Children with in utero cocaine exposure may be at risk for adverse neurodevelopmental outcome. To evaluate such outcome in young children, we administered the Battelle Developmental Inventory (BDI) to a group of inner-city children with (COC) and without (CON) in utero cocaine exposure at ages 3 and 5 years. Sixty-five COC and 68 CON, similar at age of testing, were evaluated at both time points by examiners masked to child group status. Both groups scored poorly and worsened over time. Although Total BDI raw scores were lower in the COC group than in the CON group at 3 years, this difference was related to postnatal environmental factors, caregiver (p= .022), and home environment (p= .010), not to in utero cocaine exposure (p= .88). At 5 years, the Total BDI score was related to the home environment (p< .001) but not to the caregiver (p= .36) or in utero cocaine exposure (p= .83). We conclude that inner-city children are at risk for adverse developmental outcome regardless of in utero cocaine exposure.