According to the Centers for Disease Control and Prevention, every 25 minutes a baby is diagnosed with neonatal abstinence syndrome (NAS) in the United States. NAS is a condition that occurs in newborns who are exposed to opioids in utero and develop withdrawal symptoms after birth. Historically, research has focused on the impact of NAS, also known as neonatal opioid withdrawal syndrome, on infant health and development, finding that prenatal opioid exposure is associated with an increased risk of adverse developmental, cognitive, and behavioral outcomes in early childhood.
But by the time infants with NAS reach the classroom, opioid exposure may have minimal impact on neurodevelopmental outcomes, according to a new study led by researchers at Penn State College of Medicine. They compared school-age children with and without a history of NAS and found that the two groups performed similarly on standardized tests, taking into account socio-economic and environmental factors. The findings suggest that external factors such as school quality, economic status, race, and mother’s education level have a significant impact on academic performance. The study was published in the journal Lancet Community Health – Americas.
Historically, we have been quick to blame prenatal opioid exposure as the cause of academic decline, but socio-environmental factors appear to play a much larger role. There is good reason to believe that, given the right resources, these children can do well and thrive. ”
Tammy Coe, associate professor of pediatrics at Penn State College of Medicine and corresponding author of the study
Academic performance can be a good indicator of both early childhood neurodevelopment and future success as an adult, Koh said. In this study, researchers assessed standardized test scores in English/language arts and mathematics for 3,494 students in grades 3 through 8. 23% of students had a history of NAS, and 77% had no history of NAS.
To determine whether test performance was affected by NAS or other factors, the researchers compared children with NAS with a control group matched for age, gender, maternal education level, and type of health insurance at birth.
The data comes from the South Carolina Integrated Data System, which integrates health, demographic, socioeconomic, social services, and education data from multiple state agencies. The researchers explained that this uniquely integrated database allows researchers to connect mothers and children in a way that allows them to track mothers and children longitudinally over time. Although the data are from South Carolina, the results may be generalizable to the broader U.S. population because the socioeconomic and environmental factors present in children with a history of NAS in this study are strikingly similar to literature from previously published studies across the United States, Coe said.
After adjusting for age, gender, and socioeconomic factors, the differences in standardized test scores between students with and without a history of NAS were minimal. Mean English/language arts test scores were similar between the two groups. In mathematics, there was a small but statistically significant decrease in test scores among students with a history of NAS use.
Overall, the children in the study performed below the state average in all grades, regardless of NAS history. Although the children in the study were from all over the state, due to a matching strategy, more than 30% were born to mothers with less than a high school diploma, and 85% were uninsured or covered by Medicaid, which is generally an indicator of socioeconomic status, the researchers explained.
Factors such as attending a low-rated school, limited access to early childhood education, and other indicators of economic stress, such as participation in the Women, Infants, and Children (WIC) Supplemental Nutrition Program, played a much larger role in determining students’ academic performance. Children of non-Hispanic black mothers also tested about one grade level lower than non-Hispanic white students. The researchers also found that test scores increased as the mother’s education level increased.
“Based on previous literature, we expected to see more pronounced differences in academic performance,” Koh said. “But when you put the whole story together, they may not have access to early childhood education to get a solid start, they may end up in poorly rated schools, and their families may be struggling with financial insecurity. It’s not hard to see why children with a history of NAS may not perform as well as some other children.”
The research team plans to build on this study through interviews with parents and guardians of school-age children with a history of prenatal opioid exposure or NAS, with the aim of elucidating the factors that lead to differences in long-term academic performance and better understanding the everyday experiences that can promote or hinder children’s success in school.
Other Penn State School of Medicine authors include Emily Wasserman and Eric Schaefer, biostatisticians on the project.
This research was supported by funding from the National Institute on Drug Abuse of the National Institutes of Health.
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Reference magazines:
Mr. Ko, T.E. Others. (2026). Long-term academic performance of children with a history of neonatal abstinence syndrome: A retrospective observational cohort study. Lancet Community Health – Americas. DOI: 10.1016/j.lana.2026.101459. https://www.thelancet.com/journals/lanam/article/PIIS2667-193X(26)00089-X/fulltext
