We report on a systematic review of studies of executive function and attention in preterm children. Using meta-analysis, we confirm this is an area of weakness for preterm children, and show that the extent of difficulties is influenced by gestational age (GA), age at test, and skill under investigation. Effect size for selective and sustained attention and inhibition is related to GA. For studies with mean GA > or = 26 weeks, selective attention skills catch up with age, phonemic fluency skills are increasingly delayed, and ongoing deviance is shown for shifting skills (when assessed with specific measures). Implications for research and practice are discussed.

Deficits in executive functions (EF) have been found in school-age children and adolescents with externalizing behavior disorders. Present meta-analysis was carried out to determine whether these EF impairments can also be found in preschool children with externalizing behavior problems. Twenty-two studies were included with a total of 4021 children. Four separate meta-analyses were conducted, concerning overall EF, working memory, inhibition and cognitive flexibility. A medium correlation effect size was obtained for overall EF (ESzr = 0.22) and for inhibition (0.24), whereas a small effect size was found for working memory (0.17) and for cognitive flexibility (0.13). Moderator analyses revealed a stronger effect for older preschoolers compared to younger preschoolers, and for children from referred samples compared to community samples. These results show that EF, especially inhibition, is related to externalizing behavior problems already in preschool years.

a b s t r a c tThe relationship between structural quality and process quality in early childhood education and care (ECEC) has been addressed in several studies. However, the findings are not conclusive. The present study was conducted in the Netherlands, which has a strongly regulated mid-quality ECEC system regarding structural aspects, with still considerable variation in process quality. The study employed a multi-method approach and extended the existing research in two ways. First, both observations of teacher-child interactions as well as teacher-reported developmental and educational activities were included as indicators of comprehensive emotional and educational process quality constructs. Second, to examine the relation between process quality and structural quality, commonly studied structural quality characteristics were complemented by less frequently studied measures of the professional development activities and education programs implemented at the centers. Results indicate that group size and child-to-teacher ratio are not related to emotional and educational process quality in the Dutch ECEC system. Teachers' formal pre-service education has a positive, but small association with emotional process quality. The use of an education program and professional development activities at the center show the strongest associations with emotional and educational process quality. Implications for policy and practice are discussed.

Processing speed and working memory are important factors underlying academic attainment in VPT children. Specific tests of processing speed and working memory, which together take approximately only 10 min to administer, could potentially be used as efficient screening instruments to assess which children are at risk of educational problems and should be referred for a full neuropsychological assessment.

Executive function (EF) is an important predictor of numerous developmental outcomes, such as academic achievement and behavioral adjustment. Although a plethora of measurement instruments exists to assess executive function in children, only few of these are suitable for toddlers, and even fewer have undergone psychometric evaluation. The present study evaluates the psychometric properties and validity of an assessment battery for measuring EF in two-year-olds. A sample of 2437 children were administered the assessment battery at a mean age of 2;4 years (SD = 0;3 years) in a large-scale field study. Measures of both hot EF (snack and gift delay tasks) and cool EF (six boxes, memory for location, and visual search task) were included. Confirmatory Factor Analyses showed that a two-factor hot and cool EF model fitted the data better than a one-factor model. Measurement invariance was supported across groups differing in age, gender, socioeconomic status (SES), home language, and test setting. Criterion and convergent validity were evaluated by examining relationships between EF and age, gender, SES, home language, and parent and teacher reports of children's attention and inhibitory control. Predictive validity of the test battery was investigated by regressing children's pre-academic skills and behavioral problems at age three on the latent hot and cool EF factors at age 2 years. The test battery showed satisfactory psychometric quality and criterion, convergent, and predictive validity. Whereas cool EF predicted both pre-academic skills and behavior problems 1 year later, hot EF predicted behavior problems only. These results show that EF can be assessed with psychometrically sound instruments in children as young as 2 years, and that EF tasks can be reliably applied in large scale field research. The current instruments offer new opportunities for investigating EF in early childhood, and for evaluating interventions targeted at improving EF from a young age.

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Executive function and attention difficulties are reported in very preterm (VPT) children at school entry, but it is unclear if these remain at later ages and/or if these difficulties are mediated by more basic functions, such as processing speed. Processing speed has been shown to underlie academic and behavioral problems in VPT children in middle childhood (Mulder, Pitchford, & Marlow, 2010, 2011), so may also underpin executive function and attention difficulties. We investigated this by comparing VPT (gestational age <31 weeks; N = 56) to term children (N = 22) aged 9-10 years on a comprehensive battery of executive function and attention tasks from the Test of Everyday Attention for Children (Manly, Robertson, Anderson, & Nimmo-Smith, 1999) and NEPSY (Korkman, Kirk, & Kemp, 1998). Selective and sustained attention, inhibition, working memory, shifting, verbal fluency, planning, and processing speed were examined. Group differences favoring term children were shown on most executive function tasks (i.e., inhibition, working memory, verbal fluency, and shifting), all of which were mediated by slow processing speed in the VPT group, except response inhibition. Seemingly, processing speed is an important determinant underpinning many neuropsychological deficits seen in VPT children in middle childhood.

BACKGROUND. Problem behaviour is common following pre-term birth, but the underlying nature of these difficulties is not well known. AIMS. We sought to establish the mechanisms underpinning behavioural difficulties in very pre-term (VPT) children in middle childhood by comparing their performance to that of term born peers on tasks of working memory, inhibition, and processing speed, and relating these to parent and teacher assessments of their behaviour. Particular focus was given to inattention and overactive/impulsive behaviour, as these behaviours have been associated with different neuropsychological problems in term children. SAMPLES. A group of VPT children (gestational age < 31 weeks, N= 56) aged 9-10 years and term controls (N= 22) participated in the study. METHOD. Children were assessed with measures of working memory, inhibition, and processing speed. Parents and teachers reported behavioural problems using the Strengths and Difficulties Questionnaire and two additional scales measuring overactive/impulsive behaviour and inattention. RESULTS. Results revealed increased rates of problem behaviour in VPT compared to term children for parent-rated total difficulties, hyperactivity, emotional problems, peer problems, prosocial behaviour, overactive/impulsive behaviour, and parent- and teacher-rated inattention. Processing speed and working memory, but not inhibition, were significantly related to inattentive and overactive/impulsive behaviour. CONCLUSIONS. The increased rates of inattention and overactive/impulsive behaviour in VPT children may be explained by impairment in processing speed and working memory. Expected links between overactive/impulsive behaviour and inhibitory control were not identified, suggesting the nature of such difficulties may be different in VPT compared to term children.