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Health and Neurodevelopment of Children Born to Opioid-Dependent Mothers at School Entry

Lee, Samantha J. PhD*; Pritchard, Verena E. PhD; Austin, Nicola C. DM; Henderson, Jacqueline M. T. PhD*; Woodward, Lianne J. PhD*,§

Journal of Developmental & Behavioral Pediatrics: August 01, 2019 - Volume Publish Ahead of Print - Issue - p
doi: 10.1097/DBP.0000000000000711
Original Article: PDF Only

Objective: To examine the school readiness of a regional cohort of prenatally methadone-exposed children across 5 domains and to examine factors contributing to impairment risk.

Methods: Data were drawn from a single-center, prospective longitudinal study. One hundred children born to women in methadone maintenance treatment and 110 randomly identified non–methadone-exposed children were studied from birth (2003–2008) to age 4.5 years. At 4.5 years, children underwent comprehensive assessment of their physical/motor development, social-emotional skills, approaches to learning, language development, and cognitive functioning. Predictors of children's overall school readiness were examined, including the extent of prenatal substance exposure (number and quantity of different substances), social risk, maternal mental health, infant clinical factors, and the quality of the home environment at age 18 months Home Observation for Measurement of the Environment (HOME) score.

Results: Methadone-exposed children had higher rates of delay/impairment across all outcome domains (odds ratios 4.0–5.3), with 72% impaired in at least 1 domain. Multiple problems were also common, affecting 48% of methadone-exposed children compared with 15% of control children. The mean number of school readiness domains impaired increased, with increasing prenatal substance exposure (rate ratio [RR] = 1.05 [1.01–1.11]), higher social risk (RR = 1.35 [1.20–1.53]), male sex (RR = 1.69 [1.27–2.25]), and lower HOME scores indicating a poorer quality postnatal environment (RR = 0.96 [0.94–0.99]).

Conclusion: Children born to opioid-dependent mothers are at high risk of impaired school readiness, with multiple domain problems being common. Impaired school readiness was associated with greater maternal prenatal substance use, higher social risk, male sex, and lower‐quality caregiving environments.

This article has supplementary material on the web site:

*Canterbury Child Development Research Group, School of Psychology, Speech and Hearing, University of Canterbury, Christchurch, New Zealand;

Institute of Learning Sciences and Teacher Education, Australian Catholic University, Brisbane, Australia;

Department of Paediatrics, University of Otago, Christchurch, New Zealand;

§Canterbury Child Development Research Group, School of Health Sciences, University of Canterbury, Christchurch, New Zealand.

Address for reprints: Lianne J. Woodward, PhD, School of Health Sciences, University of Canterbury, Private Bag 4800, Christchurch 8140, New Zealand; e-mail:

Disclosure: The authors declare no conflict of interest.

This research was funded from grants from Cure Kids, the Wayne Francis Trust, the New Zealand Lottery Grants Board, and the Health Research Council of New Zealand.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (

Received January 07, 2019

Accepted June 17, 2019

Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.