Neurodevelopmental impacts of unique postnatal adversity subgroups in children with prenatal alcohol exposure

Individuals prenatally exposed to alcohol experience elevated rates of adverse postnatal experiences, including neglect, abuse, and caregiver separation, which often co-occur. Identifying distinct adversity patterns may clarify their links to neurodevelopmental outcomes. Latent class analysis was conducted in a clinical sample with 811 youth with prenatal alcohol exposure (PAE; mean age 6.9 years, range 0-21) to identify distinct profiles of postnatal adversity. Class differences in neuropsychological functioning were examined using the Bolck, Croon, and Hagenaars method. A four-class solution demonstrated best fit AIC = 5121.272, BIC = 5266.918, aLRT = 55.874, p < .001. Classes reflected: 1) high probability of neglect and caregiver change with moderate probability of familial mental health challenges; 2) low familial mental health risk with moderate caregiver change; 3) high probability of familial trauma and neglect; and 4) high probability of all adverse experiences. Classes differed significantly in memory, executive functioning, and mental health domains (anxiety). Demographic differences included age, number of caregiver placements, and age of placement with long-term caregiver. Distinct adversity patterns in youth with PAE are linked to neurodevelopmental outcomes and demographic factors. Findings highlight the importance of early intervention, addressing familial mental health, and developing or adapting trauma-responsive supports for children with PAE.