58 Step 1 – Infant characteristics Gestational age .06 Gender ).16 Neonatal morbidity .04 Ethnicity .00 Step 2 – Environmental factors Quality of caregiving .15 Maltreatment of the child .21* Maternal stress ).01 Adequacy of income .08 Step 3 – Fetal drug exposure .36** African-American Asian-American Euro-American Hispanic-American Native-American Non-drug-exposed (n ¼ 90) 50 3 34 13 0 15 6 39 36 4 F .02 .13 .03 .14 .02 .39 .02 .01 .02 .06 .17 .06 .66 .18 2.14 Table 5 Results of hierarchical regression analysis for the child’s intensity of behavior and emotional expression Beta Drug-exposed (n ¼ 30) R2 Note: *p < .05; **p < .001. Note: *p < .05; **p < .01. Table 3 Percent of drug- and non-drug-exposed children in each ethnic group SE Step 1– Infant characteristics Gestational age ).11 Gender .00 Neonatal morbidity .07 Ethnicity .35* Step 2 – Environmental factors Quality of caregiving .18 Maltreatment of the child .02 Maternal stress .04 Adequacy of family income .05 Step 3 – Fetal drug exposure .15 Note: *p < .01. Ó 2007 The Authors Journal compilation Ó 2007 Association for Child and Adolescent Mental Health. SE R2 F .02 .13 .03 .15 .10 2.68 .02 .01 .02 .06 .18 .13 1.67 .15 1.75 778 Sandra J. Weiss, Mary St. Jonn-Seed, and Carolyn Harris-Muchell Discussion Overall, our results suggest that fetal drug exposure had a very circumscribed effect on a child’s temperament at 6 months of age. Drug exposure was associated only with a child’s distractibility, but accounted for a notable, moderate effect size as defined by Cohen (1987). This dimension of temperament has received strong support from previous studies in which increased distractibility and deficits in the ability to sustain attention have been found for infants, preschool and young school aged children exposed to cocaine prenatally (Bandstra et al., 2001; Coles et al., 1999; Garavan et al., 2000; Heffelfinger et al., 2002; Karmel & Gardner, 1996; Leech et al., 1999; Mayes, Grillon, Granger, & Schottenfeld, 1998; Noland et al., 2005; Nulman et al., 2001; Richardson et al., 1996; Savage et al., 2005; Singer et al., 2004). Similar difficulties with distractibility and attention have been noted for children exposed to marijuana (Fried & Smith, 2001; Fried & Watkinson, 2001; Goldschmidt et al., 2000; Leech et al., 1999; Noland et al, 2005), to opiates (Suess, Newlin & Porges, 1997), to alcohol (Burden, Jacobson, Sokol, & Jacobson, 2005; Kable & Coles, 2004; Lee, Mattson, & Riley, 2004), and to polydrug use (Butz, Pulsifer, Leppert, Rimrodt, & Belcher, 2003). Animal research provides additional evidence of attention deficits, increased reactivity, and a persistent hyperattentive response to novel stimuli in offspring who have prenatal exposure to cocaine and alcohol (Foltz et al., 2004; He, Bai, Champoux, Suomi, & Lidow, 2004; Schneider et al., 2002), with enduring effects into adulthood (Gendle et al., 2003, 2004; Hausknecht et al., 2005; Mactutus, 1999; Morgan et al., 2002). Results of these various studies suggest that distractibility and problems sustaining attention may occur from exposure to cocaine, opiates, alcohol or marijuana rather than being unique effects of any one type of substance. with diminished inhibition and augmented excitation of the nervous system. The frontal striatal system of the brain has primary responsibility for inhibitory control of stimuli and regulation of attention (Botvinick et al., 2001; Casey, Giedd, & Thomas, 2002; Noland et al., 2005; Roberts et al., 2004). Previous research suggests that the striatal system is altered as a result of cocaine exposure (Garavan et al., 2000; Gendle et al., 2004). In a meta analysis, Glatt and colleagues (2000) noted that prenatal cocaine exposure appeared primarily to produce a down-regulation of the nigrostriatal dopamine system, including decreased dopamine receptors in both infants and adults and an overall decrease in striatal dopamine levels. Dopamine acts on its receptors to modulate excitatory and inhibitory processes that play an important regulatory role in attention (Silvers et al., 2006). This regulatory role is central to information processing by adjusting the signal to noise ratio across sensory systems (Gilman & Newman, 2003). Substantial evidence for both cocaine and alcohol suggests that they alter dopamine neurotransmitter levels during gestation which then affects structural organization of the brain during development (Choi et al., 1998; Lester et al., 2003; Lidow, 2003; Mayes, 2002, 2003; Stanwood & Levitt, 2004; Zhou, Sari, & Powrozek, 2005). Research using animal models indicates that an increase in extracellular dopamine levels