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The authors thank the parents and children who participated in this study and the research staff who were responsible for conducting numerous assessments with these families. Special thanks to Claire Coles and Phillip S. Zeskind for their collaboration on the larger study, Amol Lele and Luther Robinson for collaboration on data collection at Women and Children's Hospital of Buffalo, and Michael Ray for his collaboration on data collection at Sisters of Charity Hospital of Buffalo. This study was made possible by a grant from the National Institute on Drug Abuse (1R01DA013190). In the interest of full disclosure, the second author (D.A.G.) is founder and Chief Scientific and Strategy Advisor at Salimetrics LLC (State College, PA). This relationship is managed by the Conflict of Interest Committee at the Johns Hopkins University School of Medicine.
The field of developmental psychopathology has long advocated the need to examine mediators and moderators of child outcomes among high-risk cohorts (Cicchetti & Toth, 2009; Rutter & Garmezy, 1983). Mediation implies that there are different pathways to risk or resilience, while moderation examines variables that may exacerbate or ameliorate risk or resilience. One such risk outcome for substance exposed children may be the development of behavior problems. A number of studies have examined the association between prenatal cocaine exposure and children's behavior problems (e.g., Accornero, Anthony, Morrow, Xue, & Bandstra, 2006; Bagner et al., 2009; Linares et al., 2006; Richardson, Goldschmidt, & Willford, 2009; Warner, Malik, Lindahl, & Claussen, 2006). Results have been mixed with a few studies reporting significant direct associations between prenatal cocaine exposure and child behavior problems (Bada et al., 2007; Richardson et al., 2009), some reporting associations only for boys (Bailey et al., 2005; Delaney-Black et al., 2004), and some reporting no direct associations (e.g., Bada et al., 2008; Warner et al., 2006). Several studies have reported associations that were moderated by other variables or predictors other than prenatal substance exposure (e.g., Bailey, Avitsur, Engler, Padgett, & Sheridan, 2004; Bennett, Bendersky, & Lewis, 2002; Warner et al., 2006; Yumoto, Jacobson, & Jacobson, 2008).
Maternal stress or psychopathology (Bada et al., 2007; Bagner et al., 2009; Bennett et al., 2002; Warner et al., 2006), and maternal parenting behavior or caregiving situation (Bada et...