The objective of this study was to compare mental health at 5 years in children born extremely preterm with a reference group, and assess associations between functional abilities and mental health within the preterm group. In a national Norwegian cohort with gestational age 22-27 weeks or birthweight 500-999 g, mental health was assessed with the Strengths and Difficulties Questionnaire (SDQ), cognitive function with the Wechsler Preschool and Primary Scale of Intelligence-Revised (WPPSI-R), motor function with the Movement Assessment Battery for children (ABC-test) and severity of cerebral palsy (CP) with the Gross Motor Function Classification for CP (GMFCS). Neurodevelopmental disabilities (NDD) were described as mild and moderate/severe. SDQ of the preterm children was compared with that of an unselected reference group. SDQ sub-scores ≥90th percentile of the reference group were defined as a mental health problem and a Total Difficulties Score ≥90th percentile (TDS90) as suggestive of psychiatric disorder. Of 361 eligible preterm children, parents completed SDQ for 255 (71%). 97 (38%) had TDS90 compared to 116 (11%) of the reference group (OR 5.1; 95% CI 3.7-7.1). For the preterms, the rate of TDS90 was higher for those with moderate/severe NDD (27/37 vs. 27/116, adjusted OR 8.0; 95% CI 3.2-19, and mild NDD 43/102 [adjusted OR 2.2 (1.2-4.1)]. For preterms with no NDD, TDS90 was more common than for the reference group (27/116 vs. 116/1,089, OR 2.5; 95% CI 1.6-4.1). Extreme prematurity was associated with increased risk of later mental health problems, particularly if they had other functional impairments.

ADHD is more common in children born preterm than at term. The purpose of the study was to examine if, and to what extent, ADHD symptoms are associated with minor neurodevelopmental impairments (NDI) in extremely preterm children. In a national population-based cohort with gestational age 22-27 weeks or birth weight <1,000 g assessed at 5 years of age, scores on Yale Children's Inventory (YCI) scales (seven scales) were related to normal functions vs. NDI defined as mild impairments in cognitive function (IQ 70-84), motor function (Movement Assessment Battery for children score > the 95th percentile or freely ambulatory cerebral palsy), vision (correctable), and hearing (no hearing aid). YCI was completed for 213 of 258 eligible children (83%). Children with minor NDIs (n = 98) had significantly higher scores (more ADHD symptoms) than those without NDI (n = 115) on the YCI scales of Attention, Tractability, Adaptability and Total score. Increasing numbers of minor NDIs were associated with higher mean YCI scores. In multivariate analysis only decreased hearing, IQ, and male gender were significantly associated with scores on the Attention scale. Thirty-three children (16%) had scores >3 on the Attention scale (probably ADHD), and the proportion was significantly higher for those with mild NDIs compared to those without (Odds ratio = 2.7, 95% CI 1.3-6.0). Children born extremely preterm with minor NDIs were more likely to have ADHD symptoms than those with no NDI, and increasing number of minor NDIs were associated with more ADHD symptoms.

Objective: To compare mental health at 5 years in children born extremely preterm and at term and assess associations between functional abilities and mental health within the preterm group. Design: In a national Norwegian cohort with gestational age (GA) 22-27 weeks or birthweight 500-999g mental health was assessed with The Strengths and Difficulties Questionnaire (SDQ), cognitive function with WPPSI-R, motor function with ABC movement test and severity of cerebral palsy (CP) with the Gross Motor Function Classification for CP (GMFCS). Neurodevelopmental disabilities (NDD) were described as mild and moderate/severe. SDQ of the preterm children was compared with that of a non-selected reference group born at term. SDQ sub-scores ≥90 th percentile were defined as a mental health problem and a total difficulty score ≥90 th percentile (TDS90) as suggestive of psychiatric disorder. Results: Of 361 eligible preterm children parents completed SDQ for 255 (71 %). 28 (11%) had TDS90 compared to 10 of 758 (1%) of the reference group (OR: 8.4, 95% CI 4.0 to 17.0). For the preterms the rate of TDS90 was higher for those with moderate/severe NDD (12/37 vs. 6/116, OR: 9. 3.0;26.0), but not for those with mild NDD (10/102 vs. 6/116) compared with those with no NDD. For preterms with no NDD TDS90 was more common than for the term reference group (6/116 vs. 10/758, OR:3.7, 1.3;10.0), and the most distinguishing features were emotional and peer problems. Conclusion: Extreme prematurity is associated with increased risk of later mental health problems, particularly if they have other functional impairments.