Academic performance of children born preterm: a meta-analysis and meta-regression

Twilhaar, E. Sabrina; Kieviet, Jorrit F. de; Aarnoudse-Moens, Cornelieke S.H.; Elburg, Ruurd M. van; Oosterlaan, Jaap

doi:10.1136/archdischild-2017-312916

Cited by 134 publications

(150 citation statements)

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“…However, this is unlikely, as others have found poorer than expected mathematics achievement among older children and adolescents who were born preterm (Akshoomoff et al, 2017;Litt et al, 2012;Taylor et al, 2009). Similar to our findings, a meta-analysis of 17 studies found that arithmetic performance of preterm children and adolescents (6-18 years of age) was 0.71 SD below full-term controls (Twilhaar, Kieviet, Aarnoudse-Moens, Elburg, & Oosterlaan, 2018). This hints towards persistent lower performance in complex mathematics skills following preterm birth.…”

Section: Discussionsupporting

confidence: 89%

Cognitive Functions Mediate the Effect of Preterm Birth on Mathematics Skills in Young Children

Adrian

Bakeman

Akshoomoff

et al. 2019

Preprint

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AbstractChildren born preterm are at risk for cognitive deficits and lower academic achievement. Notably, mathematics achievement is generally most affected. Here, we investigated the cognitive functions mediating early mathematics skills and how these are impacted by preterm birth. Healthy children born preterm (gestational age at birth < 33 weeks; n = 51) and children born full term (n = 27) were tested at ages 5, 6, and 7 years with a comprehensive battery of tests. We categorized items of the TEMA-3: Test for Early Mathematics Abilities Third Edition into number skills and arithmetic skills. Using multiple mediation models, we assessed how the effect of preterm birth on mathematics skills is mediated spatial working memory, inhibitory control, visual-motor integration, and phonological processing. Both number and arithmetic skills showed group differences, but with different developmental trajectories. The initial poorer performance observed in the preterm children decreased over time for number skills but increased for arithmetic skills. Phonological processing, visual-motor integration, and inhibitory control were poorer in children born preterm. These cognitive functions, particularly phonological processing, had a mediating effect on both types of mathematics skills. These findings help define and chart the trajectory of the specific cognitive skills directly influencing math deficit phenotypes in children born very preterm. This knowledge provides guidance for targeted evaluation and treatment implementation.

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Section: Discussionsupporting

confidence: 89%

Cognitive Functions Mediate the Effect of Preterm Birth on Mathematics Skills in Young Children

Adrian

Bakeman

Akshoomoff

et al. 2019

Preprint

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“…Preterm birth and low birthweight co‐occur frequently, with 69.2% of children born preterm also being born with a low birthweight and 49.8% of children born with a low birthweight also being born preterm . Preterm birth and/or low birthweight survivors are at high risk of adverse cognitive, academic, and behavioural outcomes . Children born preterm/low birthweight have 0.8 standard deviation (SD) lower IQ scores and perform about a 0.5 SD poorer than term‐born peers on mathematics, reading, and spelling tests .…”

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confidence: 99%

“…3 Preterm birth and/or low birthweight survivors are at high risk of adverse cognitive, academic, and behavioural outcomes. 1,4,5 Children born preterm/low birthweight have 0.8 standard deviation (SD) lower IQ scores and perform about a 0.5 SD poorer than term-born peers on mathematics, reading, and spelling tests. 4,5 Also, a two to four times higher risk of being diagnosed with attention-deficit/hyperactivity disorder than for term-born peers has been reported.…”

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confidence: 99%

“…1,4,5 Children born preterm/low birthweight have 0.8 standard deviation (SD) lower IQ scores and perform about a 0.5 SD poorer than term-born peers on mathematics, reading, and spelling tests. 4,5 Also, a two to four times higher risk of being diagnosed with attention-deficit/hyperactivity disorder than for term-born peers has been reported. 4,6,7 A large body of studies has also shown impairments in the so-called executive functions in children born preterm/low birthweight.…”

