Effects of Prenatal Exposure to Cocaine in Early Infancy: Toxic Effects on the Process of Mutual Regulation.

In this paper, recent studies of the effects of prenatal cocaine abuse and other toxic substances on infant behavior and development during early infancy are critically reviewed. The inevitable conclusion from this review is that compromising main effects of single drugs such as cocaine on infant behavior and development have not been reliably established. It is argued that the tong-term developmental outcome of prenatally drug-exposed infants cannot be fully understood without a thorough consideration of other confounding factors associated with prenatal drug use, such as the quality of the infant's postnatal caregiving environment. Specifically, it is argued that the infant's ability to resolve macro-level developmental tasks during early infancy such as physiologic and behavioral state regulation, sustained face-to-face interaction, and joint attention to objects is primarily determined by dyadic processes at a micro-level; namely, via the communicative and affective mutually regulated processes established over time by the exposed infant and its caregiver. Critically, these processes are affected both by the biological competence Of the infant and by the protective or disruptive role of the caregiving environment. Both caregiver and infant factors associated with cocaine exposure that may disrupt the regulatory capacity of the dyad are described, and illustrations of how resulting dyadic dysregulation may preclude the infant's successful resolution of current and future developmental tasks are provided. Thus it is argued that to understand the effects of cocaine on development we must understand the process of mutual regulation of the cocaine-exposed dyad. [ABSTRACT FROM AUTHOR]