Prenatal Exposure to Opiates, Illicit Substances Associated With ADHD, Autism in Offspring

Children exposed to opiates and a number of illicit substances while in utero had more mental health symptoms associated with attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorders (ASD) than children not exposed to those substances, according to research published in Substance Abuse: Research and Treatment.¹

Lisbeth Beate Sandtorv of the Department of Children and Adolescent Psychiatry at Haukeland University Hospital in Bergen, Norway, and colleagues evaluated a hospital-based population of 57 school-age children prenatally exposed to opiates and/or a number of illicit substances for mental health symptoms associated with ADHD and ASD using the Swanson, Nolan and Pelham Questionnaire revision IV (SNAP-IV) and the Autism Spectrum Screening Questionnaire (ASSQ) and compared the scores with those of a reference group of 171 children from the population-based Bergen Child Study.

Compared with the reference group, the investigators found significantly higher SNAP-IV scores associated with ADHD symptoms in both areas of inattention and hyperactivity/impulsivity, and also found higher ASSQ scores related to an increased number of symptoms associated with ASD among children exposed prenatally to opiates and illicit substances. Intelligence quotient (IQ) was the only available predictor of mental health outcomes in the exposed group of children that could explain variances in some of the mental health scales, and neonatal abstinence syndrome was a predictor of inattention.

The authors noted, however, that a previous study had found that adults with substance use disorder had a higher rate of ADHD symptoms, suggesting that ADHD was an independent risk factor for substance abuse.² Sandtorv and colleagues suggested the possibility that prenatally exposed children are genetically predisposed to ADHD, which could explain the increased number of ADHD symptoms in this group.¹

The mean level of symptoms associated with ASD was increased in exposed children as well, with more than one-third of exposed children having high ASSQ scores, mainly on the social difficulties subscale. The authors also noted that they found children with overlapping ADHD and ASD symptoms in the exposed group, lending support to the suggestion of neurodevelopmental vulnerability in exposed children.

The authors argue that the results of this study suggest that children prenatally exposed to substances should receive early mental health assessment.

References

1. Sandtorv LB, Fevang SKE, Nilsen SA, et al. Symptoms associated with attention deficit/hyperactivity disorder and autism spectrum disorders in school-aged children prenatally exposed to substances [published online March 22, 2018]. Subst Abuse. doi: 0.1177/1178221818765773
2. Sullivan MA, Rudnik-Levin F. Attention deficit/hyperactivity disorder and substance abuse. Diagnostic and Therapeutic Considerations. Ann NY Acad Sci. 2001;931:251-270.