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confidence: 99%

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

Houdt

Oosterlaan

Wassenaer-Leemhuis

et al. 2019

Develop Med Child Neuro

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AimTo investigate the magnitude of executive function deficits and their dependency on gestational age, sex, age at assessment, and year of birth for children born preterm and/or at low birthweight.MethodPubMed, PsychINFO, Web of Science, and ERIC were searched for studies reporting on executive functions in children born preterm/low birthweight and term controls born in 1990 and later, assessed at a mean age of 4 years or higher. Studies were included if five or more studies reported on the same executive function measures.ResultsThirty‐five studies (3360 children born preterm/low birthweight, 2812 controls) were included. Children born preterm/low birthweight performed 0.5 standardized mean difference (SMD) lower on working memory and cognitive flexibility and 0.4 SMD lower on inhibition. SMDs for these executive functions did not significantly differ from each other. Meta‐regression showed that heterogeneity in SMDs for working memory and inhibition could not be explained by study differences in gestational age, sex, age at assessment, or year of birth.InterpretationChildren born preterm/low birthweight since 1990 perform half a SMD below term‐born peers on executive function, which does not seem to improve with more recent advances in medical care or with increasing age.What this paper adds Children born preterm/low birthweight perform below term‐born children on core executive functions.Lower gestational age or male sex are not risk factors for poorer executive functions.Executive function difficulties in children born preterm/low birthweight remain stable across childhood.Executive function difficulties are similar for children born recently and children born in earlier eras.

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“…The early identification of a preterm profile characterised by inattentive ADHD symptomatology associated with lower IQ and perinatal clinical risk suggests the need for early screening and educational interventions aimed at improving specific attention problems in very preterm children, many of whom exhibit academic difficulties at school age and are three times more likely to have special educational needs than their term-born peers (51). Attention is a crucial requirement in school settings as it allows the child to engage with classroom education activities.…”

Section: Discussionmentioning

confidence: 99%

ADHD symptoms and their neurodevelopmental correlates in children born very preterm

Montagna

Karolis

Batallé

et al. 2019

Preprint

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23 This study investigated the association between attention-deficit/hyperactivity disorder (ADHD) 24 symptomatology in preschool-aged children who were born very preterm (<32 weeks) and cognitive 25 outcomes, clinical risk and socio-demographic characteristics. 119 very preterm children who participated 26 in the Evaluation of Preterm Imaging Study at term-equivalent age were assessed at a mean age of 4.5 27 years. Parents completed the ADHD Rating Scale IV, a norm-referenced checklist that evaluates ADHD 28 symptomatology according to diagnostic criteria, and the Behavior Rating Inventory of Executive 29 Function-Preschool version. Children completed the Wechsler Preschool and Primary Scales of 30 Intelligence and the Forward Digit Span task. Longitudinal data including perinatal clinical, qualitative 31 MRI classification, socio-demographic variables and neurodevelopmental disabilities were investigated in 32 relation to ADHD symptomatology. All results were corrected for multiple comparisons using false 33 discovery rate. Results showed that although the proportion of very preterm children with clinically 34 significant ADHD did not differ from normative data after excluding those with neurodevelopmental 35 disabilities, 32.7% met criteria for subthreshold ADHD inattentive type and 33.6% for combined type, 36 which was higher than the expected 20% in normative samples. Higher ADHD symptom scores (all) were 37 associated with greater executive dysfunction (inhibitory self-control, flexibility, and emergent 38 metacognition, corrected p<0.001 for all tests). Higher inattentive ADHD symptom scores were 39 associated with lower IQ (ρ=-0.241, p=0.036) and higher perinatal clinical risk (more days on mechanical 40 ventilation (ρ=0.206, p=0.025) and more days on parenteral nutrition (ρ=0.223, p=0.015)). Higher 41 hyperactive ADHD symptom scores instead were associated with lower socio-economic status (ρ=0.278, 42 p=0.002). These results highlight the importance of monitoring and supporting the development of very 43 preterm children throughout the school years, as subthreshold ADHD symptoms represent risk factors for 44 psychosocial problems and for receiving a future clinical diagnosis of ADHD. 45 3 46 List of Abbreviations and Acronyms: 47 ADHD (Attention-deficit/hyperactivity disorder) 48 MRI (magnetic resonance imaging) 49 NDD (Neurodevelopmental disability) 50 51 52 53 54 55 56 57 58 59 60 4 61 Introduction 62 Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental condition which affects 5-7%63 of children, depending on the source of information used to reach a diagnosis (1, 2). Children who were 64 born very preterm (< 32 weeks of gestation) have a 2-to 3-fold increased risk of being diagnosed with 65 ADHD compared to their term born peers (4-fold risk in those born at < 26 weeks) (3-7). 66According to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-67 V), ADHD is characterized by two main symptom presentations, inattention and hyperactivity-68 impulsivit...

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Academic performance of children born preterm: a meta-analysis and meta-regression

Cited by 134 publications

References 40 publications

Cognitive Functions Mediate the Effect of Preterm Birth on Mathematics Skills in Young Children

Cognitive Functions Mediate the Effect of Preterm Birth on Mathematics Skills in Young Children

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

ADHD symptoms and their neurodevelopmental correlates in children born very preterm

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