Prenatal drug exposure and the conceptualization of long-term effects

Maternal substance use disorder predicting children's emotion regulation in middle childhood: the role of early mother-infant interaction

Background

Maternal prenatal substance use disorder (SUD) represents a dual risk for child wellbeing due to teratogenic impacts and parenting problems often inherent in SUD. One potential mechanism transferring this risk is altered development of children's emotion regulation (ER). The present study examines how mother's prenatal SUD and early mother-infant interaction quality predict children's ER in middle childhood.

Method

The participants were 52 polysubstance using mothers and 50 non-users and their children. First-year mother-infant interaction quality was assessed with the Emotional Availability (EA) Scales and children's ER with the Children's Emotion Management Scales (CEMS), and its parent version (P-CEMS) at 8–12 years.

Results

Mother's prenatal SUD predicted a low level of children's adaptive ER strategies, whereas early mother-infant interaction problems predicted a high level of emotion dysregulation. The dyadic interaction also mediated the effect of SUD on emotion dysregulation. In the SUD group, more severe substance use predicted high emotion inhibition.

Conclusion

Early mother-infant interaction quality is critical in shaping children's ER, also in middle-childhood. Interventions aimed for mothers with prenatal SUD should integrate parenting components to support the optimal development of multiply vulnerable children.

Child Effects on Parental Negativity: The Role of Heritable and Prenatal Factors

This study examined two possible mechanisms, evocative gene-environment correlation and prenatal factors, in accounting for child effects on parental negativity. Participants included 561 children adopted at birth, and their adoptive parents and birth parents within a prospective longitudinal adoption study. Findings indicated child effects on parental negativity, such that toddlers' negative reactivity at 18 months was positively associated with adoptive parents' over-reactive and hostile parenting at 27 months. Furthermore, we found that child effects on parental negativity were partially due to heritable (e.g., birth mother [BM] internalizing problems and substance use) and prenatal factors (e.g., BM illicit drug use during pregnancy) that influence children's negative reactivity at 18 months. This study provides critical evidence for "child on parent" effects.

COGNITIVE AND SOCIOEMOTIONAL FUNCTIONING AT 4½ YEARS IN CHILDREN BORN TO MOTHERS WHO HAVE RECEIVED TREATMENT FOR SUBSTANCE-ABUSE PROBLEMS WHILE PREGNANT

Cognitive and socioemotional functioning at 4½ years of age were examined in children born to mothers with substance-abuse problems (n = 22) recruited from residential treatment institutions while pregnant, and then compared to children born to mothers with mental health problems (n = 18) and children from a low-risk group (n = 26). No significant group differences in cognitive functioning were found, but the children born to mothers with substance-abuse problems showed more caregiver-reported socioemotional problems than did the low-risk children, like the children born to mothers with mental health problems. Birth weight had an effect on internalizing problems at 4½ years and mediated the relation between group and socioemotional problems, although not when controlling for caregiver education, single parenthood, and anxiety and depression. At 4½ years, 7 children born to mothers with substance-abuse problems were placed in foster care. These children had lower birth weight and higher caregiver-rated internalizing problems. In addition to emphasizing the importance of the quality of the prenatal environment, this study suggests that families with previous substance abuse are in need of long-term follow-up to address socioemotional problems and enhance further positive child cognitive development. The foster-placed children may be in particular need of long-term follow-up.

Symptoms Associated With Attention Deficit/Hyperactivity Disorder and Autism Spectrum Disorders in School-Aged Children Prenatally Exposed to Substances

Prenatal exposure to substances may influence a child's neurodevelopment and impact on subsequent mental health. In a hospital-based population of school-aged children prenatally exposed to opiates and a number of illicit substances (n = 57), we evaluated mental health symptoms associated with attention deficit/hyperactivity disorder (ADHD) and autism spectrum disorders (ASD) using the Swanson, Nolan, and Pelham Questionnaire, revision IV (SNAP-IV) and the Autism Spectrum Screening Questionnaire (ASSQ) and compared the scores to a reference group which comprised children from the population-based Bergen Child Study (n = 171). Prenatally exposed children had significantly higher SNAP-IV scores associated with ADHD symptoms in both areas of inattention and hyperactivity/impulsivity and also reported a higher ASSQ score related to an increased number of symptoms associated with ASD, compared with the reference group. Of tested predictors of mental health outcomes in the exposed group, the intelligence quotient was a strong predictor of most mental health outcomes, and neonatal abstinence syndrome was a predictor of inattention. In conclusion, prenatally exposed children had more mental health symptoms associated with ADHD and ASD, compared with the reference group.

