Executive Functioning and Learning Skills of Adolescent Children Born at Fewer than 26 Weeks of Gestation

Abstract

AimsTo assess the cognitive and behavioral aspects of executive functioning (EF) and learning skills in extremely preterm (EPT) children compared with term control children aged 10 to 15 years.MethodsA total of 132 of 134 (98% of all eligible survivors) EPT children born at the 2 Swedish regional tertiary care centers from 1992 to 1998 (mean age = 12 years, mean birth weight = 718 g, and mean gestational age = 24.4 weeks) and 103 matched term controls were assessed. General intelligence was assessed using the Wechsler Intelligence Scale for Children (WISC-III-R), and cognitive aspects of EF were analyzed using EF-sensitive subscales of the WISC-III-R and Tower test of the Delis-Kaplan Executive Function Scale (D-KEFS). Behaviors related to EF and learning skills were assessed using the Five to Fifteen questionnaire, which is a validated parent and teacher instrument. Academic performance in school was assessed by teachers’ responses on Achenbach’s Teachers Report Form. Analyses performed included multivariate analyses of covariance (ANCOVA and MANCOVA) and logistic regression analyses.ResultsThe EPT children displayed significant deficits in cognitive aspects of EF compared with the controls, exhibiting decreases on the order of 0.9 SD to 1.2 SD for tasks of verbal conceptual reasoning, verbal and non-verbal working memory, processing speed and planning ability (P <0.001 for all). After excluding the children with major neurosensory impairment (NSI) or a Full Scale intelligence quotient (FSIQ) of < 70, significant differences were observed on all tests. Compared with controls, parents and teachers of EPT children reported significantly more EF-related behavioral problems. MANCOVA of teacher-reported learning skills in children with FSIQ >70 and without major NSI revealed no interactions, but significant main effects were observed for the behavioral composite executive function score, group status (EPT vs control) and FSIQ, for which all effect sizes were medium to large. The corresponding findings of MANCOVA of the parent-reported learning skills were very similar. According to the teachers’ ratings, the EPT children were less well adjusted to the school environment.ConclusionEPT children born in the 1990s who received active perinatal care are at an increased risk of executive dysfunction, even after excluding children with significant neurodevelopmental disabilities. Even mild to moderate executive dysfunctions has a significant impact on learning skills. These findings suggest the need for timely interventions that address specific cognitive vulnerabilities and executive dysfunctions.

Executive function deficits in children born preterm or at low birthweight: a meta‐analysis

“…A total of 45 studies met all the inclusion criteria. Executive function data were provided by 35 of these studies (3360 children born preterm/low birthweight and 2812 term‐born controls) either in the study paper or after a request for additional data sent to the authors . The characteristics and main study results are given in (Tables SI, SII, and SIII, online supporting information; working memory, inhibition, and cognitive flexibility respectively).…”

“…Also, for inhibition, there were only a small number of studies investigating the ends of the gestational age range. To be able to draw robust conclusions on whether there is an effect of gestational age on executive function, more studies in children born extremely preterm (<26wks gestational age) and moderate-to-late preterm (32-37wks gestational Aarnoudse-Moens et al 63 Anderson et al 32 Brecht et al 86 Brummelte et al 86 Campbell et al 88 Crotty et al 90 de Kieviet et al 21 Farooqi et al 61 Ford et al 91 Grunewaldt et al 93 Guarini et al 94 Hodel et al 62 Lohaugen et al 97 Mulder et al 18 Ni et al 98 Potharst et al 99 Ritter et al 100 Sayeur et al 101 Wehrle et al 102 Litt et al 96 Rose et al 24 -2.00 -1.00 0.00 1.00 2.00…”

“…4a). 61,62 Rerunning analyses without these two studies yielded a non-significant relationship between gestational age and working memory (b=0.03; 95% CI -0.05 to 0.11; R 2 =0.00, p=0.48 (Fig. 4b).…”

Executive function in children born preterm: Risk factors and implications for outcome

“…66,72–75 Two meta-analyses found that the performance of children born preterm on measures of executive control is, on average, 0.3 to 0.6 standard deviations lower than that of full term children, 63,64 although effects as great as 1 standard deviation have been reported in studies of children with extreme prematurity. 76 Rates of deficits in EF relative to age standards on tests and parent and teacher ratings are substantially higher for children with more extreme prematurity compared to NBW controls, with rates 2 to 4 times higher in one sample 65 and 3 to 5 times higher in another. 67 Impairments in EF are found even when excluding children with low IQs or when adjusting group comparisons for IQ or estimates of ‘crystallized’ intelligence based on vocabulary knowledge.…”

Exposures to structural racism and racial discrimination among pregnant and early post‐partum Black women living in Oakland, California

“…Given that preterm birth and low birthweight are the leading causes of infant mortality and are associated with long-term cognitive developmental child and adult health issues, it is imperative to understand factors associated with these disparities (Farooqi, Adamsson, Serenius, & Hägglöf, 2016;Taylor & Clark, 2016).…”