Resident Physician Emory University School of Medicine Emory University School of Medicine Atlanta, Georgia, United States
Background: Independently, prenatal substance exposure and postnatal trauma have been studied extensively given their common deleterious effects on childhood development. Sex differences in vulnerability to the impact of adverse events, however, have not been well studied in children without a history of prenatal polydrug exposures. Understanding the moderating effects of these interactive or cumulative risk factors will help reflect a more complex model of co-exposures affecting childhood behavioral outcomes.
Objective: This study investigated: 1) whether trauma exposure interacts with prenatal polydrug exposure in the disruption of childhood behavior control; 2) whether the type of prenatal substance exposure alters this relationship; and 3) whether these effects differ by sex.
Design/Methods: A sample of 308 youth (1-17 years) from the Emory Neurodevelopmental Exposure Clinic were categorized by sex, trauma exposure (above or below sample mean) and prenatal polydrug exposure (alcohol, stimulants, marijuana, tobacco, and opioids). Behavioral disturbance was then measured as a function of both trauma and polydrug exposure via the Child Behavior Checklist (CBCL) to assess level of behavioral disturbance.
Results: Only the coaction of prenatal stimulant (cocaine or methamphetamine) exposure and trauma was found to demonstrate synergism in behavioral disturbance. Additionally, when analyzing the relationship between sex and trauma-resultant problem behaviors, a dimorphism opposite from sex stereotype expectancies arose. Trauma exposure in female children demonstrated relative worsening of total problems and externalizing problems than in male children. Conclusion(s): Prenatal stimulant exposure appears to affect development such that children are less resilient to early life traumatic exposures. Other polydrug exposures also appear to increase vulnerability to trauma, though risk appears to be additive. Thirdly, through environmental changes or possible neurostructural differences, female children appear to be more susceptible to worsening behavior in response to childhood trauma than males. The implications for these findings will hopefully improve considerations for screening, prevention, and intervention.
Table 1. Sample demographic characteristics by sex
Figure 1. Average traumatic experiences per prenatal exposure group by sex.
Figure 2. Percentage of children with clinically significant problem behaviors as a function of greater than or less than the sample mean trauma exposure and sex.
Figure 3. Percentage of children with clinically significant problem behaviors as a function of greater than or less than the sample mean trauma exposure and prenatal exposure group status.
Authors/Institutions: Philip Bowers, Emory University School of Medicine, Atlanta, Georgia, United States; Julie A. Kable, Emory University School of Medicine, Atlanta, Georgia, United States; Molly Millians, Emory University School of Medicine, Atlanta, Georgia, United States; Claire D. Coles, Emory University School of Medicine, Atlanta, Georgia, United States