Care and supportive measures in school-aged children with prenatal substance exposure

AIMS

Prenatal exposure to substances, including alcohol, opiates, and a number of illicit drugs, may have a negative impact on fetal development. Studies have shown that substance exposure can influence a child's neurodevelopment and the need for care and supportive measures. In this study, we aimed to investigate the care status and the level of supportive measures in school-aged children prenatally exposed to alcohol and other substances.

METHODS

This study included children aged between 6 and 14 years who were referred to Haukeland University Hospital in Norway with developmental impairment and a history of prenatal substance exposure. Participants were classified according to their main prenatal exposure to either alcohol or other substances. Information on care status and supportive measures was obtained from medical records and participants' caregivers. We also compared the use of supportive measures for children placed into foster care before and after 1 year of age.

RESULTS

A total of 111 (87% of 128 referrals) eligible children participated in the study. Of these 111 children, 96 (86%) were in foster care, of whom 29 (30%) were placed into foster care during their first year of life and 83 out of 90 (92%) had supportive measures, including reinforced foster care and school or social support.

CONCLUSIONS

A high proportion of the sample lived in foster care and received supportive measures. Findings may reflect an increased need of care and support in school-aged children with prenatal substance exposure, highlighting the importance of awareness among caregivers and public agencies.

Neonatal abstinence syndrome and the gastrointestinal tract

Development of a healthy gut microbiome is essential in newborns to establish immunity and protection from pathogens. Recent studies suggest that infants who develop dysbiosis may be at risk for lifelong adverse health consequences. Exposure to opioid drugs during pregnancy is a factor of potential importance for microbiome health that has not yet been investigated. Since these infants are born after an entire gestation exposed to mu opioid receptor agonists and have severe gastrointestinal and neurological symptoms, we hypothesize that these infants are at risk for dysbiosis. We speculate that opioid exposure during gestation and development of NAS at birth may lead to a dysbiotic gut microbiome, which may impair normal microbiome succession and development, and impact future health of these children.

Psychological Distress Among School-Aged Children with and Without Intrauterine Cocaine Exposure: Perinatal Versus Contextual Effects

Whether intrauterine cocaine exposure (IUCE) explains unique variance in psychiatric functioning among school age children, even after controlling for other biological and social risk factors, has not been fully delineated. As part of a longitudinal birth cohort study of children with and without IUCE, we conducted and analyzed data based on structured clinical interviews with 105 children (57% male) and their caregivers when the child was approximately 8.5 years old; 47% of the children had experienced IUCE. Interviews included past and current major psychological disorders and sub-threshold mental health symptoms. Potential covariates were ascertained by interviews of birth mothers and other caregivers from shortly after the child's birth until the 8.5-year visit. More than one-third of children met DSM-IV criteria for one or more mood, anxiety, attention deficit, or disruptive behavior disorders. IUCE was not significantly associated with children's history of psychological distress, in either bivariate or multiple logistic regressions. In contrast, birth mothers' acknowledgement of greater psychiatric distress at baseline and higher levels of alcohol consumption during pregnancy, and at 8.5 years caregivers' reports of their own psychological distress, and children's lower IQ were predictors of higher rates of psychological morbidity. Findings are consistent with prior reports suggesting that, regardless of IUCE status, children from low-income, urban backgrounds are at heightened risk for psychological distress. Results underscore the need for closer monitoring of the mental health of children living in low-income households, with or without intrauterine substance exposures, to facilitate access to appropriate services.

Long-Term Outcomes of Infants with Neonatal Abstinence Syndrome

Parents of infants with neonatal abstinence syndrome (NAS) in the NICU may have questions about the long-term consequences of prenatal exposure to methadone, both asked and unasked. Although the signs of withdrawal will abate relatively quickly, parents should be aware of potential vision, motor, and behavioral/cognitive problems, as well as sleeping disturbances and ear infections so their infants can be followed closely and monitored by their pediatrician with appropriate referrals made. Furthermore, this knowledge may inspire parents to enroll their infants in an early intervention program to help optimize their outcomes. There are still many unanswered questions about epigenetic consequences, risk for child abuse/neglect, and risk of future substance abuse in this population.

