Wouldn’t it be great if researchers collaborated with parents and caregivers just like you? The people who live with these resilient children day in and day out? That’s exactly what the authors of this study did. And by analyzing the data they collected, we can see trends in the developmental outcomes of opioid exposed children, who have transitioned from preschool to grade school and beyond.

Title: Developmental implications of prenatal opioid exposure among school-aged children: a mixed methods and community-initiated analysis

Published in BMC Public Health, September 2023

Summary in plain English :

Results of this study, which included 163 opioid exposed children, indicate the following:

• almost half of them have multiple developmental delays, behavioral health conditions, and specific learning difficulties

• about 85% face behavioral challenges

• negative outcomes in their development were not linked to the type of opioid their mothers used during pregnancy or whether their mothers used multiple substances

• more than 80% of the families mentioned positive qualities in their children, including, empathy, being socially friendly, and being able to bounce back from tough situations

The authors concluded, children born with prenatal opioid exposure may continue to face difficulties as they grow and start school. These findings align with previous research involving younger children, emphasizing the importance of developing effective ways to support and care for these children as they progress beyond the early stages of life.

Methodology:

This research project was initiated by the non-profit organization, "To The Moon And Back" (TTMAB). This community organization has been helping children and families affected by prenatal opioid exposure in Massachusetts and West Virginia since 2017. Child Trends partnered with TTMAB to gather data from the families they support.

To do this, a mixed methods approach was used, specifically a method that gives equal importance to both quantitative (numbers-based) and qualitative (descriptive) data. This approach helps avoid letting one type of data influence or limit the other. Data was collected through surveys and focus groups involving families in West Virginia and Massachusetts. The research aimed to answer several questions, including:

1. What are the effects of prenatal opioid exposure on a child's development, both positive and negative?

2. Do the developmental outcomes connected to prenatal opioid exposure differ based on the type of opioids or multiple substances used, while taking into account adverse childhood experiences?

3. What services do families with children affected by POE use, which ones are beneficial, and what services do they wish were available? (Question #3 data is not presented in this study)

Substance Exposures:

The children studied were exposed to various types of opioids, including illegal ones (74%), methadone or buprenorphine for medication assisted therapy (43%), opioids not prescribed to them (34%), and opioids prescribed by a doctor (11%).

A majority of these children (85%) were also exposed to other substances before they were born, typically around four additional substances on average. These additional substances included nicotine (94%), marijuana (89%), alcohol (76%), tranquilizers (71%), methamphetamines (66%), other stimulants (61%), and hallucinogens (24%).

When asked which trimester of pregnancy the child was exposed to these substances, most respondents said it was throughout the entire pregnancy. Only a few reported exposure during the first and second trimesters for alcohol, nicotine, and/or marijuana.

The rates of using multiple substances did not differ between pregnant individuals using legally prescribed opioids, methadone, or buprenorphine and those using non-prescribed or illegal opioids. Moreover, many pregnant individuals using methadone or buprenorphine were also exposed to illegal opioids.

Behavioral Issues and Tantrums:

The results from the survey's behavioral questions, give a better understanding of the complex behavioral and symptom profiles of the children in this study. They are based on what parents and caregivers have noticed and their opinions. Here's what the survey revealed:

• More than half of the respondents mentioned that their children exhibited behaviors like being impulsive (67%), having tantrums (60%), struggling with transitions (58%), showing aggression (57%), seeking or avoiding sensory input (57%), and having difficulty with changes in routine (55%).

• Among those who reported tantrums, nearly half (45%) said that the frequency of tantrums had increased in the past year.

• Children with sensory processing issues showed varying preferences for different sensory inputs. For instance, when it came to sensitivity to light, 60% of children avoided it, while 40% actively sought out light.

• There were more consistent patterns of sensory avoidance when it came to sound and clothing, and more consistent patterns of sensory-seeking behavior for physical touch.

• For smells and tastes, an equal number of children were reported to seek and avoid them.

In the focus group discussions, parents shared how these behavioral issues could manifest in their children. They described their children bouncing while sitting or banging their heads against walls to seek physical sensory input. Parents also mentioned that their children sometimes struggle to regulate their own behavior.

In responses to open-ended survey questions, parents mentioned that their children's tantrums were triggered by unusual things, such as feeling overwhelmed (for example, during baths, haircuts, or loud noises) and when their child couldn't complete a task. Some parents linked these tantrums to past experiences their children might have had.

About one-third of parents also reported that their children's tantrums could be aggressive or violent, involving actions like pushing, hitting, spitting, biting, kicking, head banging, hair pulling, breaking toys, or throwing things. Some parents even mentioned physical damage to their homes, like "the bedroom door has noticeable dents" and "my child has left bruises on me more than once."

Additionally, over 10% of parents described these tantrums as intense and unpredictable, with sudden shifts in mood from happiness to extreme anger in just seconds, and a complete loss of reasoning during tantrums, which made it necessary to ensure everyone's safety.

Conclusions:

As the use of opioids during pregnancy continues to increase, and research shows that children exposed to opioids before birth can face developmental challenges that extend into their school years, it's crucial for states to invest in services for these children and their families. This investment is essential as we await further medical research to provide clearer guidance.

While there are established best practices for caring for newborns with prenatal opioid exposure, there's currently a lack of such guidance for toddlers, preschoolers, and school-age children with this exposure, who often encounter significant difficulties. Without a clear roadmap for supporting these children throughout their growth, they are at risk of facing disparities in education and healthcare.

Parents have shared stories of their kindergartners being referred to juvenile justice programs for their behavior, children being diagnosed with oppositional defiance disorder, and caregivers mistreating them out of frustration. Instead of punishing these children for challenges beyond their control, we should focus on providing them and their families with support to help these resilient young individuals succeed. The more that educators and healthcare providers understand these children and how to assist them, the better it is for everyone involved.

Many thanks to the authors of this article: Wilkinson, A., Rackers, H.S. & Harmon, T.M.

The full report is accessible here: https://doi.org/10.1186/s12889-023-16702-8