Language delay is a well documented problem that occurs on a higher rate in preterm children compared to full term children. Preverbal social skills, such as the ability to share attention to an object with another person (i.e., triadic interaction), are suggested to reflect part of the processes through which children learn language. This longitudinal study examined preverbal and verbal skills in 25 preterm and 35 full term children in order to investigate if birth status affects language development through the proposed mediating processes of preverbal dyadic and triadic skills. Dyadic initiatives during the still-face episode were assessed at 6 months. Triadic responsiveness (gaze following) was examined at 9 and 14 months. Triadic initiatives (joint attention and behavioral request) were also assessed at 14 months. At 30 months, receptive and expressive language was examined. The data showed group differences in 6-month dyadic initiatives, 9-month triadic responsiveness, 14-month triadic behavioral request initiatives and 30-month receptive and expressive language skills at the expense of the preterm children, confirming their risk for a less favorable preverbal and verbal development. Multiple mediation analyses confirmed the hypothesis that birth status affects language development partially through preverbal skills, which is important for clinical practice.

Preterm infants avert their gaze more often and for longer periods in early social interactions compared to full term infants. In previous studies this finding is interpreted as being a function of the higher degree of parental stimulation that is often found in parents of preterm children. The current study explores an additional hypothesis. Since the development of general visual attention abilities is found to be less optimal in preterm children, it is possible that less optimal maturation of attention abilities partially explains the elevated gaze aversion in a social context. Therefore, the current study investigated the association between gaze aversion in a social context and the ability to disengage and shift visual attention in a non-social context in 20 preterm and 42 full term infants aged 4 and 6 months. Results confirm that preterm infants are slower to shift their attention in a non-social context and that they avert their gaze more often in a social context compared to full term children.Furthermore, more frequent gaze aversion during social interaction at 6 months was related to longer disengagement and the shifting of attention at 4 and 6 months, but only within the preterm group. The results suggest that attention maturation is less optimal in preterm children; this can be observed in a non-social as well as a social context. Less attention maturation in preterm children can negatively influence the amount of time they can stay actively involved in social interaction.

This longitudinal study examined dyadic and triadic skills in 26 preterm and 31 full term infants at 3, 6 and 9 months of age. In dyadic interaction, infants engaged with a stranger in face-to-face play interrupted by a still-face episode. In triadic interaction, infants interacted with the adult stranger as she coordinated gaze between the infant and object. Both groups were sensitive for non-contingency in both dyadic and triadic interactions. There were significant group and developmental differences for dyadic and triadic competencies. Compared to full term infants, preterms made less positive elicits during the still-face at 6 months and followed gaze less at 9 months of age. Six-month dyadic skills and 9-month triadic competencies were positively related in preterm and full term infants.