Abstract
Given the concerns raised regarding the effects of prenatal exposure to methadone and buprenorphine on the developmental outcomes of the children, this study assessed mental health and use of services in a national sample of school-aged children (N = 78) born to women enrolled in opioid maintenance treatment during pregnancy, compared with a group of foster children (N = 140). The majority of the opioid-exposed children lived with their birth parent(s) at the time of assessment (N = 62), while 16 lived in foster homes. Caregivers completed the Strengths and Difficulties Questionnaire (SDQ) and the Reactive Attachment Disorder scale. Teachers completed the SDQ. Three kinds of services were included in measuring service use: school-based education services, child mental health services, and hospital-based habilitation services. The main finding of the study is that children prenatally exposed to methadone or buprenorphine living with their family of origin had significantly better mental health status than their foster-placed counterparts and that of the comparison group of foster children. In addition, the exposed children living at home had less child welfare involvement, and only half of them were using any of the three services measured. The odds for using services increased significantly in accordance with increasing mental health problems, independent of group affiliation, indicating a need-based access to services. In line with other studies, we found that the odds for using one or more services was 2.3 times greater for boys than for girls. Our results contribute to a more-nuanced understanding of the developmental outcomes of prenatal exposure to methadone and buprenorphine, and factors associated with increased service use in groups of at-risk children.
Highlights
As a result of the increase in use of legal and illegal opioids worldwide, many research reports have focused on developmental outcomes in children prenatally exposed to opioids, primarily in the neonatal period [1]
It is possible that the boys and children with more behavior difficulties had a higher a priori likelihood of being placed in foster care, which has been previously reported [81]. This is the first study comparing mental health status of school-aged children of mothers engaged in long-term opioid maintenance treatment (OMT), to fosterplaced children of the same age without known prenatal opioid exposure
Identification of children with emerging mental health problems is critical for both clinicians and health care providers to address needs and instigate targeted interventions
Summary
As a result of the increase in use of legal and illegal opioids worldwide, many research reports have focused on developmental outcomes in children prenatally exposed to opioids, primarily in the neonatal period [1]. A substantial number of newborns exposed to opioids in utero exhibit neonatal abstinence syndrome (NAS); a postnatal withdrawal condition of irritability and dysregulation in newborns that by itself predisposes for early interaction problems and increased vulnerability and, eventually to postnatal maltreatment [2]. Studies on long-term effects are inconclusive with respect to developmental sequelae [6] there seems to be a pattern linking prenatal opioid exposure to hyperactivity/inattention problems and increased risk of ADHD [7,8,9], especially in the context of unsupportive caregiving settings where early dysfunctional maternal–infant relationship potentiate the negative effects of the exposure [10]. Interpretation of results is made difficult due to methodological challenges such as small sample sizes, high prevalence of concomitant drug use, and maternal psychopathology [14, 15]
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