(Converted as ePoster, See Poster Gallery) Co-Occurrence of Psychopathology Problems in Adolescents with Prenatal Drug Exposure: Childhood Antecedents and Emerging Adulthood Outcomes

Background: Due to biologic insults combined with suboptimal postnatal environmental contexts, children exposed to drugs in utero are at risk of multiple psychopathology problems. This study investigated potential heterogeneity in the co-occurrence of psychopathology problems and roles of childhood irritability and social disinhibition as antecedents of such variation among prenatally drug exposed adolescents. This study further examined how adolescent comorbidity patterns were associated with subsequent emerging adulthood problematic use of alcohol, tobacco, and marijuana, clinically relevant mental health problems, and educational achievement.

Methods: Participants were 358 adolescents (53% girls), urban, primarily Africa Americans and of low socioeconomic status, drawn from a 21-year prospective birth-cohort study of the developmental effects of prenatal drug exposure. At age 15, adolescents’ psychopathology symptoms were assessed through Youth Self-Report (anxious/depressed, withdrawn/depressed, aggressive, delinquent, somatization, inattention, thought problems; t-scores ≥ 65 coded as ‘1’) and substance (alcohol, tobacco, marijuana) use via biologic assays (urine, hair, bloodspots) and self-report. At age 12, irritability and social disinhibition were self-reported using the Assessment of Liability and Exposure to Substance Use and Antisocial Behavior. At age 21, problematic use of alcohol, tobacco, and marijuana via the Substance Abuse Module, mental health symptoms via Adult Self-Report, and high school graduation were assessed.

Results: Latent class modeling indicated four patterns (entropy = .83): normative (57%), substance-use (SU; 24%), mental-health- problems-without-substance-use (MH; 11%), and substance-use-and-other-mental-health-problems (SUMH; 7%).

Higher irritability increased the odds of developing the MH pattern (aOR = 3.27, p = .01) whereas higher social disinhibition increased the odds of developing the SU pattern (aOR = 2.57, p < .001). The odds of manifesting the SUMH pattern were 3.03 times higher for children with higher irritability (p = .02). For children with higher social disinhibition, the odds of manifesting the SUMH pattern were 2.12 times higher at trend level (p = .06).

Compared to the normative (8%) and MH (7%) groups, respectively, more adolescents in the SU (27%) and SUMH (59%) groups had problematic use of marijuana. The same findings were observed on problematic use of tobacco (normative 15%, MH 15% vs SU 43%, SUMH 54%). Compared to the normative (23%) and SU (11%) groups, respectively, more adolescents in the MH (45%) and SUMH (66%) groups reported clinically relevant mental health problems. Fewer number of adolescents from the SUMH group (53%) had completed high school education, compared to the normative group (82%).

Conclusions: The SUMH class with heightened levels of most assessed symptoms demonstrates that there is considerable variance shared among the symptoms which can be accounted for by a general psychopathology factor. The SU and MH classes reflect specific psychopathology domains that account for unique covariances among the symptoms. These findings imply that psychopathology syndromes should not solely be conceived as discrete categories as posited in current classification systems, such as DSM–5. Peri-pubertal identification of individual differences in irritability and social disinhibition may mitigate the emergence of adolescent psychopathology, which could potentially influence emerging adulthood adjustment in a prenatally drug exposed population.