These findings suggest that children born with NAS could have learning challenges in childhood and beyond. Data were linked to Tennessee Department of Education special education data during early childhood (3–8 years of age). A post hoc subanalysis was conducted to understand the educational disability referral pathway. This may be the result of the environment in which the baby grows up as well. This reinforces the need for both early and ongoing evaluation of children at a high risk of educational disabilities. Cognitive delays may affect a child’s intellectual functioning, interfering with awareness and causing learning difficulties that often become apparent after a child begins school. Infants with intrauterine opioid exposure might be at risk for adverse neurodevelopmental, cognitive, or behavioral outcomes. Because children in our analysis were born between 2008 and 2011, they were 3 to 8 years of age at the time that educational data were obtained. Adverse neurodevelopmental outcome of infants exposed to opiate in-utero. Researchers were not able to control for all factors that may increase a child’s risk for developmental delay or speech or language impairment. A developmental delay can happen in just one area or in a few. One such study revealed that, even when controlling for socioeconomic status, gestational age, and birth weight, children with prenatal exposure to opioids or other substances who were fostered or adopted had lower cognitive abilities than the control group. This study was approved by the Tennessee Department of Health Institutional Review Board and determined to be an evaluation or a control of a public health problem by the Centers for Disease Control and Prevention. A developmental delay means that a child does not reach certain milestones, such as the ability to roll over, sit up independently, walk, speak, interact, etc., within the broad range of what is considered normal for his age. FINANCIAL DISCLOSURE: The authors have indicated they have no financial relationships relevant to this article to disclose. Increasing incidence and geographic distribution of neonatal abstinence syndrome: United States 2009 to 2012 [published correction appears in, Opioid Use in Pregnancy, Neonatal Abstinence Syndrome, and Childhood Outcomes Workshop Invited Speakers. Developmental disabilityis estimated to occur in 5-10% of the population with enormous psychological, emotional, and economic impact on the affected individuals and society. We performed a novel analysis by linking health and education data sets and demonstrated that children with a history of NAS were significantly more likely to be referred for evaluation of an educational disability, to meet criteria for an educational disability, and to receive therapies or services for educational disabilities. Despite the increasing incidence of NAS worldwide, data regarding the long-term outcomes of intrauterine opioid exposure are limited and inconsistent.5 Several studies have revealed that infants with intrauterine exposure to opioids might be at an increased risk for neurodevelopmental problems or adverse cognitive, psychomotor, and behavioral outcomes; however, the quantifiable impact on these children, their families, and society is less understood.6,7. Prescription opioid analgesics rapidly change the human brain. It can be diagnosed when a child is delayed in one or more milestones, categorised into motor skills, speech, cognitive skills, and social and emotional development. Saving Lives, Protecting People, https://www.marchofdimes.org/baby/neonatal-abstinence-syndrome-(nas).aspx, Centers for Disease Control and Prevention, Treatment Before, During, and After Pregnancy, Identifying Babies Born Exposed to Opioids, U.S. Department of Health & Human Services. Preliminary findings on neuropsychological and personality functioning in young drug addicts exposed to drugs early. In Tennessee, NAS is an automatically qualifying diagnosis for early intervention services.39 Early intervention services are the precursor to special education services for children <3 years of age; however, the proportion of all children with a history of NAS who undergo evaluation for early intervention is unclear. Researchers linked birth certificate data of children born with NAS and children born without NAS to Tennessee Department of Education data to track special education service use during early childhood (3-8 years of age). Receive classroom support or speech therapy. Academic failure in secondary school: the inter-related role of health problems and educational context. Children with cognitive delays may also have difficulty communicating and playing with others.This type of delay may occur in children who have experienced a brain injury due to an infection, such as meningitis, which can cause swelling in the brain known as encephalitis. They can range from minor to something more significant. Because children in our analysis were born between 2008 and 2011, they were 3 to 8 years of age at the time of the linkage to educational data. Identifiers from the matched data set were provided to the Tennessee Department of Education for linkage (first name, last name, and date of birth) to special education data through November 2016 (Fig 1). All P values were 2-sided and were considered statistically significant if P < .05. Developmental delay can be temporary or permanent — persistent developmental delays are also called developmental disabilities and can be signs of more serious conditions such as cerebral palsy or