, Dieter Wolke, PhD, Dr rer nat hc a,d abstract BACKGROUND: Very preterm (VP; gestational age ,32 weeks) and very low birth weight (VLBW; ,1500 g) births are related to impaired cognitive function across the life span. It is not known how stable cognitive functions are from childhood to adulthood for VP/VLBW compared with term-born individuals and how early adult cognitive function can be predicted.

Background. Children born very preterm (VP< 32 weeks gestation) and/or with very low birth weight (VBLW< 1500 gr; subsequently VP/VLBW) have been previously reported to have more cognitive impairment and specific executive functioning problems than term children; however, it remains unclear whether these problems persist into adulthood. This study aimed to examine general intelligence (IQ) and executive functioning (EF) of adults born VP/VLBW in comparison to term controls. Additionally, the effects of smallness for gestational age (SGA) and family socio-economic status (SES) at birth were investigated. Results. VP/VLBW adults scored significantly lower than controls in IQ and EF. There was a 1.16 standard deviation (SD) unit difference between the VP/VLBW and controls in FullScale IQ. VP/VLBW adults were found to have general and multiple cognitive problems rather than specific deficits in EF. SGA was not a significant predictor of cognitive impairment. Family SES had a significant impact on general intelligence in both VP/VLBW and term controls. The SES effects amounted to 1.13 SD units between individuals born into high versus low SES. Methods. The Bavarian Longitudinal Conclusions.No narrowing of cognitive deficits between VP/VLBW and term control adults to previous childhood assessments at 6 years of age was found. VP/VLBW adults do not outgrow their cognitive problems despite many receiving special educational support in childhood. Low family SES at birth has similar additive adverse effects on cognitive performance in VP/VLBW and term offspring.

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(2013) Poor attention rather than hyperactivity/impulsivity predicts academic achievement in very preterm and full-term adolescents. Psychological Medicine, Vol.43 (No.1). pp. 183-196. ISSN 0033-2917 Permanent WRAP url: http://wrap.warwick.ac.uk/52783/ Copyright and reuse:The Warwick Research Archive Portal (WRAP) makes this work by researchers of the University of Warwick available open access under the following conditions. Copyright © and all moral rights to the version of the paper presented here belong to the individual author(s) and/or other copyright owners. To the extent reasonable and practicable the material made available in WRAP has been checked for eligibility before being made available.Copies of full items can be used for personal research or study, educational, or not-forprofit purposes without prior permission or charge. Provided that the authors, title and full bibliographic details are credited, a hyperlink and/or URL is given for the original metadata page and the content is not changed in any way. Publisher's statement: Copyright © Cambridge University Press 2012 A note on versions:The version presented in WRAP is the published version or, version of record, and may be cited as it appears here. Background. Very preterm (VP) children are at particular risk for attention deficit/hyperactivity disorder (ADHD) of the inattentive subtype. It is unknown whether the neurodevelopmental pathways to academic underachievement are the same as in the general population. This study investigated whether middle childhood attention or hyperactivity/impulsivity problems are better predictors of VP adolescents' academic achievement.Method. In a geographically defined prospective whole-population sample of VP (<32 weeks gestation) and/or very low birth weight (<1500 g birth weight) (VLBW/VP ; n=281) and full-term control children (n=286) in South Germany, ADHD subtypes were assessed at 6 years 3 months and 8 years 5 months using multiple data sources. Academic achievement was assessed at 13 years of age.Results. Compared with full-term controls, VLBW/VP children were at higher risk for ADHD inattentive subtype [6 years 3 months : odds ratio (OR) 2.8, p<0.001 ; 8 years 5 months : OR 1.7, p=0.020] but not for ADHD hyperactiveimpulsive subtype (6 years 3 months : OR 1.4, p=0.396 ; 8 years 5 months : OR 0.9, p=0.820). Childhood attention measures predicted academic achievement in VLBW/VP and also full-term adolescents, whereas hyperactive/ impulsive behaviour did not.Conclusions. Attention is an important prerequisite for learning and predicts long-term academic underachievement. As ADHD inattentive subtype and cognitive impairments are frequent in VLBW/VP children, their study may help to identify the neurofunctional pathways from early brain development and dysfunction to attention problems and academic underachievement.

Preterm birth is a leading cause for impaired neurocognitive development with an increased risk for persistent cognitive deficits in adulthood. In newborns, preterm birth is associated with interrelated white matter (WM) alterations and deep gray matter (GM) loss; however, little is known about the persistence and relevance of these subcortical brain changes. We tested the hypothesis that the pattern of correspondent subcortical WM and GM changes is present in preterm-born adults and has a brain-injury-like nature, i.e., it predicts lowered general cognitive performance. Eighty-five preterm-born and 69 matched term-born adults were assessed by diffusion- and T1-weighted MRI and cognitive testing. Main outcome measures were fractional anisotropy of water diffusion for WM property, GM volume for GM property, and full-scale IQ for cognitive performance. In preterm-born adults, reduced fractional anisotropy was widely distributed ranging from cerebellum to brainstem to hemispheres. GM volume was reduced in the thalamus, striatum, temporal cortices, and increased in the cingulate cortices. Fractional anisotropy reductions were specifically associated with GM loss in thalamus and striatum, with correlation patterns for both regions extensively overlapping in the WM of brainstem and hemispheres. For overlap regions, fractional anisotropy was positively related with both gestational age and full-scale IQ. Results provide evidence for extensive, interrelated, and adverse WM and GM subcortical changes in preterm-born adults. Data suggest persistent brain-injury-like changes of subcortical-cortical connectivity after preterm delivery.