Methodological Issues in Assessing the Impact of Prenatal Drug Exposure

Prenatal drug exposure is a common public health concern that can result in perinatal complications, birth defects, and developmental disorders. The growing literature regarding the effects of prenatal exposure to specific drugs such as tobacco, alcohol, cocaine, and heroin is often conflicting and constantly changing. This review discusses several reasons why the effects of prenatal drug exposure are so difficult to determine, including variations in dose, timing, duration of exposure, polydrug use, unreliable measures of drug exposure, latent or “sleeper” effects, genetic factors, and socioenvironmental influences. In addition to providing research guidelines, this review also aims to help clinicians and policy makers to identify the strengths and weaknesses in studies investigating the effects of prenatal drug exposure. This knowledge may be used to make better informed decisions regarding the appropriate treatment for pregnant, drug-dependent women and their children.

Child neuroanatomical, neurocognitive, and visual acuity outcomes with maternal opioid and polysubstance detoxification

BACKGROUND

Maternal opioid and polysubstance use during pregnancy is associated with an increased risk of child neurocognitive and visual problems and neuroanatomical differences. We hypothesized that, in contrast to findings from a previous study of children born to mothers not detoxified, children born to detoxified mothers would not show gross neuroanatomical and neurocognitive differences.

METHODS

Mothers with opioid and polysusbstance abuse problems and their infants (n = 11 + 12) were recruited from residential treatment institutions. Comparison mothers and infants (n = 12 + 12) were recruited from child health centers. The studies were approved by the Regional Committee of Medical Research Ethics. Children had magnetic resonance imaging scanning, neurocognitive, and visual acuity testing at 4.5 years. Neuroanatomical, cognitive, and visual acuity characteristics were compared across groups by analysis of variance and general linear models.

RESULTS

There were no significant differences across groups in neuroanatomical volumes, or cortical thickness, area, or volume. There were no differences in general neurocognitive functioning, but significantly lower left eye visual acuity, and a trend toward lower binocular visual acuity, in the drug-exposed relative to the comparison group.

CONCLUSIONS

The present study does not demonstrate gross differences relative to a comparison group in neuroanatomical and general neurocognitive characteristics of children born to mothers with opioid and polysubstance abuse who were detoxified during pregnancy. However, visual acuity was significantly lower in the drug-exposed group, requiring attention. There is a pressing need for additional and larger studies of long-term and specific child outcomes in this at-risk group.

Longitudinal development of mother-infant interaction during the first year of life among mothers with substance abuse and psychiatric problems and their infants

The quality of mother-infant interaction during the first year may be hampered by maternal substance abuse and co-existing non-optimal factors such as psychiatric problems and difficult relational experiences. In the present study three groups of women were recruited during pregnancy: One group with substance abuse problems from residential treatment centers (n = 28), a second group from psychiatric outpatient treatment centers (n = 22), and a third group from well-baby clinics (n = 30). Four maternal optimality indexes were assessed (substance abuse, psychiatric problems, relational experiences and SES). Mother-infant interaction was observed at 3 and 12 months. The substance abuse group showed the most disturbed mother-infant interaction at 12 months. Low maternal optimality as well as impairments in maternal affective involvement at 3 months influenced negatively both on infant and dyadic affective behavior in interaction at 12 months. Long-term interventions are needed to promote affective reciprocity among mother-baby pairs with low optimality.

Cognitive, emotional and social development in adolescents born to substance using women

The aim of this article is to investigate the long-term developmental consequences of being born to a substance-using mother, focusing on cognitive functions, attention, emotional and social development. The longitudinal sample comprised 48 adolescents aged 12-16 at the time of follow-up assessments, which included the Wechsler Intelligence Scale for Children-III, the Test of Everyday Attention for Children, The Tower of London test and the Strengths and Difficulties Questionnaire. The adolescents scored significantly lower than the norms on Wechsler's subtests and Full-Scale IQ, and on The Everyday Attention test. There were few differences on the Strengths and Difficulties Questionnaire. The girls reported significantly more hyperactivity than the British norms, and the teachers reported higher impact scores in boys, compared to the British norms. Thus, the results on cognitive consequences of maternal substance use appear to be very substantial while the emotional and social consequences do not. The results suggest serious negative effects of substance exposure in utero on attention and cognitive functioning in general.

