1. Introduction
Methamphetamine abuse is the fastest growing illicit drug problem
worldwide, and is reaching epidemic proportions (United Nations
Office on Drugs, and Crime 2013). In the United States,
approximately 5% of women ages 15-44 reported being exposed to
methamphetamine while pregnant (U.S. Department of Health and
Human Services, 2013). Although research on the
neurodevelopmental impact of prenatal methamphetamine exposure
(PME) is relatively limited, studies suggests that PME can impact
fetal growth and may potentially lead to a variety of developmental,
behavioral, and neurological differences (Nguyen et. al. 2010),
including elevated levels of neurobehavioral disinhibition (Abar et al.
2013), deficits in attention and concentration (Kiblawi et al., 2013),
reduced cognitive inhibition (Derauf et al., 2012), and externalizing
behaviors (LaGasse et al., 2012). Further, PME children have been
characterized as fitting a profile of neurobehavioral disinhibition
(ND), which is a set of co-occurring problems including deficits in
executive and cognitive functioning, emotional regulation, and
behavior control (Himes et al., 2014). Elaborating on the functional
impact of PME, as well as attempting to differentiate the
neurodevelopmental impact of PME from polysubstance exposure
may help guide practitioners and care-providers in developing
effective treatment strategies.
The purpose of the current study was to assess externalizing
behaviors in PME children while controlling for the potential impact
of polysubstance exposure to alcohol, a substance which is known
to impact neurodevelopment and behavioral regulation (Behnke &
Smith; 2013). Specifically, when compared to a control-sample of
ADHD children, we hypothesize that PME children will be rated as
experiencing elevated levels of externalizing behaviors as measured
by the BASC-2 parent-report measure. Further, these externalizing
behaviors are believed to remain consistent when controlling for
alcohol exposure in PME.
Method
Participants. Archival neuropsychological test data for 113 children
with caregiver-reported PME and 113 children of similar ages with
ADHD were used as a clinical and comparison sample, respectively.
Of the 113 PME children 67 were reported to have been exposed to
both methamphetamine and alcohol, while 46 were not reported to
have been exposed to methamphetamine but not alcohol during
gestation. The PME and ADHD samples did not significantly differ in
age, although there were a significantly higher number of males
within the ADHD sample. All subjects within the sample were
administered the BASC-2, a parent-report measure assessing social
and emotional functioning. Considering the aim of the study, the
primary variables analyzed were the BASC-2 externalizing problems
index and subsequent variables (including hyperactivity, aggression,
and conduct problems), and the overall Behavioral Symptom Index.
Measures.
Behavior Assessment System for Children, Second Edition (BASC-2)
Statistical Procedures. Independent sample T-tests were runs
to analyze the differences between PME and ADHD samples, while a
one-way Anova was run to assess significant differences between
the ADHD, PME-only, and PME+alcohol exposure groups.
A Comparison of Externalizing Behaviors Between Children Prenatally
Exposed to Methamphetamine and Children with ADHD
Miranda Boote, Shane Donnell, Ryan Hick,
Kristin Hill, and Michael J. Brinker
Northwest Neurobehavioral Health, University of Idaho, & Boise State University
a
a
Conclusions
•Consistent with pervious research, results indicate that PME children
exhibit significantly elevated levels externalizing difficulties when
compared to ADHD peers, including elevated levels of aggression,
conduct behaviors, hyperactivity, and overall behavioral problems. The
elevated levels of hyperactivity found within this sample is especially
notable given that the normative base for this study is children who are
already predisposed towards potential difficulties within this area.
•Differences with conduct problems, externalizing behaviors, and overall
behavioral problems remained statistically significant when controlling for
prenatal alcohol exposure in PME children, suggesting that prenatal
exposure to methamphetamine may impact emotional regulation skills and
behavioral control independent of alcohol exposure.
•Non-alcohol exposed PME children also exhibited higher levels of
depressed affect (p < .01) when compared to ADHD peers, which may be
a secondary impact of the social and behavioral difficulties that their
disruptive behaviors are likely to produce.
•While PME children typically meet behavioral criteria for a diagnosis of
ADHD (approximately 70% of PME children within this sample received a
diagnosis of ADHD following a comprehensive neuropsychological
evaluation), they exhibit notably more externalized behavioral challenges
compared to ADHD peers. As such, the overall functional profile of PME
children may not be adequately by a diagnosis of ADHD.
