Purpose: To examine the longitudinal effects of a history of neonatal abstinence syndrome (NAS) on language development over the first 10 years of life. Design and methods: This study used a retrospective, longitudinal design. The data were analyzed using generalized linear mixed models (GLMM) to examine the effects of NAS on language delay over time while controlling for demographic, prenatal, and household factors. Results: There was a significant difference in the pattern of language delays over time between the NAS and non-NAS groups. At the age of 5 (est: −1.788, p <.001), children with a history of NAS had a decreased log odds of developing language delays than those without NAS. Conversely, compared with age 1, at the age of 10 (est: 1.098 p <.001), children with a history of NAS had an increased log odds of developing language delays than those without NAS. Conclusions: Children with a history of NAS had significantly different rates of language delays over time. Children with a history of NAS had significantly higher rates of language delays at 10 years than children without NAS. Practice implications: There is a need to increase developmental surveillance, along with referrals for specialized services, for children with a history of NAS through middle childhood.