Neurobehavioural development of preschool-age children born to addicted mothers given opiate maintenance treatment with buprenorphine during pregnancy

AIM

To study the neurobehavioural development and somatic growth of children at preschool-age born to opioid-addicted mothers given opiate maintenance treatment (OMT) with buprenorphine during pregnancy.

METHODS

Twenty-eight children, whose 21 opiate-addicted mothers were treated with OMT during pregnancy and accepted participation to the study, went through a battery of neurobehavioural tests (WPPSI-R, McCarthy, BROWN and SDQ). Twenty-five children fulfilled the tests at an age of 5-6 years.

RESULTS

The children showed evidence of serious visual motor and attention problems in the field of performance (WPPSI-R scales) and major problems in the field of motor skills and memory abilities (McCarthy Scales). The results of behavioural tests also showed significantly elevated levels of hyperactivity, impulsivity and attention problems on the attention deficit hyperactivity disorder (ADHD) scale in BROWN and in SDQ tests estimated by the teachers, while the parents estimated no problems for their children. Regarding the outcomes, there were no significant differences in terms of neonatal abstinence syndrome, gender or socio-economic factors. The somatic growth of the children corresponded to the mean values of the normal population in weight, length and head circumference at birth and at preschool-age, respectively.

CONCLUSION

Children to opiate-addicted mothers with buprenorphine maintenance treatment during pregnancy constitute a risk population, which should be recognized before start of the school. Whether the effects are associated with buprenorphine exposition during foetal life or not are discussed and need further investigation.

Neural tract development of infants born to methadone-maintained mothers

The early cerebral connective tract development of infants born to methadone-maintained mothers and comparison infants was examined using diffusion tensor imaging. Drawing on animal models, we hypothesized higher mean diffusivity in methadone-exposed infants, corresponding to the delayed or altered maturation of neural connective tracts. Thirteen methadone-exposed infants and seven comparison infants were scanned within 13-44 days after birth. Mean diffusivity was compared across groups voxelwise throughout a common white matter skeleton defined for the sample, and in probabilistically defined tracts of interest overlapping the skeleton, i.e., the superior and inferior longitudinal fasciculi. Higher mean diffusivity (P < 0.05) in methadone-exposed infants was evident in the superior longitudinal fasciculus regionally by voxelwise analysis and whole-tract analysis. These results are preliminary, given the small sample. However, all observed effects were in the hypothesized direction, with methadone-exposed infants exhibiting higher mean diffusivity, suggesting altered maturation of connective tracts. Such differences may underlie some of the increased risk for cognitive and behavioral difficulties in children born to mothers using opioids. These findings highlight the need for further assessments of the effects of prenatal methadone exposure on neural development.

Substance use during pregnancy and postnatal outcomes

Substance exposure in utero has been associated with physical birth defects and increased risk of regulatory and neuropsychological difficulties. The aims of this study were to describe women who use substances and are in treatment with respect to the type and number of substances used during pregnancy, as well as their background, and to examine the effect substance use has on gestational age, birth weight, and the development of neonatal abstinence syndrome at birth. A sample of 161 pregnant women and their 163 newborn children were included. The results indicate that the children whose mothers continued to use substances throughout their pregnancies were born at a lower gestational age (Chi-Square = 15.1(2), P < .01); children exposed to poly-substances in utero were more affected than those exposed to only alcohol and those with no substance exposure. The same children were more vulnerable to the development of neonatal abstinence syndrome at birth (Chi-Square = 51.7(2), P < .001). Newborns who were exposed primarily to alcohol in utero were at a significant risk of being born with low birth weight (Chi-Square = 8.8(2), P < .05) compared with those exposed to other types of substances. More than 50% of the mothers ceased using any substances (with the exception of tobacco) by birth, indicating that the treatment program did have an interventional effect on the mothers. The mothers' ability to either cease or decrease the use of substances during pregnancy appears to have direct positive effect on their newborns.

Substance exposure in utero and developmental consequences in adolescence: a systematic review

BACKGROUND

The impacts of maternal substance use have been observed in both research and clinical experience. Several studies have shown that preschool children are at heightened risk of developing various cognitive, behavioral, and socioemotional difficulties. Most knowledge has been generated concerning alcohol consumption during pregnancy and the postnatal effects thereof. Less is known about substance use other than alcohol (for instance, opiates, marijuana, and cocaine) during pregnancy and the long-term developmental consequences.

