Emotional and Behavioral Trajectories of 2 to 9 Years Old Children Born to Opioid-Dependent Mothers

Julia Jaekel,Jacqueline M T Henderson,Lianne J Woodward,Samantha J Lee,Hyun M Kim,Ashlyn Schwartz

doi:10.1007/s10802-020-00766-w

Abstract

Maternal opioid use in pregnancy has increased dramatically. Knowledge about children’s longer-term emotional and behavioral development after prenatal opioid exposure is scarce. A regional sample of 89 opioid-exposed and 104 non-exposed comparison children were studied prospectively at ages 2, 4.5, and 9 years using the Strengths and Difficulties Questionnaire (SDQ) completed by primary caregivers. Across all childhood assessments, opioid-exposed children obtained significantly higher total difficulties scores than non-exposed comparison children. Growth curve modeling revealed that, relative to their same age peers, opioid-exposed children’s emotional and behavioral difficulties significantly worsened over time. Moreover, fixed effects estimates showed that total difficulties trajectories were poorer for children subject to higher prenatal risk (Est = 1.78, 95% CI = [0.46, 3.09]) who were born to mothers with high levels of social adversity (1.11 [0.51, 1.71]), and were then raised in families characterized by high levels of psychosocial risk (1.94 [0.90, 2.98]) and unstable caregiving (1.91 [0.33, 3.48]). A complex set of pre- and postnatal processes contribute to opioid-exposed children’s emotional and behavioral development. Efforts to mitigate the long-term consequences of opioid use in pregnancy need to consider both children’s and their caregivers’ biopsychosocial risks.

Highlights

Over the last 20 years, the use and abuse of licit and illicit opioids has skyrocketed globally (Sanlorenzo, Stark, & Patrick, 2018), including among women of reproductiveage (Bateman et al, 2014; CDC, 2017)
maintenance treatment (MMT) involves chronic fetal opioid exposure placing the infant at risk of neonatal opioid withdrawal syndrome (NOWS) (Conradt, Crowell, & Lester, 2018)
We know from normative population studies that the prevalence as well as the nature and severity of children’s behavioral and emotional problems vary with age (Koumoula, 2012; Lenze & Wetherell, 2011; Sasser, Kalvin, & Bierman, 2016; Spencer, Biederman, & Mick, 2007)

Summary

Introduction

Over the last 20 years, the use and abuse of licit and illicit opioids has skyrocketed globally (Sanlorenzo, Stark, & Patrick, 2018), including among women of reproductiveage (Bateman et al, 2014; CDC, 2017). For example, can occur in childhood but have a median age of onset in early adolescence, while rates of depressive symptoms typically rise dramatically during adolescence and peak in young adulthood (Kessler et al, 2004) At present, it is not known whether prenatally opioidexposed children follow similar behavioral trajectories as their non-exposed peers. We can only really understand the mechanisms underlying potential problems associated with prenatal opioid-exposure when accounting for normative developmental changes This can be accomplished by longitudinally administering an established, standardized, and developmentally appropriate instrument such as the Strengths and Difficulties Questionnaire (SDQ) (Goodman, 2001) to assess the development of children exposed to opioids as well as a representative regional comparison group

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