Longitudinal academic achievement in children with a history of neonatal abstinence syndrome: a retrospective observational cohort study

Background: Neonatal abstinence syndrome (NAS) has been associated with increased risks for adverse developmental, cognitive, and behavioral outcomes in childhood. However, there are limited data on academic achievement. We aimed to compare longitudinal academic achievement test scores in school-aged children with and without a history of NAS while controlling for relevant biologic and socioenvironmental variables.MethodsThis retrospective, observational cohort study used a large, comprehensive, linked dataset from the South Carolina Integrated Data System to evaluate standardized English/Language Arts (ELA) and math achievement scores from grades 3–8 for children with and without a history of NAS. Linear mixed effects modeling assessed test scores by NAS group and grade, with random effects to account for correlation within school districts, schools, students, and mothers. Thirteen bio-socio-environmental variables were also included in the models.FindingsThe analysis sample included 3494 students: 814 (23%) children with a history of NAS and 2680 (77%) without, frequency matched in a 1:3 ratio according to birth year, sex, mother's education level, and insurance payer at birth. 30.5% had a mother with less than a high school education and 85.1% were insured by Medicaid/uninsured. Mean test scores between students with and without a history of NAS were similar for ELA (−6.3 points, [95% confidence interval (CI): −15.1 to 2.5], p = 0.16) and math (−8.9 points, [95% CI: −16.9 to −0.9], p = 0.030).InterpretationIn a sample of children matched on bio-socio-environmental factors and for whom potential confounders were controlled, we found similar academic achievement scores between children with and without a history of NAS. These results emphasize the importance of socioenvironmental factors on childhood outcomes and suggest prenatal opioid exposure and NAS contribute minimally to academic achievement.FundingThis work was supported by funding from the National Institute on Drug Abuse 5K23DA055096 award to Dr. Tammy Corr.