OBJECTIVE

The aims of this review are to identify relevant published data on adolescents who have been exposed in utero to alcohol and/or other substances and to examine developmental consequences across functions and mental health at this point in life.

METHODS

PubMed, Embase, and PsychInfo were searched for publications during the period of 1980-2011 and titles and abstracts selected according to prespecified broad criteria.

RESULTS

Twenty-five studies fulfilled all of the specific requirements and were included in this review. Most research covered prenatal alcohol exposure. Other substances, however, included cocaine, marijuana, opiates, and poly-substances. Results showed that prenatal exposure to alcohol has long-term cognitive, behavioral, social, and emotional developmental consequences depending on amount and timing of exposure in utero. Less evidence exists for long-term consequences of exposure in utero to other substances than alcohol. However, recent brain-imaging studies have provided important evidence of serious effects of other substance exposure on the developing brain and recent follow-up studies have found an association with deficits in language, attention, areas of cognitive performance and delinquent behavior in adolescence.

Adolescents with and without gestational cocaine exposure: Longitudinal analysis of inhibitory control, memory and receptive language

Preclinical studies of gestational cocaine exposure (GCE) show evidence of changes in brain function at the anatomical, physiological, and behavioral levels, to include effects on developing dopaminergic systems. In contrast, human studies have produced less consistent results, with most showing small effects or no effects on developmental outcomes. Important changes in brain structure and function occur through adolescence, therefore it is possible that prenatal cocaine exposure has latent effects on neurocognitive (NC) outcome that do not manifest until adolescence or young adulthood. We examined NC function using a set of 5 tasks designed to tap 4 different systems: inhibitory control, working memory, receptive language, and incidental memory. For each NC task, data were collected longitudinally at ages 12, 14.5 and 17 years and examined using generalized estimating equations. One hundred and nine children completed at least two of the three evaluations. Covariates included in the final model were assessment number, gender, participant age at first assessment, caregiver depression, and two composites from the Home Observation for Measurement of the Environment (HOME), Environmental Stimulation and Parental Nurturance. We found no cocaine effects on inhibitory control, working memory, or receptive language (p=0.18). GCE effects were observed on incidental face memory task (p=0.055), and GCE by assessment number interaction effects were seen on the incidental word memory task (p=0.031). Participant performance on inhibitory control, working memory, and receptive language tasks improved over time. HOME Environmental Stimulation composite was associated with better receptive language functioning. With a larger sample size smaller differences between groups may have been detected. This report shows no evidence of latent effects of GCE on inhibitory control, working memory, or receptive language. GCE effects were observed on the incidental face memory task, and GCE by assessment number interaction effects was seen on the incidental word memory task.

White matter characteristics and cognition in prenatally opiate- and polysubstance-exposed children: a diffusion tensor imaging study

BACKGROUND AND PURPOSE

Prenatal drug exposure may influence the developing brain. Our aim was to study WM characteristics with DTI in children with prenatal opiate and polysubstance exposure and in controls. We assessed whether group differences in FA, DA, and DR could be found and related to cognitive function.

MATERIALS AND METHODS

The study was approved by a committee for medical research ethics. Parents signed an informed consent; children gave spoken consent. Our sample included 14 prenatally substance-exposed adopted children (5 girls; age range, 8.6-13.9 years; mean, 11.3 +/- 1.7 years) and 14 control children (7 girls; age range, 9.0-10.2 years; mean, 9.8 +/- 0.3 years). Tract-based spatial statistics were used to define a common WM skeleton for the sample, and FA was compared between groups throughout the skeleton, controlling for age and sex. Clusters of significant group differences >or=100 voxels (P <. 05) were identified. FA, DA, and DR within clusters were correlated with cognitive function.

RESULTS

Ten clusters of FA group differences, mostly in central, posterior, and inferior parts of the brain, were identified (P <. 05), showing lower FA in substance-exposed children. FA and DA correlated positively and DR, negatively with cognitive function across groups.

CONCLUSIONS

Prenatally substance-exposed children exhibited lower FA in restricted areas of WM, mostly relatively central, inferior, and posterior, where myelination occurs early in development. Myelin in these areas may be particularly vulnerable to prenatal substance exposure. FA and DR related moderately to cognitive function. Potential confounding factors existed and were considered.