during sensitive growth periods during gestation may decrease neuronal proliferation, axonal arborization, transporter levels, and synaptic connectivity in the dopaminergic system (Glatt et al., 2004; Silvers et al., 2006). Thus, abnormalities in distractibility and attention observed in children exposed to alcohol, marijuana, opiates, and cocaine may be influenced by long-lasting changes in the function of dopamine neurons (Singer et al., 2002), including alterations in transporter protein levels and signaling in the striatum (Choong & Shen, 2004; Fang & Ronnekleiv, 1999; Salvatore et al., 2004). Potential mechanisms underlying distractibility Higher distractibility in drug-exposed children may be a behavioral indicator of difficulties with the cortical regulation of arousal and excitation in response to stimulation. Mayes (2002) views arousal regulation as a gating mechanism that serves to enhance orientation and attention to the environment but also to protect the brain from excessive environmental stimulation. Under optimal conditions, development results in effective regulation of arousal, with a balance of inhibitory and excitatory processes that help the child modulate responses to the environment (Crowell et al., 2004; Strelau, 1995). High levels of distractibility in children have been associated with a pattern of brain activity that indicates involuntary shifting of attention to novel stimuli (Gumenyuk et al., 2001). Such a predisposition may imply ineffective regulation of arousal, Other factors influencing temperament Results of regression testing in this research indicate few relationships between the predictors studied and either intensity or distractibility at 6 months. Other studies also have found that environmental risk factors, including socioeconomic status, education, maternal behavior, and maternal stress, have no significant effect on child temperament (Austin, Hadzi-Pavlovic, Leader, Saint, & Parker, 2005; Larroque et al., 2005; Noland et al., 2005). Similarly, gender (Larroque et al., 2005; Weiss et al., 2004) and perinatal biological risks (Austin et al., 2005; Eckerman et al., 1999; Weiss et al., 2004) have shown minimal effects on temperament in some studies. However, replication with a larger sample of drugexposed children is essential to determine the stability of our findings. In addition, some of the Ó 2007 The Authors Journal compilation Ó 2007 Association for Child and Adolescent Mental Health. Fetal drug exposure and temperament factors we examined may be delayed in their effect and expressed later in development. Still, our findings suggest that factors we did not examine may be more critical in determining a child’s temperament. The genetic basis of temperament was not examined in this study and there is growing evidence of the influence of specific polymorphisms on temperament (Gonda et al., 2006; Kim, Kim, Lee, Kim, & Kim, 2006). Of relevance to distractibility are studies that have found significant associations between a dopamine transporter gene and childhood attention deficit hyperactivity disorder (ADHD; Brookes et al. 2006; Kahn, Khoury, Nichols, & Lanphear, 2003). These researches also have identified interactions of this gene with maternal substance use during pregnancy in predicting childhood risk for ADHD in children. Because we didn’t control for genetic factors in the study reported here, it is possible that our measure of drug exposure reflects some aspect of a genetic contribution. Clearly, the links between genetic profiles and specific temperament traits are an important area of future inquiry. Other medical factors such as the child’s status regarding HIV exposure, infant malnourishment, or intrauterine growth restriction also must be considered. Lastly, the nature of the family’s dynamics, including domestic violence, ongoing drug use by parents, or other characteristics of the home environment will likely play a role. Our results did show a significant contribution of maltreatment to distractibility in children. Maltreated children could become more vigilant and responsive to stimuli in their environments because of concerns regarding their emotional or physical well being. Increased attention to environmental cues may serve as a successful strategy for selfprotection but with detrimental effects on their ability to sustain attention to ongoing tasks that are important for adaptation in general. Conclusions After controlling for a number of important confounds, drug exposure accounted for 12% of the variance in a child’s likelihood of distractibility at 6 months of age. Research suggests that problems sustaining attention and focus in the first year of life are predictive of later cognitive deficits as well as hyperactivity and impulsivity through the preschool years (Lawson & Ruff, 2004). Distractibility has been associated with a number of psychiatric disorders, particularly ADHD (American Psychiatric Association, 1994; De Quiros & Kinsbourne, 2001). The dopamine deficiencies noted in drug-exposed children (Slotkin, Seidler, & Yanai, 2003) have been found in ADHD as well (Himelstein, Newcorn, & Halperin, 2000; Swanson et al., 2000), suggesting the potential for a common underlying mechanism. 