The combined effects of prenatal drug exposure and early adversity on neurobehavioral disinhibition in childhood and adolescence

The negative effects of prenatal substance exposure on neurobiological and psychological development and of early adversity are clear, but little is known about their combined effects. In this study, multilevel analyses of the effects of prenatal substance exposure and early adversity on the emergence of neurobehavioral disinhibition in adolescence were conducted. Neurobehavioral disinhibition has previously been observed to occur frequently in multiproblem youth from high-risk backgrounds. In the present study, neurobehavioral disinhibition was assessed via behavioral dysregulation and poor executive function composite measures. Data were drawn from a prospective longitudinal investigation of prenatal substance exposure that included 1,073 participants followed from birth through adolescence. The results from latent growth modeling analyses showed mean stability but significant individual differences in behavioral dysregulation and mean decline with individual differences in executive function difficulties. Prior behavioral dysregulation predicted increased executive function difficulties. Prenatal drug use predicted the emergence and growth in neurobehavioral disinhibition across adolescence (directly for behavioral dysregulation and indirectly for executive function difficulties via early adversity and behavioral dysregulation). Prenatal drug use and early adversity exhibited unique effects on growth in behavioral dysregulation; early adversity uniquely predicted executive function difficulties. These results are discussed in terms of implications for theory development, social policy, and prevention science.

Drug Use during Pregnancy

Prevention and intervention services for pregnant, drug-using women have often developed prior to gaining empirical data on the antecedents of prenatal drug use. These data are important to address some of the underlying factors of drug use during pregnancy. A review of the literature indentified at least six categories of psychosocial risk factors that have been investigated as relevant to drug use among women, including pregnant women. These factors include: (1) history of childhood sexual abuse, (2) family history of alcohol or drug problems, (3) male partner's alcohol or drug use, (4) current depression, (5) social support, and (6) homelessness or transiency. An examination of these psychosocial risk factors indicates that the existing literature on these factors in drug use is limited by a lack of methodological rigor, resulting in large variations in prevalence rates due to factors such as definition. This paper summarizes the existing literature and methodological iussues regarding the relation between psychosocial risk factors and drug use among women, including pregnant women. It also discusses some of the limitations and issues in assessing prenatal drug use with a particular focus on self-report and urine toxicologies.