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Children with neonatal abstinence syndrome more likely to perform poorly in NAPLAN

Study finds that exposure to opiates in the womb can have a negative effects on a child’s school results

Children exposed to heroin and other opiates in the womb are more likely to perform poorly in school, an Australian study has found.

When a woman uses addictive drugs during pregnancy, her baby is likely to suffer from neonatal abstinence syndrome (NAS) when born. Babies with NAS have similar withdrawal symptoms to adult drug users who are trying to quit, including vomiting, diarrhoea, tremors, fever and sweating.

Although researchers suspected that children with NAS were at risk of ongoing neurodevelopmental and cognitive problems, the difficulties of long-term follow up studies made it hard to test this theory.

In the study,“Neonatal Abstinence Syndrome and High School Performance”, published in the journal Pediatrics, the researchers used National Assessment Program for Literacy and Numeracy (NAPLAN) results to trace the downstream effect of NAS on educational outcomes. NAPLAN is a compulsory curriculum-based test for all Australian students in Years 3, 5, 7 and 9.

The team compared a group of 2,234 babies born with NAS in New South Wales between 2000 and 2006 with a control group of 4,330 children matched for gestation, socioeconomic status and gender, and with other NSW children born during the same time period. They then analysed the mean test results of each group in Years 3, 5, and 7 from NAPLAN data.

The mean test scores of children with NAS were significantly lower than those of either the matched controls or other NSW school children in every year and every area of testing (numeracy, reading, writing, spelling and grammar/punctuation). And the deficit was progressive: by the first year of high school children with NAS performed even more poorly compared to the control groups. By Year 7, 44 per cent of children with NAS failed to meet the national minimum standard in at least one area of testing.

Low school performance is known to increase poor outcomes into adulthood, including psychiatric and physical illness, unemployment, delinquency, crime, drug use and intergenerational disadvantage.

University of Wollongong (UOW) researchers Professor Ian Wright, from the School of Medicine and Illawarra Health and Medical Research Institute, and Professor Edward Melhuish, from the School of Psychology and Early Start, were co-authors of the paper. The lead author was Dr Ju-Lee Oei from the School of Women's and Children's Health at the University of NSW.

“The findings are stark,” Professor Ian Wright said. “By Year 3, mean test scores for children with NAS were significantly lower than the two other cohorts, and results deteriorate even more by high school. By Year 7, children with NAS scored lower than other children in Year 5.”

Based on their findings, the authors are calling for ongoing support beyond withdrawal for children with Neonatal Abstinence Syndrome in an effort to help improve school performance and long term socioeconomic outcomes.

“We believe that this study provides a compelling reason to support children with NAS beyond the withdrawal stage to minimise risk of school failure and its consequences,” Professor Wright said.

“Interestingly, significant geographical variation exists in this data, suggesting that these outcomes are not inevitable for children exposed to drugs or staying with their families.

“The high risk of poor academic performance in this vulnerable group of children is applicable to all countries. Strategies to address this risk, and prevent poor adult outcomes and intergenerational vulnerability, should be urgently addressed.”