Vibeke Moe

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.

Foster-placed and Adopted Children Exposed In Utero to Opiates and Other Substances: Prediction and Outcome at Four and a Half Years

ABSTRACT. This article presents a Norwegian prospective, longitudinal study of children prenatally exposed to opiates and other substances under conditions of minimal postnatal social risk. Outcome at 4½ years of age is presented. The study reports on the prediction of later intellectual performance, on the basis of the children’s prenatal, perinatal, and early developmental status, as well as the foster or adoptive parents’ socioeconomic level. Significant differences were found between the substance-exposed group and the comparison group on the Bayley Scales at age 1 year and on the McCarthy Scales at age 4½ years. The findings showed that although the mean cognitive scores were within normal limits at age 4½ years, a special weakness in the area of visual-motor and perceptual abilities was detected among the substance-exposed children. It is indicated that these areas of performance are especially sensitive to the effect of prenatal adversity. A special vulnerability among the substance-exposed boys, detected at an earlier age, persisted at 4½ years. The study indicates that even if children experience adequate caregiving, the accumulation of biomedical risk factors associated with prenatal substance exposure is still a potential determinant of developmental problems, especially in the area of perceptual-performance functions. The study also hints at differential influences of biomedical and environmental variables on outcome at age 4½ years.

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 ≥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.

Longitudinal cognitive development of children born to mothers with opioid and polysubstance use

Background:Previous studies indicate an increased risk for neuropsychological difficulties in young children prenatally exposed to opioids and polysubstances, but longitudinal information is scarce. The present longitudinal study investigated whether these waned, persisted, or increased over time.Methods:The cognitive functioning of 72 children with prenatal opioid and polysubstance exposure and 58 children without any established prenatal risk was assessed at 1, 2, 3, 4½, and 8½ y.Results:The exposed boys had significantly and stably lower levels of cognitive functioning than the control group, whereas there were increasing differences over time for the girls. The exposed group had significantly lower IQ scores than the control group on Wechsler Intelligence Scale for Children—Revised at 8½ y after controlling for earlier cognitive abilities, and for children who were permanently placed in adoptive/foster homes before 1 y of age and whose mothers used heroin as their main drug during pregnancy (B = 17.04, 95% CI 8.69–25.38, P < 0.001).Conclusion:While effects of prenatal substance exposure cannot be isolated, group effects on cognition rather increased than waned over time, even in adoptive/foster children with minimal postnatal risk.

Patterns of pregnancy and postpartum depressive symptoms: Latent class trajectories and predictors.

Depressive symptoms among pregnant and postpartum women are common. However, recent studies indicate that depressive symptoms in the perinatal period do not follow a uniform course, and investigations of the heterogeneity of time courses and associated factors are needed. The aim of this study was to explore whether depressive symptoms in the perinatal period could be categorized into several distinct trajectories of symptom development among subgroups of perinatal women, and to identify predictors of these trajectory groups. The study used data from 1,036 Norwegian women participating in a community-based prospective study from midpregnancy until 12-months postpartum. Depressive symptoms were assessed with the Edinburgh Postnatal Depression Scale at 7 time points (4 during pregnancy). Partner-related attachment, stress, childhood adversities, pregnancy-related anxiety, previous psychopathology, and socioeconomic conditions were assessed at enrollment. By means of growth mixture modeling based on piecewise growth curves, 4 classes of depressive symptom trajectories were identified, including (a) pregnancy only (4.4%); (b) postpartum only (2.2%); (c) moderate-persistent (10.5%); and (d) minimum symptoms (82.9%) classes. Multinomial logistic regression analyses showed that membership in the pregnancy only and postpartum only classes primarily was associated with pregnancy-related anxiety and previous psychopathology, respectively, whereas the moderate-persistent class was associated with diverse psychosocial adversity factors. Findings suggest heterogeneity in temporal patterns of elevated depressive mood, relating specific trajectories of time courses with distinct adversity factors. Researchers and clinicians should be aware of possible multiple courses of elevated perinatal depressive mood, and inquire about possible diverse adversity factors, aberrant pathways, and prognoses.

Behavior and Attention Problems in Eight-Year-Old Children with Prenatal Opiate and Poly-Substance Exposure: A Longitudinal Study.

Multiple studies have found that children born to mothers with opioid or poly-substance use during pregnancy have more behavior and attention problems and lower cognitive functioning than non-exposed children. The present study aimed to investigate whether behavior and attention problems are more prominent than general cognitive deficits in this risk group and whether the problems wane or increase over time. This prospective longitudinal cross-informant study compared 72 children who were prenatally exposed to heroin and multiple drugs with a group of 58 children without known prenatal risk factors. Group differences in caregivers’ and teachers’ reports of the children’s behavior and attention problems based on the Child Behavior Check List and the ADHD Rating Scale were compared based on group differences in general cognitive functioning at 4 ½ and 8 ½ years of age. Both parent and teacher reports suggest that the exposed group has significantly more problems in several behavioral areas than the comparison group, particularly with regard to attention problems. The preschool teachers had already reported these problems when the children were 4 ½ years old, whereas the caregivers reported these problems mainly when the children were 8 ½ years old. The group differences in behavioral and attentional problems were not significantly greater and some were even significantly smaller than the group differences in general cognitive abilities. These findings suggest that children subject to prenatally drug exposure have increasing problems in multiple areas related to behavior from preschool age to 8 ½ years but that these problems do not seem to be specific; i.e., they are not more severe than the problems with general cognitive abilities found for this group.