Literature Cited
Abar, B., LaGasse, L.L., Newman, E., Smith, L.M., Huestis, M., Neal, C., … & Lester, B.M. (2013) Examining the
Relationships Between Prenatal Methamphetamine Exposure, Early Adversity, and Child Neurobehavioral
Disinhibition. Psychology of Addictive Behavior, 27(3), 1-21. doi: 10.1037/a0030157
Behenke, M., & Smith, V.C. (2013). Prenatal Substance Abuse: Short- and Long-term Effects on the Exposed
Fetus. American Academy of Pediatrics, 131(3), 1009-1024. DOI: 10.1542/peds.2012-393
Derauf, C., LaGasse, L. L., Smith, L. M., Newman, E., Shah, R., Neal, C. R., ... & Lester, B. M. (2012). Prenatal
methamphetamine exposure and inhibitory control among young school-age children. The Journal of
pediatrics, 161(3), 452-459. doi: 10.1016/j.jpeds.2012.02.002
Himes, S.K., LaGasse, L.L, Derauf, C., Newman, E., Smith, L.M., Arria, A.M., … & Huestis, M.A. (2014). Risk of
Neurobehavioral Disinhibition in Prenatal Methamphetamine–ExposedYoungChildrenWithPositive Hair
Toxicology Results. Therapeutic Drug Monitoring, 36, 535-543. doi: 10.1097/FTD.0000000000000049
Kiblawi, Z. N., Smith, L. M., LaGasse, L. L., Derauf, C., Newman, E., Shah, R., ... & Lester, B. (2013). The Effect
of Prenatal Methamphetamine Exposure on Attention as Assessed by Continuous Performance Tests:
Results from the Infant Development, Environment, and Lifestyle (IDEAL) Study. Journal of developmental
and behavioral pediatrics: JDBP, 34(1), 31. doi: 0.1097/DBP.0b013e318277a1c5
LaGasse, L.L, Derauf, C., Smith, L.M., Newman, E., Shah, R., … & Lester, B.M. (2012). Prenatal
Methamphetamine Exposure and Childhood Behavior Problems at 3 and 5 Years of Age. Pediatrics, 129(4),
680-688. DOI: 10.1542/peds.2011-2209
Nguyen, D., Smith, L.M., LaGasse, L.L., Derauf, C., Grant, P., Shah, R., … & Lester, B.M. (2010). Intrauterine
Growth of Infants Exposed to Prenatal Methamphetamine: Results from the Infant Development,
Environment, and Lifestyle Study. The Journal of Pediatrics, 157(2), 337-339.
doi:10.1016/j.jpeds.2010.04.024
Substance Abuse and Mental Health Services Administration (2012). Results from the 2012 National Survey on
Drug Use and Health: Summary of National Findings. U.S. Department of Health and Human Services.
Retrieved from: http://www.samhsa.gov/data/sites/default/files/NSDUHresults2012/NSDUHresults2012.pdf
United Nations Office on Drugs and Crime, World Drug Report 2013 (United Nations publication, Sales No.
E.13.XI.6). Retrieved from:
https://www.unodc.org/unodc/secured/wdr/wdr2013/World_Drug_Report_2013.pdf
Results
Figure 1 illustrates the difference in BASC-2 variables between PME and
ADHD subjects; and Figure 2 illustrates differences in BASC-2 variables
between ADHD, PME+alcohol subjects, and PME-only subjects.
According to parent-report, PME children exhibited statistically
significantly elevated levels of Hyperactivity (effect size = .15, p=.03),
Aggression (effect size =.20, p<.01), Conduct Problems (effect size = .23,
p<.01), and Externalizing Problems (effect size = .52, p<.01), and had
significantly elevated Behavioral Symptom Index scores (effect size = .
245, p<.01) when compared to ADHD peers. When controlling for alcohol
exposure, one-way ANOVA indicated that differences between the PME-
no alcohol exposure and ADHD samples remained statistically significant
Conduct Problems (p < .01), Externalizing Problems (p = .03), and
Behavioral Symptom Index (p = .01), while Aggression (p = .063) was
approaching significance.
Figure 2: BASC-2 Externalizing Symptoms
PME no Alcohol v. PME+Alcohol v. ADHD
Figure 1: BASC-2 Externalizing Symptoms
PME v. ADHD