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Extremely preterm birth increases odds children will develop behavioral problems by school age

Wednesday, October 08 2008 | Comments
Evidence Grade 11 What's This?
Children born at a gestational age of <26 weeks have increased odds of pervasive behavior problems at age 6 years than their peers born at term, suggests a total-population study of all extremely preterm (EP) children in the United Kingdom and Ireland.

The goal of the study was to examine whether children who were born EP have more pervasive behavior problems than classroom peers. To test for this possible association, researchers looked at data from the EPICure study for all children born at <26 weeks of gestation in the United Kingdom and Ireland during a 10-month period in 1995.

When the children were approximately 76 months of age, the researchers conducted assessments that relied on both teacher and parental reports of behavior problems to determine the pervasiveness of any identified difficulties.

Parents of 241 of the 308 children who had survived to 30 months (78%) agreed to participate in the study, and researchers obtained full reports on behavior problems for 200 of these children. A control group included 148 age- and sex-matched classroom peers. The researchers defined pervasive behavior problems as scoring >90th percentile on parent and teacher reports with a standard behavior scale--the Strengths and Difficulties Questionnaire (SDQ). Additional assessment items were adapted from the Conners Scales, the Child Behavior Checklist, the DSM-IV, and the International Classification of Diseases, 10th Revision, using the same Likert-scale format to assess components of attention-deficit/hyperactivity disorder.

Compared with control children, EP children had significantly more frequent pervasive behavior difficulties (P=.001), including emotional problems (P<.01), conduct problems (P<.05), hyperactivity (P<.001), poorer peer relationships (P<.001), and prosocial behavior (P<.001), and they also had higher impact scores (P<.001) on the SDQ. In addition, they had more frequent clinical overactivity/impulsivity problems (P<.01), attention problems (P<.001), and school adaptation difficulties (P<.001).

Hyperactivity, which was seen in 30.6% of the EP children and 8.8% of the controls, as well as conduct problems, which were seen in 12.5% of the EP children and 5.4% of the controls, could be accounted for by cognitive deficits. However, attention (33.3% for the EP group and 6.8% for the controls), peer (25.4% and 5.4%, respectively), and emotional (13.5% and 4.1%) problems were not explained by poor cognitive functioning.

While both boys and girls in the EP group were significantly more likely to have clinically significant differences for pervasive total behavior difficulties compared with their same-sex counterparts in the control group, EP boys had behavior problems in excess of sex differences observed in the control group for hyperactivity, attention, and prosocial problems.

Parents and teachers agreed that for 23% of the EP children, these behavior problems had a considerable impact on home or school life compared with only 7% in the comparison group (OR, 4.0; 95% CI, 1.9–8.3).

"Some of the behavior problems are accounted for by general cognitive deficits, but problems of attention, emotion, peer relationships, and school adaptation are more common than expected from cognitive scores," the researchers concluded. "These patterns of behavior difficulties may have important implications for brain imaging research, primary prevention of prematurity and neurodevelopmental problems, and clinical psychological care for EP children."  (Samara M, et al. Pediatrics 2008;122:562–573.)

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