Cognitive function of youths born to mothers with opioid and poly-substance abuse problems during pregnancy

Previous research has provided inconclusive evidence regarding the neuropsychological difficulties of children born to mothers partaking in opioid or poly-drug use during pregnancy. Little is known about how these children fare as they get older. The present longitudinal study includes follow-up data on 45 children born to mothers who used heroin and poly-drugs and a group of 48 children without prenatal drug exposure. Most of the drug-exposed youths were placed in permanent foster or adoptive homes before one year of age. The youths (ages 17 to 21) were administered 10 neuropsychological tests. The drug-exposed youths had cognitive and fine motor functions within the normal range compared to population norms but performed significantly worse than the non-exposed group. There were indications of generally lower cognitive functions rather than specific problems with executive functioning. Lower mean birthweight in the risk group (619 grams mean difference, p < .001) only partially mediated the group differences in cognitive functioning. There was a tendency for youths who had few and early changes in their caregivers or who were born to mothers who had used the least number of different drugs during pregnancy to have the best cognitive scores. The study indicates that youths born to mothers who used multiple drugs during pregnancy are vulnerable relative to their peers within a wide range of cognitive functions. The vulnerability seems to be related not only to the mother’s drug use during pregnancy but also to factors such as birthweight and unstable parental care during infancy.

Attachment security in young foster children: continuity from 2 to 3 years of age

The present study investigated attachment patterns among 60 foster children (FC) and 42 comparison children (CC) at 2 years (T1) and again at 3 years (T2) of age, as well as stability from T1 to T2. Descriptive analyses, including cross-tabulation, were used to present attachment patterns, group differences and stability from T1 to T2. Most FC were securely attached at T1, and no group differences were identified; neither the FC nor CC differed from typical children in their attachment patterns. Furthermore, the majority of children in both groups received the same classification at both time points. Among FC who were securely attached at T1, a majority remained so at T2, while among those classified as disorganized at T1, significantly less remained so at T2. The study suggests that young FC have the possibility to form enduring secure attachments when placed in stable and well-functioning foster homes.

Early identification of social-emotional problems: Applicability of the Infant-Toddler Social Emotional Assessment (ITSEA) at its lower age limit.

ITSEA is an often recommended tool for assessment of social-emotional problems and competence delays in children aged 12-36 months, but concerns have been raised about low variability and age-inappropriate questions for children as young as 12 months. This study explored ITSEAs (1) psychometric properties, (2) properties concerning the detection of clinically significant problems and competence delays and (3) discriminant validity at 12 months. A total of 102 children with high versus low risk scores on marker measures of developmental status and parenting stress obtained at 6 months, were selected from a longitudinal population-based study to participate in the present study. Risk status was operationalized as Bayley III Screening Test (Bayley, 2005a. Bayley scales of infant and toddler development: Screening test manual (3rd ed.). San Antonio, TX: Pearson) Composite Subscale scores and Parenting Stress Index total score (PSI, 3rd edition, Abidin, 1995. Parenting Stress Index. Professional manual. (3rd ed.). Odessa, FL: Psychological Assessment Resources). At 12 months, ITSEA was administered to parents as a structured interview to identify guidance needs and to collect qualitative information about the items, and the assessment of developmental level and parenting stress was repeated. All ITSEA domains and subscales were found to be relevant. However, nearly all respondents needed guidance. Moreover, there were substantial floor/ceiling effects on subscale level and one item had to be discarded. ITSEA was used in combination with the Bayley-III Screener and PSI to detect cases with clinically significant scores, with ITSEA making a unique contribution to case detection. Dysregulation problems were the most frequently detected, and the differences between high-risk and low-risk group children and gender differences indicated adequate discriminant validity. The results suggest that ITSEA may be meaningfully applied even among children as young as 12 months.

The Association between Hair Cortisol and Self-Reported Symptoms of Depression in Pregnant Women

Depression has been linked to an imbalance in cortisol. Until recently, cortisol has been studied by measuring concentrations at single time points in blood or saliva samples. Cortisol concentrations vary with circadian rhythm and experiences, from time point to time point. The measurement of hair cortisol concentration (HCC) is a new method of accessing mean, long-term cortisol concentrations. Recent studies show positive associations between depression and HCC, and prenatal maternal cortisol is thought to influence the developing fetus. We therefore examined the association between HCC and self-reported symptoms of depression in second trimester pregnant women. Participants were 181 women, recruited between September 2011 and October 2013 to the Little-in-Norway (LiN)-study. These women answered the Edinburgh Postnatal Depression Rating Scale (EPDS) on self-reported symptoms of depression, and one cm maternal scalp hair was collected and analyzed for cortisol concentrations. Multiple regression analyses did not show depressive symptoms as a predictor for HCC in our selection of pregnant women, while gestational age was significantly related. In conclusion, our study indicated that symptoms of depression during pregnancy did not predict HCC, but further studies of clinically depressed, pregnant women using gestational age as an adjustment variable are warranted.