Examining Symptoms of Autism Spectrum Disorder in Children with Prenatal Drug Exposure

Background:  Newborn infants exposed to maternal drug use in utero often experience neonatal abstinence syndrome (NAS) characterized by symptoms of drug withdrawal shortly after birth. Infants with NAS are at an increased risk for language delays, inattentive behaviors, hyperactivity, and social-emotional problems in early childhood (Hunt et al., 2007;Logan et al., 2012; van Baar et al., 1994). The behavioral phenotype associated with NAS overlaps with symptoms observed in Autism Spectrum Disorder (ASD) including impairments of social-communication, withdrawal, and emotional dysregulation. Despite behavioral similarities in children with NAS and ASD, little is known about how symptoms of ASD present in children with NAS. It is important to identify populations that may be at-risk for ASD in order to inform differential diagnosis and treatment practices.

Objectives:  The present study aims to examine symptoms of ASD in children with NAS. Developmental and behavioral profiles will be compared in children with NAS that meet and do not meet diagnostic criteria for ASD.

Methods:  Participants consisted of 76 children that received a medical diagnosis of NAS in infancy and subsequently present to the Child Developmental Center at a tertiary care hospital between the years 2010-2016. Participants were categorized into two groups: children who received a diagnosis with ASD and NAS (N = 36) and children with NAS who did not receive an ASD diagnosis (N = 40). This retrospective chart review study enables the characterization of presenting problems, referral patterns, developmental trajectories, as well as psychological test results examining cognition, language, social communication, repetitive and restrictive behaviors, adaptive and broad behaviors for those who received interdisciplinary team evaluation for ASD. Specifically, the Autism Diagnostic Observation Schedule (ADOS), Autism Spectrum Rating Scale (ASRS), and Childhood Autism Rating Scale (CARS) were used as measures of autism symptomology. Developmental functioning was assessed using the Mullen Scales of Early Learning (MSEL) and behavioral symptoms were assessed using the Child Behavior Checklist (CBCL).

Results:  Of the 76 children diagnosed with NAS that were evaluated for ASD, 47% met diagnostic criteria for ASD at a hospital-based child development clinic between the years 2010-2016. Trend analysis reveals an increase in NAS, which elevates the need to understand the relationship between NAS and ASD in future efforts to ensure screening and early identification in populations particularly at risk. Overall, preliminary results from this study indicate specific behavioral patterns of social-emotional and developmental outcomes in children with NAS and ASD.

Conclusions: NAS is associated with a unique behavioral phenotype in early childhood that often overlaps with symptoms observed in ASD. In the current study, we found that almost half of the children with NAS evaluated for Autism Spectrum Disorder met diagnostic criteria for ASD suggesting that infants with NAS are at-risk for pervasive developmental and behavioral problems. It is important to examine how behavioral symptoms emerge and present in children NAS in order to gain a better understanding of how different etiological pathways may result in similar behavioral profiles associated with ASD. Future efforts include the establishment of a rural outreach clinic to track the children at-risk for NAS given prenatal drug exposure.