Preterm birth

Question 1

preterm birth

Answer 1

• born before 37 weeks
• ~9% of children born each year
• 32-36 weeks = late to moderate preterm
• 29-31 weeks = very preterm
• <28 weeks = extremely preterm

Question 2

body and brain impact of preterm birth

Answer 2

• the lungs and brain are particularly susceptible to early damage
• De Kieviet et al. (2012):
• meta-analysis
• brain volumes measured later in life - most studies adolescences
• overall brain volume smaller
• less white matter & less grey matter

Question 3

cognition impact of preterm birth

Answer 3

• motor problems
• general learning difficulties
• speed of processing
• visuo-spatial impairments
• EFs
• more likely to be diagnosed with a dev disorder

Question 4

gestational gradient

Answer 4

the earlier a child is born, the greater their difficulties are likely to be

Question 5

best to worst ways of sampling when studying prevalence of disorders

Answer 5

1. national sample of children born preterm and term born controls followed from birth e.g. EPICure study
2. regional sample of children born preterm and term born controls contacted when older
3. opportunistic sample recruited via advert

Question 6

best to worst ways for measurement when studying prevalence of disorders

Answer 6

1. diagnostic interview
2. disorder-specific questionnaire e.g. Conners rating scale for ADHD (based on DSM criteria)
3. general psychopathology questionnaire e.g. SDQ

Question 7

strengths and difficulties questionnaire (SDQ)

Answer 7

• covers internalising and externalising areas of difficulty
• emotional symptoms
• peer relationship problems
• conduct problems
• inattention and hyperactive symptoms (ADHD)
• prosocial beh

Question 8

johnson & marlow (2014)

lecture & pre-reading

Answer 8

• EPICure study, SDQ & diagnostic interviews given at age 11 years
• parents more likely to report emotional and conduct
• teachers also more likely to report ADHD & ASD compared to diagnostic interviews
• behavioural & neuroimaging studies provide evidence of a neurodevelopmental original for mental health disorders in this population
• children born extremely preterm may have attention, emotional or peer relationship problems that don’t meet diagnostic criteria but which may impact on daily function, for which intervention may be beneficial

Question 9

ADHD diagnosis when preterm

johnson et al. (2010)

Answer 9

• 11% of those born preterm were likely to have a diagnosis of ADHD
• very preterm = 2-3 times increased risk of ADHD
• extremely preterm = 4 times increased risk of ADHD
• also many cases where children born preterm have higher level of ADHD symptoms but don’t reach clinical cut-off (e.g. Brogan et al., 2014)

Question 10

compare to ADHD in general population, children born preterm:

Answer 10

• are more likely to be diagnosed with the inattentive subtype
• are not at increased risk of comorbid conduct disorder
• don’t show the same 3:1 gender bias towards boys

Question 11

how can we test whether being preterm leads to a different form of ADHD

Answer 11

look at the cognitive and neural predictors of ADHD in children born preterm and those born at term

Question 12

inhibition in preterm children

mulder et al. (2009)

Answer 12

• very varied results across diff tests
• <26 weeks impaired on go/no-go (but only 2 studies)

Question 13

visual WM in children born preterm

jongbloed-pereboom et al. (2012)

Answer 13

• review of 9 studies testing school-age children & adolescents
• used a backwards span task or self-directed search
• 8/9 studies reported worse visual WM in children born preterm
• children at greater risk (lower gestational ages and/or lower birth weight, & children with additional medical risk factors) also tend to perform worse than control children

Question 14

EFs in children born preterm

de kieviet et al. (2012)

Answer 14

• 66 very preterm children aged 7-8 & matched controls
• no diff from controls: inhibition, processing speed, verbal WM
• worse than controls: visuospatial WM, RT variability

Question 15

EFs, inattention & being preterm

de kieviet et al. (2012)

Answer 15

• parents & teachers completed 2 questionnaires with some questions about inattention & hyperactivity
• child behaviour checklist/teacher report form
• parent/teacher disruptive behaviour disorder rating scale
• both parents & teachers rates the preterm children as more inattentive, but not more hyperactive, than the control children
• preterm birth correlates with inattentive symptoms (poorer attention skills)
• preterm birth correlates with cognitive functioning
• cognitive functioning correlates with inattentive symptoms
• does cognitive functioning mediate the relationship between preterm birth and symptoms of inattention? - yes, including visuospatial WM & lapses in attention there becomes a non-sig interaction

Question 16

reward processing & preterm

hodel et al. (2015)

Answer 16

• 4yos born at 32-36 weeks and term-born controls
• delay discounting task: children born moderate-to-late preterm were less likely than the term born children to choose the delayed reward no matter the size of the delayed reward
• Maudsley’s index of childhood delay aversion (MIDA): no difference between preterm and term-born children

Question 17

preterm birth and ADHD

retzler et al. (2018)

Answer 17

• 8-11yos born very preterm or born at term
• matched on the strengths and weaknesses of ADHD and normal-behaviour (SWAN) questionnaire
• continuum of symptoms, look across spectrum of ADHD scores
• relationship between WM very similar between the two groups

