In a prospective longitudinal study of 149 inner-city children of low SES, half with in utero cocaine exposure (COC) and half controls (CON), at age 4 yrs there were 31 Achievers (ACH) with average or above average Full Scale (FS) IQ scores (Average range 90-109) and 118 children with FS IQ<90 on the Wechsler Preschool and Primary Scale of Intelligence-Revised (WPPSI-R). Eighty-two of these 149 children, including 11 ACH, have now also had the WPPSI-R at age 6 yrs. The original 11 ACH maintained their ACH status and were joined by 13 new ACH. AIM: To define characteristics that differentiate 13 new ACH from 58 children who continue to have FS IQ<90 (CIQ<90). STUDY DESIGN: Comparison of ACH and C-IQ<90 on natal factors, maternal characteristics, and environmental influences. RESULTS: The 13 new ACH did not differ from C-IQ <90 on the following natal factors: in utero exposure to cocaine (ACH=31% vs C-IQ<90 =55%; p=.13), marijuana, or alcohol, GA, Apgar score at 5 min., or admission to NICU. ACH in utero cigarette exposure was less than in C-IQ <90 (31 vs 67%; p=.026). Assessment of postnatal environment showed ACH were in care of their biologic mothers for a greater part of their lives (95 ±14% vs 78 ±37%; p=.012), and there were fewer other children in the household (1.3 ±1.1 vs 2.6±1.9; p=.005) than C-IQ <90. Mothers of ACH had more education at time of child testing (12.6 ±0.9 yrs. vs 11.6 ±1.0; p=.011) and higher FS IQ (WAIS-R) (92.8±10.6 vs 78.6±7.9; p=.005) than mothers of C-IQ<90. There was no difference in school experience of ACH vs C-IQ<90; p=.58. Home Observation Measurement of the Environment scores were higher in ACH than in C-IQ<90 (46.3 ±2.8 vs 43.8 ±6.1), but this did not reach statistical significance (p=.065). Although continued maternal drug use was higher in C-IQ<90 (n=14; 24%) vs ACH (n=1; 8%) this, too, did not reach significance (p=.26). CONCLUSIONS: Taken together, the maternal and family factors of less cigarette use, higher educational level, higher IQ, increased time with child, and fewer children in the household appear important to transition of children to Achiever status. With the exception of maternal IQ, these factors can be influenced by education and counseling. This finding, coupled with our previous report of importance of home environment in ACH at age 4 yrs., gives hope for improving cognitive outcome of inner-city children.
