Relationship Between Two‐year Behaviour and Neurodevelopmental Outcome at Five Years of Very Low‐birthweight Survivors

Abstract

SUMMARY A prospective five‐year follow‐up of survivors of very low birthweight (≤1500g) born in 1979 was carried out at the Queen Victoria Medical Centre, Melbourne, between 1980 and 1985. Of the 57 children reported here, 23 had been identified during psychological testing at two years as having an attention deficit disorder (ADD). Although the number with ADD at five years had decreased to 18, the two‐year diagnosis was retained to test its predictive value for outcome at school‐age. Children with ADD at two years differed significantly from their peers at five years in verbal, performance and full‐scale IQ and had significantly more minor physical disabilities. They also had poorer visual acuity, more tremor, poorer balance, and more deviations with arms extended in pronation. The ADD children had more minor, though chronic, physical illnesses such as tonsillitis and serous otitis media. Their mothers expressed greater concern than the other mothers about hearing and behaviour. The ADD children were rated as significantly more aggressive, difficult to manage and less able to cope with frustration. As a predictor of five‐year IQ, behaviour at two years was more powerful than social class. ADD discriminated a subgroup of very low‐birthweight children whose lower IQ and multiple physical, neurological and behavioural difficulties place them at very high risk of learning disabilities. RÉSUMÉ Relations entre le comportement à deux ans d'enfants survivants de tres faible poids de naissance et le devenir neurodévelopmental à cinq ans Une étude longitudinale prospective de cinq ans des enfants de trés faible poids de naissance survivants (plus petit que 1500g), nes en 1979, a été entreprise au Queen Victoria Medical Centre de Melbourne, de 1980 à 1985. Parmi les 57 enfants de l'étude, un trouble de déficit d'attention (ADD) a été identifyé chez 23 enfants durant le test psychologique à l'age de deux ans. Bien que le nombre d'enfants avec ADD à cinq ans soit descendu à 18, le diagnostic a deux ans fut retenu pour apprecier sa valeur predictive concernant le devenir a l'age scolaire. Les enfants avec ADD à deux ans différaient significativement de leurs pairs à cinq ans, aux échelles de QI verbal, performance et général; ils présentaient significativement davantage de troubles physiques minimes. On notait chez eux également une acuite visuelle moins bonne, plus de tremblements, un moins bon équillibre et plus de deviation lors de la position étendue des bras en pronation. Les enfants ADD présentaient plus d'affections physiques, mineures bien que chroniques comme les amygdalites ou les otites moyennes séreuses. Leur mère exprimait davantage d'inquiétude que les autres méres à propos de l'audition et du comportement. Les enfants ADD étaient qualifyés significativement plus agressifs, plus difficiles à conduire et moins tolerants vis a vis de la frustration. Comme predicteur du QI a cinq ans, le comportement à deux ans était meilleur que la classe sociale. Le syndrome ADD discriminait ainsi un sous‐groupe d'enfants de tré...

Behaviour at 2 years of age in very preterm infants (gestational age >32 weeks)

“…In addition to poorer psychological testing, however, the children with ADD also had more adverse neurological manifestations and more minor physical disabilities at 5 y of age. However, even those without minor physical disabilities did not have higher scores on the WPPSI than normally behaved children with such disabilities (28). These findings indicate that it is useful to assess behaviour at an early age.…”

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

“…Some authors have raised the question if severe LBW further increases the risk of ADHD in the offspring. Four studies (Astbury et al., ; Botting et al., ; Boulet et al., ; Singh et al., ) confirmed that VLBW is a risk factor for ADHD, but the effect sizes are comparable to those that have been extrapolated for LBW (effect size d range: 0.28–0.84). Similar considerations can be done for studies with ELBW (<1 kg) subjects, although in this case the sample sizes are even smaller than in the case of VLBW (Hack et al., ; Szatmari et al., ; Van Lieshout et al., ).…”

“…In 1987 a follow‐up of 57 very low birth weight children (VLBW, <1,500 g) found that at 5 years 18 (31%) of them had ADHD (Astbury, Orgill & Bajuk, ). In line with this study, in a sample of VLBW children 23% met ADHD clinical criteria compared with 6% of matched peers at 12 years ( p < .0001) (Botting, Powls, Cooke & Marlow, ).…”

Recalled Initiation and Duration of Maternal Breastfeeding Among Children with and Without ADHD in a Well Characterized Case–Control Sample

“…Determination of early experiential correlates is thus crucial. While there has been substantial focus on perinatal and delivery problems in ADHD (Astbury, Orgill, & Bajuk, 1987; Ben Amor et al, 2005; Kotimaa et al, 2003; McGrath, Sullivan, Lester, & Oh, 2000; Mick, Biederman, Faraone, Sayer, & Kleinman, 2002; Milberger, Biederman, Faraone, Guite, & Tsuang, 1997), postnatal correlates in the first year of life are less well studied. Yet the importance of postnatal, or early infant, programming of later disease risk is now relatively well-recognized (Kaplan, Evans, & Monk, 2008; Wells, Chomtho, & Fewtrell, 2007).…”