Every 25 minutes in the United States, a baby is diagnosed with neonatal abstinence syndrome (NAS), a condition that occurs in newborns who have been exposed to opioids in the womb and develop withdrawal after birth, according to the Centers for Disease Control and Prevention. Historically, research has focused on the impact of NAS - also known as neonatal opioid withdrawal syndrome - on the health and development of young children, which has found that prenatal opioid exposure is associated with increased risk for adverse developmental, cognitive and behavioral outcomes in early childhood.
However, opioid exposure may play a minimal role in neurodevelopmental outcomes by the time the babies with NAS reach the classroom, according to a new study led by researchers at Penn State College of Medicine. They compared school-aged children with and without a history of NAS and found that the two groups performed similarly on standardized tests when socioeconomic and environmental factors were taken into account. The findings suggest that external factors like school quality, economic status, race and the mother's education level have a greater influence on academic outcomes. The study was published in the journal The Lancet Regional Health - Americas.
"Historically, we've been quick to blame prenatal opioid exposure for poor academic achievement, but it appears that socio-environmental factors play a much larger role," said Tammy Corr, associate professor of pediatrics at Penn State College of Medicine and corresponding author on the study. "There's every reason to believe that these children can do well and thrive when given the right resources."
Academic achievement can be a good indicator of both prior neurodevelopment in early childhood and future success as an adult, Corr said. In this study, the researchers evaluated standardized test scores for English/Language Arts and math for 3,494 students from grades three through eight - 23% with a history of NAS and 77% without.
To determine if test performance was influenced by NAS or other factors, the researchers compared children with NAS and a control group matched for age, sex, mother's education level and health insurance type at birth.
The data were derived from the South Carolina Integrated Data System, which integrates data on health, demographics, socioeconomics, social services and education from across multiple state agencies. The researchers explained that this uniquely integrated database can connect a mother and child in a way that allows researchers to follow the pair longitudinally over time. While the data comes from South Carolina, Corr said that the results could be generalized to the broader population in the United States because the socioeconomic and environmental factors present for the children with a history of NAS in this study are strikingly similar to previously published literature from studies across the United States.
After controlling for age, sex and socioeconomic factors, there were minimal differences in standardized test scores from students with and without a history of NAS. Mean English/Language Arts test scores were similar between the two groups. In math, there was a small but statistically significant drop in test scores among students with a history of NAS.
Overall, children in the study scored below the state average across all grades, regardless of NAS history. While children in the study were from across the state, because of the matching strategy, more than 30% were born to a mother with less than a high school degree, and 85% were either uninsured or insured by Medicaid, which is typically an indicator of socioeconomic status, the researchers explained.
Factors like attending a lower-rated school, limited access to early childhood education and other indicators of economic stress, such as participation in Women, Infants and Children (WIC) supplemental nutrition program, played a much larger role in determining a student's academic performance. Children of non-Hispanic Black mothers also scored approximately a grade level lower than non-Hispanic white students on the tests. The researchers also found that test scores rose with increasing levels of maternal education.
"Based on previous literature, I expected to see a more prominent difference in academic performance," Corr said. "But when you start to put the whole story together - they didn't have access to early childhood education to give them a solid head start, they're enrolled in poorly rated schools, their families may be struggling with financial insecurities - it's not hard to understand why kids with a history of NAS may not be performing as well as some of their peers."
The research team will continue to build on this work with the goal of teasing apart the factors that make a difference in long-term academic achievement through interviews with parents and guardians of school-aged children who have a history of prenatal opioid exposure and NAS to gain a deeper understanding of the day-to-day experiences that may promote or interfere with a child's success in school.
Other Penn State College of Medicine authors include Emily Wasserman and Eric Schaefer, biostatisticians on the project.
Funding from the National Institutes of Health's National Institute on Drug Abuse supported this work.
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