developmental disorders that include autism, intellectual disability and hearing impairment. Development delay is a condition when a child is unable to reach particular developmental milestones like talking or walking within normal age range. The scope of our analyses did not facilitate further stratification to assess our outcome of interest (educational disability) related to the source of maternal opioid exposures. Delays may occur in the areas of motor function, speech and language, cognitive, play, and social skills. These findings were sustained in a multivariable analysis, with multiple models controlling for maternal tobacco use, maternal education status, birth weight, gestational age, and/or NICU admission. Finally, because of regional variation in school systems, the groups were matched by region of residence at birth. Then it improves … Specific drugs have been linked to specific problems in the baby. Children in Tennessee with a history of NAS were significantly more likely to be referred for evaluation of a possible educational disability, to meet criteria for an educational disability, and to receive school-based therapies or services for educational disabilities. Prenatal methadone exposure is associated with altered neonatal brain development. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. Conditional Multivariable Logistic Regression Used To Analyze Special Education Outcomes of Children With a History of NAS (N = 1815) and Children Without a History of NAS (N = 5441), Various Conditional Multivariable Logistic Regression Models Used To Analyze Special Education Outcomes of Children With a History of NAS (N = 1815) and Children Without a History of NAS (N = 5441). NAS is a serious withdrawal syndrome that … In severe ID (as defined in DSM-5), an identifiable cause was detected in up to 80% of cases [4][5]. This is called developmental monitoring. Developmental delay can show up in the way children move, communicate, think and learn, or behave with others. A study from the Tennessee Department of Health, supported by the Centers for Disease Control and Prevention (CDC) and March of Dimes, found that children born with neonatal abstinence syndrome (NAS) were more likely to have a developmental delay or speech or language impairment in early childhood compared to children born without NAS. A limited number of researchers had access to identified data for the data linkage, and a deidentified data set was used for analysis. Discover the causes, how delays compare to autism, and more. Developmental delay and speech or language impairment were the most common reasons for children with NAS to receive special education. Pregnant women are eligible for TennCare if their annual (yearly) income is ≤195% of the federal poverty level.13 To ensure a comparison of children of similar ages, the groups were matched by age. Neonatal abstinence syndrome (NAS) is a postnatal drug withdrawal syndrome that can occur after intrauterine opioid exposure. Thank you for your interest in spreading the word on American Academy of Pediatrics. Developmental milestones are skills and activities that most children can do at a certain age, like sitting, walking, talking, having social … 36 percent more likely to meet their state's criteria for educational disability. TennCare enrollment status was used as a proxy for socioeconomic status; children born to women who are eligible for Medicaid are automatically eligible for 1 year after birth. Effects of prenatal cocaine and heroin exposure on neuronal dendrite morphogenesis and spatial recognition memory in mice. Developmental delay might be short term, or it might be the first sign of a long-term problem. Children can be referred for evaluation of a possible educational disability beginning at 3 years of age; the referral can be initiated through early intervention services, the school system, a health care provider, or a parent. [epub ahead of print], Centers for Disease Control and Prevention. Diagnoses of developmental delay and speech or language impairment can be applied broadly in younger-aged children to encompass other more precise syndromes (autism spectrum disorder, intellectual disability, and learning disability), which can be diagnosed when a child is older. A conditional multivariable logistic regression was conducted to assess the associations observed during the univariate analysis (Table 3). Even without neonatal abstinence syndrome, prenatal drug exposure can be related to later developmental delay. A developmental delay is more than just being “slower to develop” or “a little behind.” It means a child is continually behind in gaining the skills expected by a certain age. We used data from Tennessee’s health and education administrative databases for children who were born in Tennessee between 2008 and 2011. This question is for testing whether or not you are a human visitor and to prevent automated spam submissions. Educational disabilities of neonatal intensive care graduates. Trends in the prevalence of developmental disabilities in US children, 1997-2008. These findings support the need for more studies to better understand the longer-term effects for children born with NAS. Global developmental delay is an umbrella term used when children are significantly delayed in their cognitive and physical development. Fill, MD, Communicable and Environmental Diseases and Emergency Preparedness, Tennessee Department of Health, 710 James Robertson Pkwy, 4th Floor, Andrew Johnson Tower, Nashville, TN 37243. Neonatal withdrawal