Monday, July 15, 2024

Impact of Prenatal Drug Exposure on Academic Performance and Out-of-Home Care

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Children exposed to drugs before birth face educational challenges that are often compounded by additional adversities such as the need for out-of-home care (OOHC). This study, conducted in New South Wales (NSW), Australia, investigates the academic outcomes of these children through the National Assessment Program-Literacy and Numeracy (NAPLAN) tests. The findings reveal significant performance gaps between children with prenatal drug exposure (PDE) and those without, highlighting the urgency of tailored interventions.

Prenatal drug exposure remains a pressing global public health issue, closely linked to child protection services and OOHC placements. The study aimed to evaluate the school outcomes for children with PDE, including those diagnosed with neonatal abstinence syndrome (NAS), and to understand how OOHC influences their academic performance.


Researchers utilized linked datasets encompassing health, OOHC, and school test data from NSW, comparing NAPLAN test results of children born between 2001 and 2020. The primary measure was the ability to meet the National Minimum Standard (NMS) across various domains, including mathematics, language, writing, and spelling, from Year 3 to Year 9.

The PDE cohort comprised 3,836 children, with 3,192 diagnosed with NAS and 644 without. Comparisons were made against 897,487 children without PDE. The study examined the relative risk of scoring below NMS for children with and without PDE, considering NAS status and OOHC involvement.

Key Findings

Results indicated that children with PDE were significantly more likely to score below NMS across all test domains from Year 3 to Year 9, irrespective of NAS diagnosis. Specifically, 45.8% of children with PDE required OOHC, compared to only 1.4% of children without PDE. The likelihood of scoring above NMS was notably reduced for children with PDE, whether or not they had NAS, and for those in OOHC.

Among children with PDE, OOHC did not significantly alter the likelihood of scoring above NMS. However, children without PDE who were in OOHC were less likely to meet NMS standards compared to those without OOHC.

Concrete Inferences

The study provides valuable insights for policymakers and educators:

  • Children with PDE require long-term, culturally sensitive educational support.
  • Interventions should be proactive to address the persisting risk of poor performance.
  • OOHC status does not significantly improve academic outcomes for children with PDE.
  • Tailored support is crucial for children without PDE but in OOHC to meet NMS standards.

The findings highlight the importance of specialized strategies to support the educational needs of children with PDE, ensuring they have better chances of academic success and long-term well-being.

Original Article: Lancet Child Adolesc Health. 2024 Jul;8(7):500-509. doi: 10.1016/S2352-4642(24)00076-2.

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