Association of Preterm Birth With Attention-Deficit/Hyperactivity Disorder–Like and Wider-Ranging Neurophysiological Impairments of Attention and Inhibition

Abstract

ObjectivePreterm birth has been associated with an increased risk of attention-deficit/hyperactivity disorder (ADHD)–like symptoms and cognitive impairments similar to those seen in ADHD, including attention and inhibitory control difficulties. Yet data on direct comparisons across ADHD and preterm birth on cognitive-neurophysiological measures are limited.MethodWe directly compared 186 preterm-born adolescents to 69 term-born adolescents with ADHD and 135 term-born controls on cognitive-performance and event-related potential measures associated with attentional and inhibitory processing from a cued continuous performance test (CPT-OX), which we have previously shown to discriminate between the adolescents with ADHD and controls. We aimed to elucidate whether the ADHD-like symptoms and cognitive impairments in preterm-born individuals reflect identical cognitive-neurophysiological impairments in term-born individuals with ADHD.ResultsGo-P3 amplitude was reduced, reflecting impaired executive response control, in preterm-born adolescents compared to both controls and adolescents with ADHD. Moreover, in preterm-born adolescents, as in term-born adolescents with ADHD, contingent negative variation amplitude was attenuated, reflecting impairments in response preparation compared to controls. Although the ADHD group showed significantly increased NoGo-P3 amplitude at FCz compared to preterm group, at Cz preterm-born adolescents demonstrated significantly decreased NoGo-P3 amplitude compared to the control group, similar to term-born adolescents with ADHD.ConclusionThese findings indicate impairments in response preparation, executive response control, and response inhibition in preterm-born adolescents. Although the response preparation and response inhibition impairments found in preterm-born adolescents overlap with those found in term-born adolescents with ADHD, the preterm group also shows unique impairments, suggesting more wide-ranging impairments in the preterm group compared to the ADHD group.

Research Review: The role of obstetric and neonatal complications in childhood attention deficit and hyperactivity disorder – a systematic review

“… Mental and physical health of women (Serati, Buoli & Altamura, ) is crucial for limiting the risk of ADHD in the offspring; PB and LBW children should be carefully monitored for an early diagnosis of ADHD; Parents should be informed about the risk of LBW and preterm child to develop future ADHD (Rommel et al., ). …”

“…PB and LBW children should be carefully monitored for an early diagnosis of ADHD; 3. Parents should be informed about the risk of LBW and preterm child to develop future ADHD (Rommel et al, 2017).…”

Is Association of Preterm Birth with Cognitive-Neurophysiological Impairments and ADHD Symptoms Consistent with a Causal Inference or Due to Familial Confounds?

“…All ERP averages contained at least 20 accepted sweeps. ERPs were extracted from the CPT-OX (CNV, Go-P3, NoGo-P3), flanker task (N2, Pe, ERN, incongruent condition only) and fast task (CNV amplitude and P3 amplitude) following procedures used on previous analyses of this sample Rommel et al, 2017Rommel et al, , 2019; see online Supplementary Material I for further details.…”

“…We recently performed detailed investigations of the cognitive-neurophysiological impairments in preterm-born adolescents, when compared to unrelated term-born control adolescents, and, in order to help understand the increased risk of ADHD in preterm-born individuals, to term-born adolescents with ADHD Rommel et al, 2017Rommel et al, , 2019. Compared to the unrelated control group, the preterm group showed impairments that were similar to those observed in the ADHD group in decreased working memory, IQ, cognitive measures of preparation-vigilance [mean reaction time (MRT) and reaction time variability (RTV)], event-related potential (ERP) activity of response preparation, response inhibition, conflict monitoring and error processing Rommel et al, 2017Rommel et al, , 2019. The preterm group was further uniquely impaired on ERP activity of executive response control, compared to both ADHD and control groups .…”

“…We have available new data from term-born siblings of the same preterm-born adolescents whom we previously compared to unrelated controls Rommel et al, 2017Rommel et al, , 2019. By comparing the preterm-born adolescents to their termborn siblings, we now aim to test the within-sibling associations of preterm birth with increased ADHD symptoms and the specific cognitive-neurophysiological impairments, to investigate if the relationships are independent of unmeasured familial factors shared by siblings.…”