Impact of Drug Market Changes on Substance-Using Pregnant Women in Three Key Sydney Drug Markets

INTRODUCTION

In 2001 the supply of heroin was substantially reduced across Australia. Given the child protection concerns associated with the use of substances by pregnant women, it was pertinent to examine how the reduction in the supply of heroin affected this community of users. This paper aimed to assess the extent of any drug-related problems among pregnant women associated with the reduction in heroin supply in New South Wales (NSW).

METHOD

Two sources of data were used: (1) Data on hospital visits in NSW in which drug and alcohol problems were noted as complicating the pregnancy; and (2) Key informant reports from services targeting substance-using pregnant women across the three main Sydney drug markets.

RESULTS

The shortage did not affect the number of hospital separations for substance-using pregnant women, nor the number of women referred to services for substance use in pregnancy. Key informants reported an increase in the use of cocaine among pregnant women and a change in injection sites for some women (including into breast tissue). No substantial change in adverse outcomes was observed to be associated with this change in patterns of drug use.

DISCUSSION

The reduction in heroin supply appeared to have limited impact on the number of substance-using pregnant women as assessed by hospital episodes and key informant reports. The evidence suggested an increase in the injecting of cocaine by pregnant women using drug treatment services, similar to the changes in drug use patterns observed among other groups of injecting drug users. The lack of change observed in the qualitative and statistical data regarding adverse health consequences associated with cocaine injecting suggests the potentially negative impact of maternal cocaine use on infant health may be difficult to detect and monitor.

Emotional and behavioural difficulties of children and young people at entry into care

Emotional and behavioural difficulties of a sample of children and young people were identified at the point of entry to local authority care by analysis of social work case files. The files indicated high levels of need, including that in children aged under 5. Bedwetting was identified as an important issue related to the physical health and emotional well-being of looked-after children. There was an association between bedwetting and emotional and behavioural problems. Analysis of placement types at entry to care showed that significantly more boys than girls were first placed in residential care.

Late neurodevelopmental effects of early exposures to chemical contaminants: reducing uncertainty in epidemiological studies

Early exposures to environmental chemicals are reliably associated with late neurotoxicities in children. However, substantial scatter of observations exists around the estimated dose-effect relationships. This variability has many potential sources, one of which is interindividual differences in susceptibility. Such differences imply that the long-term impacts of exposure will not the same for all individuals, but will vary depending on a variety of factors that might either aggravate or mitigate contaminant effects. These include co-exposures, genetic polymorphisms and characteristics of the social environment. The context dependence of contaminant effects has implications both for study designs and analytical approaches. In addition, a systems approach to understanding the associations among contaminant exposures, covariates and health outcomes is necessary.

Volumetric cerebral characteristics of children exposed to opiates and other substances in utero

Morphometric cerebral characteristics were studied in children with prenatal poly-substance exposure (n=14) compared to controls (n=14) without such exposure. Ten of the substance-exposed children were born to mothers who used opiates (heroin) throughout the pregnancy. Groups were compared across 16 brain measures: cortical gray matter, cerebral white matter, hippocampus, amygdala, thalamus, accumbens area, caudate, putamen, pallidum, brainstem, cerebellar cortex, cerebellar white matter, lateral ventricles, inferior lateral ventricles, and the 3rd and 4th ventricles. In addition, continuous measurement of thickness across the entire cortical mantle was performed. Volumetric characteristics were correlated with ability and questionnaire assessments 2 years prior to scan. Compared to controls, the substance-exposed children had smaller intracranial and brain volumes, including smaller cerebral cortex, amygdala, accumbens area, putamen, pallidum, brainstem, cerebellar cortex, cerebellar white matter, and inferior lateral ventricles, and thinner cortex of the right anterior cingulate and lateral orbitofrontal cortex. Pallidum and putamen appeared especially reduced in the subgroup exposed to opiates. Only volumes of the right anterior cingulate, the right lateral orbitofrontal cortex and the accumbens area, showed some association with ability and questionnaire measures. The sample studied is rare and hence small, so conclusions cannot be drawn with certainty. Morphometric group differences were observed, but associations with previous behavioral assessment were generally weak. Some of the volumetric differences, particularly thinner cortex in part of the right lateral orbitofrontal cortex, may be moderately involved in cognitive and behavioral difficulties more frequently experienced by opiate and poly-substance-exposed children.