A Closer Look

Home | Blog | A Closer Look | 2013 | A Closer Look: Q&A with Namik Kirlic

A Closer Look: Q&A with Namik Kirlic

Namik KirlicNamik Kirlic is a doctoral student in clinical psychology at the University of Tulsa. He is the lead author of a study that looked at the effects of prenatal methamphetamine exposure (PME) and severe or chronic postnatal stress on a two year old’s stress response system.  The study is part of a large prospective, multi-site (Oklahoma, Iowa, California, and Hawaii) research project called The Infant Development, Environment, and Lifestyle (IDEAL) Study.  Dr. Barry Lester and Dr. Linda LaGasse of Brown Center for the Study of Children at Risk, Warren Alpert Medical School at Brown University and Women and Infants Hospital, Providence, Rhode Island served as Primary Investigators, while Dr. Elana Newman of The University of Tulsa served as the Primary Investigator for the Oklahoma site, where the present analyses were conducted.

Tell us a little bit about what you learned regarding the effects of PME on toddlers’ stress response system.

Our findings in this particular sample suggest that PME may be associated with alterations in the functioning of the HPA axis, the system which modulates the body’s stress response and regulates other body processes, such as digestion, the immune system, mood and emotions, and energy storage and expenditure. Because methamphetamine is a stimulant of the nervous system, PME may have affected how this fetus’ nervous system was developed and programmed. However, we also observed that a chronically stressful postnatal environment might exacerbate these effects.

We measured the stress hormone, cortisol, levels in two-year-old children with PME before and after a stress-inducing separation task. Thirty-eight percent of the children exhibited an increase in cortisol, which is in line with the suggested effects PME has on the fetus’s HPA-axis programming. The remaining children showed blunted cortisol reactivity (defined as a lack of cortisol response to a stressor) linked to chronic or severe stress in their lives, specifically behavioral dysregulation, caregiver’s alcohol use, and the interaction between higher levels of PME and the caregiver’s psychopathology. The interactions between PME and postnatal stress are particularly interesting. It appears that PME may first lead to hyperactivity of the HPA axis, which under chronic and significant environmental stress then becomes hypoactive. This phenomenon has been described as the allostatic load.

What other caregiving or environmental factors are associated with PME and a child’s development?

In these particular analyses, we found that children with PME are often exposed to other drugs prenatally, such as alcohol, marijuana, and tobacco. Children in this study were also at a greater risk for exposure to physical violence, parental psychopathology, ongoing parental drug use, change in custody, as well as abuse and neglect. Other IDEAL investigators have found that PME and early adversity were predictive of deficits in behavioral and emotional control and executive functioning (memory, attention, and motor skills) at age six. Further, associations between PME and lower birth weight, elevated physiological stress, and neurobehavioral deficits at three years of age, as well as lower maternal perceptions of quality of life, greater likelihood of substance use among family and friends, and increased risk for ongoing legal difficulties have also been observed by IDEAL investigators. Finally, my colleague, Brandi Liles, found that mothers of three-year-olds who used methamphetamine during pregnancy were more likely to report elevated rates of parenting stress and depression.

What are the implications of your findings? 

Perhaps the most surprising finding of this study was a high percentage of cortisol blunting (68% of the children).  Blunting has been previously seen only in older kids exposed to stimulant drugs prenatally and significant stress postnatally. These findings suggest that the effects of methamphetamine on the fetus’ developing stress-response system may be particularly strong. When this child then lives in circumstances of significant postnatal stress, the stress response system may start to wear down and not function properly. Subsequently, these children are at a greater risk for depression, anxiety, attention-deficit/hyperactivity disorder, and a number of other medical conditions.

What this also tells us is that the early childhood environment is extremely important. The mother’s psychological well-being and ongoing substance use play an additive adverse role. Therefore, creating positive and stress-free environments for these children could result in substantial improvements and diminish the negative impact of methamphetamine exposure.

We need to think both in terms of prevention and treatment. We should put our attention and resources toward reaching out to at risk families early on, and provide them with tools that can improve their self-efficacy and well-being.

Leave a Reply

Your email address will not be published. Required fields are marked *