syndrome: reaching epidemic proportions across the globe. At the age of 5 (est: −1.788, p < .001), children with a history of NAS had a decreased log odds of developing language delays than those without NAS.Conversely, compared with age 1, at the age of 10 (est: 1.098 p < .001), children with a history of NAS had an … Early intervention in low birth weight premature infants: results at 18 years of age for the Infant Health and Development Program. Effects of early intervention on intellectual and academic achievement: a follow-up study of children from low-income families. Children with NAS were compared to a group of kids that matched in age, socioeconomic status and gender on the National Assessment Program: Literacy and Numeracy in third, fifth, and seventh grades. Long-term effects of early childhood programs on cognitive and school outcomes. To better understand the associations between NAS and educational outcomes, 3 primary special education outcome measures were assessed: (1) referral for evaluation of a possible educational disability, (2) results of the eligibility determination, and (3) receipt of therapies or services. Discover Pediatric Collections on COVID-19 and Racism and Its Effects on Pediatric Health. Appropriate referrals for evaluation of needs for early intervention or special education services (with the first evaluation occurring before school age) are critical. In all models, the significant findings for all 3 primary special education outcome measures were sustained in a multivariable analysis. Increased awareness of available services and the importance of early referral from families and caregivers as well as health care providers, case managers, social workers, and other key stakeholders are vital to improving referral rates and outcomes for this vulnerable population. Opioid use in pregnancy, neonatal abstinence syndrome, and childhood outcomes: executive summary of a joint workshop by the Eunice Kennedy Shriver National Institute of Child Health and Human Development, American College of Obstetricians and Gynecologists, American Academy of Pediatrics, Society for Maternal-Fetal Medicine, Centers for Disease Control and Prevention, and the March of Dimes Foundation. Although further study is needed to better understand the underlying mechanisms for these neurologic changes and their quantifiable effects, much of the current evidence reveals consistent findings. Hearing problems are also commonly related to delayed speech, which is why a child’s hearing should be tested by an audiologist whenever there’s a speech concern. Although medication-assisted treatment can be associated with NAS, pregnant women who undergo treatment of opioid use disorder with medication-assisted treatment can make plans to deliver at a health care facility that is prepared to monitor, evaluate for, and treat NAS, if needed.26–28, Lack of educational success places children at a higher risk for mental and physical illness, substance abuse, unemployment, and other adverse outcomes later in life.16,29 Individual and population-level data reveal that poor academic performance can undermine occupational and educational trajectories into adulthood as well as mortality, marriage, and unemployment rates.29 Considerable resources are available to infants and children who might be at risk for developmental delay or disability through developments in the Individuals with Disabilities Education Act. A total of 1815 children with a history of NAS and 5441 children without a history of NAS were analyzed. Studies have shown that developmentally delayed children who are recognized at an early age receive more developmental optimization and greater gains than those who are identified later in life. Univariate Analysis of Special Education Outcomes of Children With a History of NAS (N = 1815) and Children Without a History of NAS (N = 5441). Children were excluded from this analysis if their educational disability was “intellectually gifted.”. It is said to affect about 1-3% of children in the world. Early recognition of children with developmental problems is therefore important. The categories of etiological diagnosis and proportion of diagnostic yield for the most common diagnoses are presented in Table 2. Prevalence of developmental delays and participation in early intervention services for young children. Special education disabilities of developmental delay and speech or language impairment were more likely to be diagnosed among children with a history of NAS, and accommodations or speech therapy services were more likely to be received. Consistent with the univariate analysis, the odds of a diagnosis of developmental delay (aOR: 1.34; 95% CI: 1.03–1.76) and speech or language impairment (aOR: 1.26; 95% CI: 1.04–1.52) were higher for children with a history of NAS. Linking to a non-federal website does not constitute an endorsement by CDC or any of its employees of the sponsors or the information and products presented on the website. We were also unable to control for some factors in the logistic regression that have been revealed in previous studies to increase the risk of NAS.14 Finally, we were unable to verify the diagnostic coding of NAS or stratify our results on the basis of NAS severity; therefore, some children in our analysis might have had iatrogenic withdrawal or mild withdrawal symptoms. Our analysis indicates that children with a history of NAS are developmentally vulnerable and more likely to have educational disabilities in early childhood. Prenatal exposure to methadone