LAUSR

OBJECTIVE Single-substance exposure effects on neurodevelopmental outcomes, such as problem behavior and intelligence quotient (IQ), have been studied in children for decades. However, the long-term consequences of polysubstance exposure are poorly understood. STUDY DESIGN Longitudinal neurodevelopmental data were gathered from cohorts across the United States (U.S.) through the Environmental influences on Child Health Outcomes (ECHO) Program. Data on prenatal exposure to opioids, nicotine, marijuana, and alcohol were collected from children ages 6-11 years (N=256). Problem behavior was assessed using the Child Behavior Checklist (school-age version, CBCL-Sch), and verbal IQ (VIQ) and performance IQ (PIQ) were assessed using the Weschler Intelligence Scale for Children, Fifth Edition (WISC-5). We first identified latent profiles in the overall sample, then evaluated differences in profile membership for children with and without prenatal substance exposure. RESULTS Latent profile analysis identified two mutually exclusive categories: average VIQ and PIQ, with typical problem behavior; and below-average VIQ with average PIQ and clinically significant problem behavior. Children with prenatal nicotine and polysubstance exposures were more likely to be classified in the below-average VIQ, elevated problem behavior profile compared with children without prenatal nicotine exposure. CONCLUSIONS The presence of clinically significant behavior problems in children with average PIQ, but below-average VIQ, could represent a unique endophenotype related to prenatal nicotine exposure in the context of other prenatal substance exposures.