Attention problems in very preterm children from childhood to adulthood: the Bavarian Longitudinal Study

Abstract

Background Very preterm (VP; gestational age <32 weeks) and very low birth weight (VLBW; <1500 grams) is related to attention problems in childhood and adulthood. The stability of these problems into adulthood is not known. Methods The Bavarian Longitudinal Study is a prospective cohort study that followed 260 VP/VLBW and 229 term‐born individuals from birth to adulthood. Data on attention were collected at 6, 8, and 26 years of age, using parent reports, expert behavior observations, and clinical ADHD diagnoses. Results At each assessment, VP/VLBW individuals had significantly more attention problems, shorter attention span, and were more frequently diagnosed with ADHD than term‐born comparisons. In both VP/VLBW and term‐born individuals, overall, attention span increased and attention problems decreased from childhood to adulthood. Attention problems and attention span were more stable over time for VP/VLBW than term‐born individuals. Similarly, ADHD diagnoses showed moderate stability from childhood to adulthood in VP/VLBW, but not in term‐born individuals. However, when those with severe disabilities were excluded, differences between VP/VLBW and term‐born individuals reduced. Conclusions Despite improvement in attention regulation from childhood to adulthood, children born very preterm remained at increased risk for attention problems in adulthood. In contrast, term‐born children with clinical attention problems outgrew these by adulthood. As inattentive behavior of VP/VLBW children may be overlooked by teachers, it may be necessary to raise awareness for school intervention programs that reduce attention problems in VP/VLBW children.

Trajectories of behavior, attention, social and emotional problems from childhood to early adulthood following extremely preterm birth: a prospective cohort study

“…For hyperactivity/inattention, scores were persistently higher among the EPT individuals but symptoms decreased slightly over time. The decline in ADHD symptoms and disorders with age for both term born and individuals with very low birth weight has been noted in previous studies which have also shown that the betweengroup difference in ADHD symptoms declines over time [2,30]. We have shown that the group difference in ADHD symptoms (SDQ scores) remains similar over time but the risk for clinically significant problems in EPT individuals declines from childhood to young adulthood.…”

“…Generally, the greater persistence of problems over time in this study compared with other very and extremely low birth weight cohorts [2,14,16,30,39] may also be related to the greater neurodevelopmental immaturity at birth, higher risk for neonatal brain injury and reduced neurodevelopmental plasticity that is conferred by birth at extremely low gestations compared with birth after 26 weeks of gestation. Indeed, moderate/severe cognitive impairment, an index of such factors [40,41], accounted for some of the difference in the overall behavioral problems with those having cognitive difficulties having persistently greater problems, but did not explain the excess entirely.…”

Early and long-term outcome of infants born extremely preterm

“…Fewer VP/VLBW adults are also married or cohabiting and reproductive rates may be lower than observed in term-born adults 57. Longitudinal studies have also shown that cognitive and behavioural problems in VP/VLBW individuals are more stable over time than in adults born at term 60 68…”

Mood and anxiety disorders in very preterm/very low–birth weight individuals from 6 to 26 years

“…The prevalence of psychiatric symptoms after VP/VLBW birth is significantly higher than that of term‐born individuals (2–4 times increased odds for symptoms in the clinical range compared with the general population) during childhood and adolescence (Johnson & Marlow, , ; Johnson & Wolke, ), and anxiety or mood problems, in particular, may be more prevalent in VP/VLBW adults (Mathewson et al., ; Pyhälä et al., ). VP/VLBW children show increased symptoms of autism spectrum and attention‐deficit/hyperactivity disorders (ADHD) (D'Onofrio et al., ), and ADHD type problems have been shown to continue more often into early adulthood in VP/VLBW than in term controls (Breeman, Jaekel, Baumann, Bartmann, & Wolke, ). In contrast, findings of increased risk for anxiety or mood disorders have been mixed (Johnson & Marlow, ; Johnson & Wolke, ).…”