Effects of medical risk and socioeconomic status on the rate of change in cognitive and social development for low birth weight children

Abstract

Using Hierarchical Linear Models (HLM) analysis, this study evaluated the effects of medical risk at birth and socioeconomic status (SES) on the rate of change in cognitive and social development over the first three years of life in premature children with low birth weight (LBW). Children with LBW (n = 79) with both high (HR) (n = 37) and low (LR) (n = 42) medical risk were compared to healthy full-term (FT) (n = 49) children. Children were assessed longitudinally at 6, 12, 24, and 36 months for cognitive development with the Bayley Scales of Infant Development and the McCarthy Scales for Children's Abilities, and for social initiative and responsiveness with observational measures. The HR LBW group had slower rates of increases in cognitive scores than did the LR LBW and FT groups and showed more deceleration in cognitive development by 36 months of age. Children with LBW, regardless of medical risk, had lower social initiating scores and slower rates of increase in initiating across the first 36 months than did FT children. As predicted, the groups did not show different rates of change for measures of social responsiveness. Higher SES was predictive of better cognitive and social development for all children. The difficulties encountered by children with LR and HR LBW in developing social initiating skills are discussed in relation to the link between learning to take initiative and early executive function skills.

Early Psychological Development of Very Preterm and/or Low Birth Weight Children: A Review of the Literature

“…In relation to social and personal development studies, the reviewed studies found that preterm children have problems in social adjustment in the first months (35,68), in task persistence also at 4 years (35,44), in emotional regulation and social interactions from the first year of life (37,39,44,68,71), in emotional adjustment (48,68), in the development of secure attachment and social competence in the early years (5,48,71), in internalizing behavior at two years (such as shyness, fear, anxiety, depression) (5, 71) and behavioral difficulties, such as hyperactivity at 3, 5 and 6 years (76). However, there is no agreement between the studies regarding externalizing behavior problems, such as aggression, hyperactivity and defiance, or emotional expression and regulation difficulties.…”

“…Similarly, Landry et al (39) found that preterm children were less initiating in social interactions than their full-term peers between 2 and 4.5 years of age. Landry et al (75) also found that at 4.5 years, preterm children differed in their levels of play and social initiating skills from full-term children, who engaged in more pretend play and needed fewer trials to succeed in tasks.…”

“…Landry et al (39) found that cognitive development was slower in preterm children during the first 2 years of life. On the other hand, Pitchford et al (40), found significant differences in the development of attention and memory in preterm children at 2 years of age.…”

Predicting cognitive-language and social growth curves from early maternal behaviors in children at varying degrees of biological risk.

“…Growth modeling may be a particularly valuable means of determining whether children who show different rates of development show different patterns of relations between specific early parenting behaviors and growth in social and cognitive processes. Very low birth weight (VLBW) infants of varying degrees of early medical risk are one group who may require more specialized parenting to optimize their development because, as a group, they show slower rates of growth in cognitive and social skills through 3 years of age as compared with FT infants (Landry, Denson, & Swank, 1997). Whereas growth appears slower for VLBW infants as a group, as within any group, there are individual differences in this growth suggesting that some children, will show faster rates of gains than will others (Landry et al, 1997).…”

Follow-up Care of High-Risk Infants

“…Normal birth weight controls are often not included when comparing the outcome of lowrisk versus high-risk birth weight groups, eg, in studies assessing the effects of chronic lung disease, brain hemorrhage, jaundice, etc. 149 In contrast to school-age studies, descriptive studies of early-childhood outcomes of high-risk children (Ͻ3 years) have often not included control subjects. However, it is currently recommended that if the true impact of prematurity is to be identified, "normal" control populations should be included at all ages.…”