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Prenatal Opioid Exposure, Neonatal Abstinence Syndrome/Neonatal Opioid Withdrawal Syndrome, and Later Child Development Research

Shortcomings and Solutions

Jones, Hendrée E., PhD; Kaltenbach, Karol, PhD; Benjamin, Tara, MD; Wachman, Elisha M., MD; O’Grady, Kevin E., PhD

doi: 10.1097/ADM.0000000000000463

The opioid epidemic has brought with it an increasing focus on the incidence of Neonatal Abstinence Syndrome (NAS) (also known as Neonatal Opioid Withdrawal Syndrome) in neonates prenatally exposed to opioids, and recently, in the putative long-term effects of NAS on child development. The purpose of the present paper is three-fold: (1) outline shortcomings regarding the current research relating NAS to child development; (2) propose solutions to minimize these shortcomings; and (3) recommend an alternative conceptual framework to understanding developmental problems in later childhood presumed to be a result of NAS. The paper focuses on issues regarding definitions of the population of interest, choice of comparison groups, matching practices, statistical analyses, and an implicit single-cause fallacy related to NAS. It offers possible solutions to the problems identified in each of these areas. Use of a NAS or Neonatal Opioid Withdrawal Syndrome diagnosis as a main indicator of adverse developmental outcomes poses potential radiating harm to the child and the family and misses the opportunity to see the complexities of interpersonal, intrapersonal, and environmental factors that contribute to the long-term developmental trajectories of children.

UNC Horizons and Department of Obstetrics and Gynecology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC (HEJ); Departments of Psychiatry and Obstetrics and Gynecology, School of Medicine, Johns Hopkins University, Baltimore, MD (HEJ); Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA (KK); Department of Obstetrics & Gynecology, Division of Maternal-Fetal Medicine, Indiana University School of Medicine, Indianapolis, IN (TB); Department of Pediatrics, Boston Medical Center, Boston, MA (EMW); Department of Psychology, University of Maryland, College Park, College Park, MD (KEO’G).

Send correspondence to Hendrée E. Jones, PhD, UNC Horizons, 410 North Greensboro, Carrboro, NC 27510. E-mail:

Received 14 May, 2018

Accepted 22 August, 2018

The authors report no conflicts of interest.

© 2019 American Society of Addiction Medicine