779 However, we cannot assume that our measure of drug exposure reflects a neurobiological effect of the substance. It could instead be a proxy for environmental factors associated with parental drug taking or other variables in the homes and communities where drugs are used. Alternatively, it might represent a familial genetic vulnerability possessed by mother and child that predisposes them more generally to behavioral challenges such as substance use or distractibility. Our findings did not differentiate effects of various teratogens and it would require a larger sample to detect these differences. The sample consisted of polydrug users so there may be interactions among various substances that influence drug effects. This issue challenges all ongoing human studies of drug exposure because of the major difficulty in finding drug-exposed children who are not exposed to multiple substances (Carmichael Olson & Toth, 1999; Lester et al., 2002). Also, we had no data on frequency, amount, or timing of drug use. These variables could have significant moderating effects and, although difficult to acquire in human studies, should be addressed in future research to the degree possible. A detailed calendar of retrospective drug use has been employed in a few studies and could be one approach to acquiring these data. A prospective study that collects weekly or monthly drug information during pregnancy could also be useful. Both of these approaches require effective strategies for addressing issues of subject burden, trust and concerns regarding social desirability. It is possible that some mothers in our study did not report drug use that occurred earlier in pregnancy. Mothers could have denied use if they believed that the infant’s early birth or medical problems were caused by drug use or if they feared consequences of honest reporting. Knowledge of previous exposure was dependent on the validity of maternal report since our toxicology data only identified current use. Thus, some exposed infants could have been assigned mistakenly to the non-drug-exposed group. A multi-system approach to studying temperament of drug-exposed children is needed, using measures that assess behavior, emotion, cognition, and neurobiology concurrently. In this way, there can be a more integrative understanding of the effects of prenatal exposure to drugs on regulation of arousal and its relationship to distractibility. It seems particularly important to continue studying dopamine abnormalities associated with drug exposure, and how they may influence behavioral, emotional and cognitive features of temperament in different or similar ways. Prospective, longitudinal research can identify the changing effects of drugs on temperament during development and how these effects may influence the child’s mental health over time. Little is known about the long-term implications of prenatal drug exposure and whether early temperament traits related to Ó 2007 The Authors Journal compilation Ó 2007 Association for Child and Adolescent Mental Health. 780 Sandra J. Weiss, Mary St. Jonn-Seed, and Carolyn Harris-Muchell exposure may endure and be markers for later psychiatric disorder. We also need to consider how traits such as distractibility could serve to enhance the child’s psychosocial functioning. For instance, children who are distractible may be more skilled in surveying and monitoring nuances in the environment. The ultimate effects of any temperament trait will be determined by the ways in which it interacts with the child’s other personal attributes and particular environmental context. Understanding this complex interplay is essential if we are to identify appropriate interventions for drug-exposed children and enhance their potential for optimal mental health. Acknowledgements Funding for this research was made possible by the U.S. National Institutes of Health, NINR, Grant R01 NR02698 and the Delphine Wentland Eschbach and Robert Eschbach Endowment. Correspondence to Sandra J. 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