1. Neurodevelopmental Impact of Prenatal Methamphetamine Exposure
Michael Brinker, Psyd
Northwest Neurobehavioral Health

2. Topics What is methamphetamine How does meth use impact functioning?
How does PME impact neurodevelopment?
NNH research on the impact of PME on cognitive, memory, adaptive, and emotional skills
Intervention considerations

5. Methamphetamine
CNS stimulant which serves as a aphrodisiac & euphoriant
Low doses can elevate mood, increase alertness, concentration, and energy, reduce appetite and promote intial weight loss
High does can produce psychosis, rhabdomyolysis, & cerebral hemorrhage
Highly addictive and is associated with dangerous sexual behaviors

6. Meth use history Created in Germany in 1887
Made more potent in Japan in 1919
Wide use in WWII to help keep troops awake
Kamikaze pilots were given high doses
1950’s prescribed as diet aid and to address depression
1960’s developed injectable form
1990’s Mexican cartel’s began mass producing

7. Chemicals used in meth

8. PME Research Neuroimaging Mouse models
CT & MRI for structural impact
Functional neuroimaging (fMRI, DTI) to assess functional changes
Mouse models
Generalizability???
Assessing abusers of methamphetamine
Cross-sectional models
Longitudinal models in the future

9. Difficulty of PME research
Meth is an uncontrolled substance
Often polysubstance exposure
Exposure history often based off parent- report
Do not necessarily have information on timing of abuse
Often exposed to environmental neglect

10. Physical impact of Meth exposure
Reduces resistance to illness & damages liver
Weight loss
Kidney damage
Difficulty regulating body temperature
Meth mouth

11. Cerebral impact of Meth exposure
Floods synapses with dopamine, produces initial euphoric rush
Overwhelms and drowns out Dopa receptors
Requires more dopamine to produce equivalent levels of pleasure
Meth abuse impacts brain structures
Reduction of gray matter in the PFC
Differences in white matter hypertrophy
Some suggestion brain structures can sustain some recover after abuse

12. Prenatal Meth Exposure
Meth crosses the placenta
What mother experiences the child experiences
PME can produce fetal difficulties
Placenta abruption
Intrauterine growth restriction
Abnormal brain metabolism
Pre-term birth

13. Gestational development
Prenatal development varies in rate
Exposure at different times may have variable impacts

14. Structural impact of PME
Reduced subcortical volumes
Limbic system vulnerable

15. Structural impact of PME
Reductions in cortical volume
Damage to fronto-striatal network
Abnormalities in the frontal white matter

16. Functional impact of PME
Fronto-striatal networks play significant role in executive skills
Selection & perception of important information
Working memory
Organization & planning
Behavioral control & decision-making
Adapting to changes
Frontal lobes are heavily myelinated

17. Functional impact of PME
Visual-motor integration
Sustained attention
Memory recall
Hyperactivity
Inhibitory control
Working memory
Planning and organization

18. Developmental impact of PME
Functional skills do not “come online” until underlying brain area develops
Brain areas do not all develop at uniform rate
May not see immediate deficits
Especially notable in frontal lobes skills

19. Prefrontal Cortex Development
PFC plays significant role in social interactions
Social inhibition, social awareness, planning, organization, self-awareness
PFC undergoes rapid growth and development during adolescence

20. Functional change of adolescence
Limbic system regulates emotional processing and reward processing
In childhood limbic system over-rules inhibition
Decrease in medial PFC growth in adolescence
Increases efficiency of PFC’s ability to regulate limbic system

21. Presenting kids all have struggles Parent-report of PME
NNH research on PME
Clinical database
Presenting kids all have struggles
Parent-report of PME
Often abuse and neglect are present
Mostly preliminary results at this time

22. Areas of focus NNH database Cognitive skills Adaptive skills
Specific WISC indices impacted
Adaptive skills
Learning and memory
Emotional regulation

23. Common presenting concerns
Most common presenting problems of PME (n=103)
87% attention span
81% disobedience
67% aggression
67% anxiety
62% lying and stealing
61% irritability
59% hyperactivity
57% tantrums

24. IQ performance
Mean FSIQ
ADHD: 98.16
PME: 87.60

26. Regression analysis of IQ & age
IQ performance
Regression analysis of IQ & age
Significant at .05
Suggested loss of .86 IQ points per year
VCI: ADHD (97) – PME (89)
PRI: ADHD (101) – PME (95)
WMI: ADHD (94) – PME (86)
PSI: ADHD (91) – PME (87)

27. Regression for VCI, PRI, & WMI non- significant
IQ index regression
Regression for VCI, PRI, & WMI non- significant
Regression significant for .01
Loss of approximately 1.8 points per year

28. IQ results summary PME found to have significantly lower IQ
Results consistent when controlling for alcohol exposure
Regression significant for FSIQ & PSI
All scores were lower, but FISQ & PSI showed relational link with age

29. Memory Results Significant lower performances (WRAML2)
Verbal Memory Composite (.002)
ADHD: 95.24
PME: 89
Contextual Verbal Learning (WRAML2 – story memory)
Initial encoding (.000), Free Recall (.000), Recognition Recall (.000)

30. Unstructured Verbal Learning (WRAML2 – verbal memory)
Initial encoding (.004)
Free recall & Recognition recall were non-significant
Visual Encoding (WRAML2 – Design memory & Picture completion)
Encoding unstructured information significant (.01)
Encoding structured information was non significant

31. Emotional Regulation Results
Increased levels of:
Externalized problems (.004)
Hyperactivity, Aggression, Conduct Problems
Behavioral problems (.005)
Atypicality, Withdrawal, Attention Problems
Adaptive Skills (.029)
Adaptability, Leadership, Functional Communication, Social Skills, Acts of Daily Living

32. Adaptive Skill Results
Increased Levels of:
Conceptual Composite (.004)
Practical Composite (.037)

33. Significant differences in IQ
Summary of NNH Results
Significant differences in IQ
Discrepancy increases over time, especially for processing speed
Trouble with verbal memory & executive mediated memory skills
Initial encoding
Free recall
Learning unstructured information

34. Summary of NNH Results
Increased levels of externalized problems, & behavioral problems
Hyperactivity, attention problems, aggression conduct problems, atypicality, withdrawal
Deficits in adaptive skills
Conceptual adaptive skills
Practical adaptive skills

35. Summary of NNH Results Present with symptoms consistent with ADHD
More functional deficits than ADHD
Cognitive impact increases as children age
Likely better conceptualized as FAE/FAS and not ADHD

36. Intervention considerations
No PME handbook
Adapting current intervention strategies to developmental model
Consider age and brain development

37. Implementing pre-emptive executive and emotional interventions
Need patience
Organic impact, learning and adaptation can be challenging
Deficits similar to ADHD, but likely more persistent & severe