Abstract
Recent research shows that preschool children born to opioid-dependent mothers are at increased risk for cognitive, psychomotor, attention, and social-emotional adjustment problems. But very little is known about their school-age functioning, particularly their educational achievement. This analysis examined the educational outcomes of a regional cohort of 100 prenatally methadone-exposed children who were prospectively studied from birth to age 9.5 years alongside a comparison group of 110 randomly identified non-exposed children born between 2003 and 2008. At age 9.5, as part of a comprehensive neurodevelopmental evaluation, children’s teachers rated their achievement across the school curriculum, and children completed the Woodcock Johnson-III Tests of Achievement (WJ-III). Detailed information about the birth mother’s social background, pregnancy substance use, and mental health was also collected during pregnancy/at term. Infant clinical data were collected after birth. Methadone-exposed children performed less well than non-exposed children across seven school curriculum areas rated by teachers (ps ≤.001), performed less well than non-exposed children on all reading and mathematics subtests of the WJ-III, and had higher rates of any educational delay on the WJ-III (57% vs. 15%), OR = 7.47 (3.71–15.02). Results were similar when children with severe intellectual impairment were excluded. After adjusting for confounding factors, methadone-exposed children had increased odds of educational delay, but this was only marginally significant (OR = 3.62, [1.01–13.01], p = .049). Maternal educational attainment level (OR = 0.69, [0.50–0.89], p = .006), and maternal benzodiazepine use during pregnancy (OR = 2.70 [1.03–7.12], p = .044) were also associated with later educational risk. Findings suggest that children born to opioid-dependent women enrolled in methadone maintenance are at high risk of educational delay by age 9.5 years. Children’s academic difficulties appeared to reflect the effects of both adverse prenatal exposures and postnatal social risk.
Highlights
The impact of the recent opioid epidemic on children and families is of growing concern, with recent data suggesting that the risks associated with maternal opioid use during pregnancy likely extend beyond neonatal abstinence syndrome (NAS) and other neonatal complications
Compared with infants born to non-opioid-dependent mothers, the mothers of ME children were more likely to engage in polysubstance use/abuse during their pregnancies, with their scores indicating that they more frequently used a wider range of different substances than comparison group mothers
Children born to mothers in maintenance treatment (MMT) were characterized by higher levels of family social risk, with the majority born into a lower socioeconomic status (SES) family where their mothers had left school before age 16, and where they were being raised in a single parent family
Summary
The impact of the recent opioid epidemic on children and families is of growing concern, with recent data suggesting that the risks associated with maternal opioid use during pregnancy likely extend beyond neonatal abstinence syndrome (NAS) and other neonatal complications. Data from a 4 1⁄2 year follow-up study found that, at school entry, children born to opioid-dependent mothers were at increased risk for a range of health and neurodevelopmental difficulties [1]. These spanned behavioural, attention, visual-motor, and cognitive domains. Several small-scale studies suggest that these neurological changes continue to be observed at school age [21, 22, 23], reinforcing existing concerns about the potential long term cognitive and educational outcomes for these children
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