Terri A Levine1, Lianne J Woodward2. 1. Department of Pediatric Newborn Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States. 2. Department of Pediatric Newborn Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States; Department of Psychology, University of Canterbury, Christchurch, New Zealand. Electronic address: ljwoodward@bwh.harvard.edu.
Abstract
BACKGROUND: Methadone maintenance is the most common method of treating opioid-dependent pregnant women. However, little is known about the impact of prenatal methadone exposure on child neurocognitive development. AIMS: To examine the early executive functioning of children born to methadone-maintained mothers, and to assess relations between executive functioning and later emotional and behavioral adjustment. STUDY DESIGN: Prospective longitudinal study. PARTICIPANTS: The sample consisted of 68 methadone-exposed children and 88 non-methadone-exposed children. OUTCOME MEASURES: At age 2years, children's inhibitory control and working memory were assessed using the Snack Delay and Three Boxes tasks. At 2 and 4.5years, their emotional and behavioral adjustment was assessed using the caregiver-completed Strengths and Difficulties Questionnaire. RESULTS: Methadone-exposed children had poorer inhibitory control than non-exposed children (p<0.0001). These differences were explained by maternal education and prenatal benzodiazepine use. With respect to working memory, although both groups performed similarly on the first trial set, non-exposed children significantly improved their performance on the second trial set (p=0.002), while methadone-exposed children did not (p=0.92). Inhibitory control at age 2years was predictive of higher conduct (p=0.001), hyperactivity (p=0.0001), peer relationship (p=0.02), and total (p<0.0001) problems at 4.5years even after adjustment for behavioral problems at 2years. CONCLUSIONS: Methadone-exposed children demonstrate difficulties with inhibitory control and possibly sustained attention/learning. These difficulties were explained by factors correlated with maternal prenatal methadone use. Longer-term follow-up of these children is needed to understand the effects of prenatal methadone exposure and related maternal factors on executive functioning and behavioral adjustment.
BACKGROUND:Methadone maintenance is the most common method of treating opioid-dependent pregnant women. However, little is known about the impact of prenatal methadone exposure on child neurocognitive development. AIMS: To examine the early executive functioning of children born to methadone-maintained mothers, and to assess relations between executive functioning and later emotional and behavioral adjustment. STUDY DESIGN: Prospective longitudinal study. PARTICIPANTS: The sample consisted of 68 methadone-exposed children and 88 non-methadone-exposed children. OUTCOME MEASURES: At age 2years, children's inhibitory control and working memory were assessed using the Snack Delay and Three Boxes tasks. At 2 and 4.5years, their emotional and behavioral adjustment was assessed using the caregiver-completed Strengths and Difficulties Questionnaire. RESULTS:Methadone-exposed children had poorer inhibitory control than non-exposed children (p<0.0001). These differences were explained by maternal education and prenatal benzodiazepine use. With respect to working memory, although both groups performed similarly on the first trial set, non-exposed children significantly improved their performance on the second trial set (p=0.002), while methadone-exposed children did not (p=0.92). Inhibitory control at age 2years was predictive of higher conduct (p=0.001), hyperactivity (p=0.0001), peer relationship (p=0.02), and total (p<0.0001) problems at 4.5years even after adjustment for behavioral problems at 2years. CONCLUSIONS:Methadone-exposed children demonstrate difficulties with inhibitory control and possibly sustained attention/learning. These difficulties were explained by factors correlated with maternal prenatal methadone use. Longer-term follow-up of these children is needed to understand the effects of prenatal methadone exposure and related maternal factors on executive functioning and behavioral adjustment.
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