3-4Methylenedioxymethamphetamine (MDMA/Ecstasy) use is widespread among young adults throughout Europe and increasing in popularity in the United States among similar populations with resultant concern over the long-term negative effects of fetal MDMA exposure on the developing child. Use of MDMA is also associated with other maternal risk factors which can negatively affect child outcomes, such as increased maternal neuropsychological deficits, greater psychological distress, and potentially altered care-giving behavior. In addition to documenting a range of infant outcomes, the proposed study aims to assess environmental and maternal psychological correlates of outcomes in MDMA-exposed children in the United Kingdom. The proposed study will achieve this aim through establishing a partnership between researchers at Case Western Reserve University in Cleveland, Ohio and community research partners at the University of East London, England where MDMA use is prevalent and an adequate sample size of MDMA exposed infants can be recruited. 150 infants (75 MDMA-exposed; 75 non-exposed) and their mothers will be seen at 1 month, 4 months, 12 months, 18 and 24 months and assessed on measures of growth, cognitive, motor, language, and behavioral outcomes. MDMA exposure will be determined by maternal self-report measures (and corroborated by hair analysis), with all children drawn from the same race/social class population. Mothers will be identified through community physicians as early in pregnancy as possible or at child birth and substance use quantity and frequency assessed at each trimester. Demographic, medical, and prenatal substance exposure will be noted from chart review and clinical interview and hair analysis. Standardized questionnaires assessing maternal psychological status, personality, social supports, intellectual ability, and history of caregiving will be administered. Videotaped observations of child play and maternal child interactions will be conducted. Data will be evaluated descriptively, and through a series of longitudinal mixed model analyses and hierarchical multiple/logistic regression analyses to describe the functioning of MDMA-exposed infants and their mothers to 2 years of age, and the relative impact of MDMA and other substance exposures to infant outcomes, maternal psychological functioning, and caregiving interactions. Changes over time and predictive models of infant risk, using HLM or structural equation models, will be utilized. The proposed research will provide information about the early developmental sequelae of fetal MDMA-exposure and maternal psychological status and caregiving behaviors which can guide the design of effective maternal drug treatment and child intervention programs.