Clinic Provides Pathway for Children With Prenatal Exposures

The Next Step Clinic, a program housed within Cincinnati Children’s Division of Developmental and Behavioral Pediatrics, launched in 2023 as a bridge for young children and their families navigating developmental disabilities and behavioral concerns related to prenatal opioid exposure.

“These children had been identified as having prenatal opioid exposure and were followed through a specialty clinic in neonatology up until around age 2,” says Next Step Clinic Director Steph Weber, PsyD, MPH. “But after that first year of life, when those withdrawal symptoms dissipate, there’s not really a name for this. And there’s no diagnosis to capture trends in their development or help prepare their families for what to expect.”

The Next Step Clinic fills that void, serving as a comprehensive evaluation and consultation clinic for children ages 2.5 to 5 with prenatal opioid exposure.

Weber, a child psychologist, leads the clinic, which is also staffed by another child psychologist, a developmental behavioral pediatrician, an occupational therapist, a speech-language pathologist and a clinical research coordinator.

Each child and their family visit the clinic for an initial evaluation with the full team of providers, who make referrals to specialists, if needed. Evaluations are repeated every 12 to 18 months until the child is close to 6 years old.

An Emerging Phenotype

Now that they’ve seen more than 150 children through the clinic, Weber and her team are noticing some trends—what they call an emerging phenotype. They’re using these findings to help families and educate pediatric providers.

“We’ve found that a little more than half of our patients have ADHD-like symptoms,” Weber says, adding that many of the kids have hyperactivity and impulse control issues characteristic of attention-deficit/hyperactivity disorder.

Weber notes that they’re also seeing kids who need occupational therapy for sensory processing intervention needs, as well as speech-language therapy for speech sound disorders and ophthalmology follow-up for vision concerns.

Thanks to these findings, the team can better help families understand what to expect developmentally for their children, but also provide anticipatory guidance to pediatricians, schools and others who support children and families.

The Value of a Multidisciplinary Team

Much of the clinic’s success relates to its makeup, Weber says.

“It’s so important for this patient population to have comprehensive, interdisciplinary care,” she says. “Each provider brings a nuanced approach from a different discipline to an evaluation.”

The team also uses a shared decision-making tool that allows families to rate their concerns in areas like behavior, inattention and impulsivity, and sleep. Families fill out the form ahead of each evaluation, and the providers use it to guide their conversation.

“By the end of that visit, we ensure we’ve addressed the top three concerns for the family before they leave the clinic,” Weber says.

“Cutting-Edge” Clinic Model

The Next Step Clinic is one of just a few in the country with a comprehensive, systematic framework combining forward-thinking research with strategies to help preschool-aged children with prenatal opioid exposure and their families, Weber says.

“We are really on the cutting-edge with this clinic,” she says. “My pie-in-the-sky dream is to eventually be able to follow these kids more into school, so that if they do have special education needs or needs for accommodation, we can really help.”

Children with prenatal opioid exposure present in a unique way compared with other children with neurodevelopmental disorders, so strategies to help them should be unique, too, Weber says. That’s why another project she and her team are working on is to develop behavioral interventions that will improve quality of life for the whole family.

(Published November 2025)

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