EPTExtremely preterm SDQ Strengths and Difficulties Questionnaire VPT Very preterm AIM To review systematically studies examining the development of social competence in children born very preterm (VPT) (gestation <33wks) and identify neonatal and family predictors.METHOD Peer-reviewed original articles were extracted from PubMed and PsycINFO following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Selection criteria included children born VPT and comparison children born at term, sample born after 1990, and children assessed between 0 and 17 years on at least one measure of social competence spanning social adjustment, performance, and/or social skills.RESULTS Twenty-three studies were included. Seven focused on social competence and another 16 examined social competence within a range of outcomes. Study quality was low. Limitations included reliance on single informant data, cross-sectional measurement, use of brief screening tools, absence of child or peer report, and no conceptual model. In terms of social adjustment, 16 out of 21 studies found children born VPT had more peer problems and social withdrawal. Findings of social performance were mixed, with some studies suggesting differences in prosocial behavior (4/14) and others not. Social skills were assessed in four studies and showed children born VPT had poorer skills than children born at term. Predictors of social competence included gestational age, neonatal brain abnormalities, and family socio-economic status.INTERPRETATION Children born VPT have poorer social competence. These difficulties emerge early and persist throughout childhood.Recent meta-analyses and systematic reviews have shown that children born very preterm (VPT) (gestation <33wks) are at increased risk of a range of neurodevelopmental impairments compared with their term-born peers. These span cerebral palsy and other motor impairments, cognitive deficits, language delay, behavioral adjustment problems, and poor school achievement. 1-6 Another important aspect of child development that has not been well studied in this high-risk population concerns their social competence or ability to relate to and form successful relationships with others. These skills are important given that studies of the general population show that poor social competence is associated with educational underachievement, peer rejection, internalizing problems, and school disengagement during adolescence as well as poorer social, occupational, and family functioning in adulthood. [7][8][9][10][11] Currently, a small but growing body of studies suggests that children born VPT are subject to a range of social and behavioral difficulties that may affect their life-course opportunities.12-14 Several contemporary follow-up studies have also found an increased risk of autism spectrum disorders and related behaviors in survivors of VPT birth. [15][16][17] Although suggestive of a possible link between prematurity and later social problems, the interpretation of existing research ...

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