Minor neurodevelopmental impairments are associated with increased occurrence of ADHD symptoms in children born extremely preterm

Abstract

ADHD is more common in children born preterm than at term. The purpose of the study was to examine if, and to what extent, ADHD symptoms are associated with minor neurodevelopmental impairments (NDI) in extremely preterm children. In a national population-based cohort with gestational age 22-27 weeks or birth weight <1,000 g assessed at 5 years of age, scores on Yale Children's Inventory (YCI) scales (seven scales) were related to normal functions vs. NDI defined as mild impairments in cognitive function (IQ 70-84), motor function (Movement Assessment Battery for children score > the 95th percentile or freely ambulatory cerebral palsy), vision (correctable), and hearing (no hearing aid). YCI was completed for 213 of 258 eligible children (83%). Children with minor NDIs (n = 98) had significantly higher scores (more ADHD symptoms) than those without NDI (n = 115) on the YCI scales of Attention, Tractability, Adaptability and Total score. Increasing numbers of minor NDIs were associated with higher mean YCI scores. In multivariate analysis only decreased hearing, IQ, and male gender were significantly associated with scores on the Attention scale. Thirty-three children (16%) had scores >3 on the Attention scale (probably ADHD), and the proportion was significantly higher for those with mild NDIs compared to those without (Odds ratio = 2.7, 95% CI 1.3-6.0). Children born extremely preterm with minor NDIs were more likely to have ADHD symptoms than those with no NDI, and increasing number of minor NDIs were associated with more ADHD symptoms.

Disruptions to the cerebellar GABAergic system in juvenile guinea pigs following preterm birth

“…The incidence of moderate-late preterm birth (32-37 weeks of gestation) has significantly increased in developed nations over the past two decades (Frey and Klebanoff, 2016;Ananth and Vintzileos, 2006;Beck et al, 2010;Martin et al, 2010). In line with this rise, it is also becoming increasingly evident that survivors of moderate-late preterm birth are at an increased risk of neurodevelopmental disorders in childhood and adolescence (Cheong and Doyle, 2012;Chyi et al, 2008; were more likely to be diagnosed with anxiety disorder than females born at term (Elgen et al, 2014). In a large Danish cohort of 2-18 year old children, preterm birth at 34-36 weeks of gestation was associated with an 80% increased risk of being diagnosed with hyperkinetic disorder (characterized by inattention, hyperactivity, and impulsivity) compared to children born after 37 weeks' gestation, interestingly 90% of affected children were male (Linnet et al, 2006).…”

“…Along with anxiety, attention deficit hyperactivity disorder (or ADHD) is the most commonly diagnosed neurodevelopmental disorder in school‐aged ex‐preterm children (Lindstrom et al, 2011; Linnet et al, 2006). ADHD is characterized by a deficit in behavioural inhibition, inattention, impulsivity and social difficulties, and in a cohort of children at 5 years old it was more commonly diagnosed in males following preterm birth compared to term birth (Elgen et al, 2014). In the same cohort, preterm females were more likely to be diagnosed with anxiety disorder than females born at term (Elgen et al, 2014).…”

“…ADHD is characterized by a deficit in behavioural inhibition, inattention, impulsivity and social difficulties, and in a cohort of children at 5 years old it was more commonly diagnosed in males following preterm birth compared to term birth (Elgen et al, 2014). In the same cohort, preterm females were more likely to be diagnosed with anxiety disorder than females born at term (Elgen et al, 2014). In a large Danish cohort of 2–18 year old children, preterm birth at 34–36 weeks of gestation was associated with an 80% increased risk of being diagnosed with hyperkinetic disorder (characterized by inattention, hyperactivity, and impulsivity) compared to children born after 37 weeks’ gestation, interestingly 90% of affected children were male (Linnet et al, 2006).…”

Mental Health in Children Born Extremely Preterm Without Severe Neurodevelopmental Disabilities

“…[13][14][15] Such disabilities are strongly associated with mental health problems irrespective of being born premature. [16][17][18][19] Assessment of mental health in children with severe NDDs, such as intellectual disability (ID) (IQ <70), requires appropriately validated tools, 18,20,21 but most EP/ELBW studies have included children with severe NDDs without using instruments validated for this subgroup. [1][2][3][4][5][6][7][8][9][10][11][12][22][23][24] In subanalyses, some studies have found increased risk of mental health problems in EP/ELBW children without severe NDDs, but frequencies and effect sizes were not reported.…”

ADHD symptoms and their neurodevelopmental correlates in children born very preterm

“…Psychiatric risk in extremely preterm children has been found to be higher in those with coexisting neurodevelopmental disabilities (35), although neurodevelopmental disabilities have been also associated with psychopathology irrespective of very preterm birth (36). In this study, up to two thirds of children with clinically significant ADHD-inattentive symptoms had comorbid neurodevelopmental disabilities, as did one quarter of those with clinically significant ADHD-hyperactive/impulsive symptoms.…”