Examined neurodevelopmental patterns and caregiving environment among 20 infants prenatally exposed to cocaine and 20 drug-free infants. The Brazelton Scale was administered 4 times. Drug-exposed infants had less optimal neurodevelopment than comparison infants at birth, but by 6 weeks only differences in autonomic stability were apparent. Neurodevelopmental performance was related positively to the child-centered quality of the environment. Though support buffered stress in both groups, the effect was more robust among drug-free mothers. Findings support the need to consider neurodevelopmental recovery and the caregiving environment in evaluations of developmental outcome among drug-exposed infants.