Question 18

early screening for autism

Answer 18

• as preterm children are at increased risk of dev disorders it makes sense to screen for them early in childhood in order to start interventions early
• one questionnaire that has been developed to identify autism in toddlers in modified checklist for autism in toddlers (M-CHAT)
• in general population: 5.7% screen positive for high risk of autism (Kleinman et al., 2008)
• in those born before 28 weeks (extremely preterm) 21-42% screened positive for autism (Kuban et al., 2008; Moore et al., 2012)

Question 19

autism in school age preterm children

hack et al. (2009)

Answer 19

• 219 extremely low birth weight (ELBW) children at age 8 years and 176 age matched controls
• parent completed the child symptom inventory (CSI-4) based on DSM4 criteria
• 4 ELBW fulfilled criteria for autism vs 1 control (3 already has diagnosis)
• 3 ELBW fulfilled criteria for Asperger’s (1 already had diagnosis)
• overall, autistic symptoms reported more often in ELBW group than in controls

Question 20

johnson et al. (2010) - autism

Answer 20

• 201 extremely preterm (EP) children at age 11yrs and 143 age matched controls
• parent completed the social communication questionnaire and the development and wellbeing assessment (DAWBA) diagnostic interview
• 16 preterm children (8%) obtained a diagnosis compared to 0 of the controls
• preterm children had higher SCQ scores than controls:
• increase in autistic symptoms in many preterm children, not just small subgroup with autism diagnosis
• more that have these difficulties - social and communication difficulties

Question 21

different form of autism in those born preterm?

Answer 21

• is characterised by social and communicative impairments rather than repetitive or stereotyped beh
• is associated with prior cog impairment that explains many social & communication difficulties
• is related to head circumference

Question 22

SEN

mackay et al. (2010)

Answer 22

• communication & interaction
• cognition and learning
• social, emotional and mental health difficulties
• sensory and/or physical needs

the earlier a child is born, the more likely they are to have SEN

Question 23

johnson et al. (2011) - reading

Answer 23

• 219 extremely preterm children at age 11 & 153 age matched controls
• completed word reading, non-word reading and reading comprehension subtests of WIAT
• phonological abilities test administered at age 6
• overall, the preterm group are worse at reading than controls
• 12 preterm children are classified as having a reading difficulty, compared to 3 controls
• more difficulties with children born preterm

Question 24

reading and preterm

aarnoudse-moens et al. (2011)

Answer 24

• 200 very preterm children and 230 age matched controls tested every year from age 4-8
• assessed with a comprehensive series of standardised tests that are part of the Dutch national pupil monitoring system
• preterm children had comparable early linguistic skills to term born controls at age 6
• very preterm children scored 0.4SD lower on simple word reading and 0.3SD lower on complex word reading at age 8
• the group diff in complex word reading remained when IQ was taken into account
• reading comprehension didn’t differ from controls

Question 25

do preterm children show the same cognitive difficulties underlying reading problems?

Answer 25

* Johnson et al. (2011) - phoneme deletion at 6yrs predicting reading at 11yrs in extremely preterm and term born children * Wocadlo & Rieger (2007) - phonological awareness related to reading skills in very preterm children * Aarnoudse-Moens et al. (2011) - no diff in early linguistic skills at age 4 for very preterm and term born children (but didn’t look at relationship with later reading skills)

Question 26

johnson et al. (2011) - mathematics

Answer 26

* visuospatial abilities test administered at age 6 * overall, the preterm group are worse at maths than the controls * 20 preterm children are classified as having a maths deficits, compared to 2 controls

Question 27

developmental dyscalculia | von aster & shalev (2007)

Answer 27

* specific difficulty in mathematics * some researchers argue it is characterised by a poor approximate number system (evolutionary system looking at quantity without counting) * a cognitive system that supports that representation & manipulation of quantity information for mathematical achievement * measured using dot comparison tasks * not such a strong theory any more

Question 28

maths and preterm | simms et al. (2015)

Answer 28

* UK regional - PRISM study * 115 very preterm (VP) children aged 9 & 77 age matched controls * completed numerical operations and mathematical reasoning subtests of WIAT * also completed a battery of tasks including IQ, EFs, visuospatial skills & maths specific measures * VP group worse at maths than controls * VP group have poorer WM & visuospatial skills than controls but no impairment in processing speed or inhibition * importantly, the VP group show no difference in measures of the approximate number system * VP group are worse than controls at counting and strategy choice but this accounted for by their poor WM & visuospatial skills * although children born very preterm do have specific difficulties with maths, this doesn’t seem to be due to a problem in the approximate number system * instead, their difficulties with maths seem to be due to their WM & visuospatial difficulties

Question 29

jorrit et al. (2012) ## Footnote further reading

Answer 29

* to clarify the severity, specificity, and neurocognitive underpinnings of attention problems in very preterm children * 66 preterm and 66 age-matched controls age 7-8 * symptoms of inattention assessed using parent and teacher-rated questionnaires * neurocognitive measures: speed and consistency in speed of information processing, lapses of attention (tau), alerting, orienting, and executive attention, as well as verbal and visuospatial working memory * large decrease in visuospatial WM abilities in preterm * medium increases in tau and ratings of inattention in preterm * tau & visuospatial WM were significant predictors of parent and teacher ratings of inattention * increase lapses of attention and poorer visuospatial WM fully account for the attention problems in very premature children at school-age