and buprenorphine: a review of the potential effects on cognitive development. Parental substance abuse as an early traumatic event. Our results revealed that children with a history of NAS were more likely to be referred for evaluation of an educational disability, to meet criteria for an educational disability, and to receive special education therapies or services. Lastly, 15.3% of children with a history of NAS received therapies or services, compared with 11.4% of children without a history of NAS. Do maternal opioids reduce neonatal regional brain volumes? CDC guideline for prescribing opioids for chronic pain - United States, 2016 [published correction appears in. In addition to controlling for the matching factors, the regression model controlled for maternal education status as a proxy for socioeconomic status and because previous studies have revealed that lower maternal education is associated with a higher prevalence of developmental disabilities,9–12,14 as well as for maternal tobacco use during pregnancy, because this increases the risk of NAS development.15 Additional models were constructed, controlling for the aforementioned factors, low birth weight, preterm birth, or NICU admission. E-mail: Copyright © 2018 by the American Academy of Pediatrics. Fill and her colleagues found that, compared with kids without the syndrome, Tennessee children born with NAS were: 44 percent more likely to be referred for evaluation of potential developmental delays. In addition, children with a history of NAS in grade 7 scored lower on standardized tests than children in grade 5 who were an average of 2 years younger. There are four areas of developmental delay: speech, cognition, social, and motor skills. CDC is not responsible for Section 508 compliance (accessibility) on other federal or private website. Longitudinal cognitive development of children born to mothers with opioid and polysubstance use. Our analysis has several limitations. All children with developmental delay still have the potential to learn and develop. You will be redirected to aap.org to login or to create your account. The phrase "developmental delay" uttered by a pediatrician at a benign well-child visit is, of course, scary for a parent. However, school systems in areas with high rates of NAS might also have a greater demand for therapies and services. In Singapore, KK Women’s and Children’s Hospital (KKH) has seen 300 to 400 mild to severe cases of GDD per year over the last three years. Fill MA, Miller AM, Wilkinson R, Warren MD, Dunn JR, Schaffner W, and Jones TF. When more than one of these areas is affected, it might be called global developmental delay. However, children with a history of NAS were significantly more likely to be born with a low birth weight (<2500 g [24.0% vs 9.2%; P < .0001]), to be born preterm (<37 weeks’ gestation [21.6% vs 11.5%; P < .0001]), and more likely to have been admitted to the NICU (20.9% vs 5.8%; P < .0001; Table 1). These findings persisted into school age and indicate that children with prenatal exposure to opioids can be at risk even when living in low-risk, stable environments.25, There is a risk of development of NAS for any infant who is exposed to opioids in utero, whether through prescription medications (obtained legally or through diversion), illicit drugs, or opioid-agonist medication–assisted treatment. The impact of low birth weight, perinatal conditions, and sociodemographic factors on educational outcome in kindergarten. We performed a novel analysis by linking health and education data sets to examine special education outcomes of children with a history of NAS in the United States. Children with a history of NAS had significantly higher odds of being referred for evaluation of a possible educational disability (adjusted odds ratio [aOR]: 1.44; 95% confidence interval [CI]: 1.23–1.67), qualifying for an educational disability (aOR: 1.36; 95% CI: 1.15–1.60), and receiving therapies or services (aOR: 1.37; 95% CI: 1.16–1.61). Every child with developmental delay present differently. Adverse neurobehavioral outcomes have been documented in infants with NAS; however, educational outcomes have not been thoroughly examined. Tennessee Division of Health Care Finance and Administration, Relational, Emotional, and Pragmatic Attributes of Ethics Consultations at a Children’s Hospital, Verbal Autopsies for Out-of-Hospital Infant Deaths in Zambia, Uncertainty at the Limits of Viability: A Qualitative Study of Antenatal Consultations, Follow American Academy of Pediatrics on Instagram, Visit American Academy of Pediatrics on Facebook, Follow American Academy of Pediatrics on Twitter, Follow American Academy of Pediatrics on Youtube, Racism and Its Effects on Pediatric Health, www.pediatrics.org/cgi/content/full/129/2/e540, https://hit.health.tn.gov/birthrateform.aspx, www.pediatrics.org/cgi/content/full/104/6/e74, https://www.tn.gov/tenncare/members-applicants/eligibility/categories.html, https://www.asam.org/docs/default-source/practice-support/guidelines-and-consensus-docs/asam-national-practice-guideline-supplement.pdf, https://www2.ed.gov/about/reports/annual/osep/2016/parts-b-c/38th-arc-for-idea.pdf, www.nectac.org/∼pdfs/pubs/outcomesofearlyintervention.pdf, http://ectacenter.org/∼pdfs/eco/OutcomesforChildren-FFY2011.pdf, www.pediatrics.org/cgi/content/full/121/6/e1503, https://www.tn.gov/education/early-learning/tennessee-early-intervention-system-teis/teis-eligibility.html, https://www.tn.gov/content/dam/tn/tenncare/documents/TennCareNASData2015.pdf.