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Attention problems of very preterm children compared with age-matched term controls at school-age
Jorrit F de Kieviet1, Ruurd M van Elburg, Harrie N Lafeber
1Department of Clinical Neuropsychology, VU University Amsterdam, Amsterdam, The Netherlands. jf.de.kieviet@vu.nl
Insights
Very preterm children show significant attention problems due to increased attention lapses and poorer visuospatial working memory. These neurocognitive factors fully explain the attention deficits observed in this population.
Area of Science:
- Developmental Neuroscience
- Cognitive Psychology
- Pediatric Neurodevelopment
Background:
- Very preterm birth is associated with increased risks for neurodevelopmental challenges.
- Attention problems are common in school-aged children, but their specific origins in preterm populations require clarification.
- Understanding the neurocognitive basis of attention deficits is crucial for targeted interventions.
Purpose of the Study:
- To investigate the severity and neurocognitive underpinnings of attention problems in very preterm children.
- To determine if specific neurocognitive deficits mediate attention problems in this cohort.
- To clarify the relationship between visuospatial working memory, attention lapses, and inattention ratings.
Main Methods:
- Compared 66 very preterm children (gestation <32 weeks) with 66 term-born controls at age 7.5 years.
- Assessed inattention using parent/teacher ratings and employed neurocognitive tests measuring information processing speed, attention lapses (tau), and working memory (verbal/visuospatial).
- Utilized ANOVA for group comparisons and Sobel tests to examine mediation effects of neurocognitive factors on attention problems.
Main Results:
- Very preterm children exhibited significantly poorer visuospatial working memory (d = 0.87) and increased attention lapses (tau, d = 0.55) compared to controls.
- Parent and teacher ratings of inattention were significantly higher in the preterm group (d = 0.40-0.56).
- Attention lapses (tau) and visuospatial working memory deficits fully mediated the relationship between very preterm birth and attention problems.
Conclusions:
- Increased attention lapses and impaired visuospatial working memory are the primary drivers of attention problems in school-aged very preterm children.
- These neurocognitive deficits completely explain the attention difficulties associated with very preterm birth.
- Findings highlight the critical role of working memory and attention regulation in the neurodevelopmental outcomes of preterm infants.
Objectives:
To clarify the severity, specificity, and neurocognitive underpinnings of attention problems in very preterm children.
Study Design:
A sample of 66 preterm (<32 weeks gestation), mean (SD) age 7.5 (0.4) years, and 66 age-matched term controls participated. Symptoms of inattention were assessed using parent and teacher-rated questionnaires, and neurocognitive measures included speed and consistency in speed of information processing, lapses of attention (tau), alerting, orienting, and executive attention, as well as verbal and visuospatial working memory. Group differences were investigated using ANOVA, and Sobel tests were used to clarify the mediating role of neurocognitive impairments on attention problems.
Results:
There was a large decrease in visuospatial working memory abilities (P < .001, d = .87), and medium increases in tau (P = .002, d = 0.55) as well as parent and teacher ratings of inattention (range d = 0.40-0.56) in very preterm children compared with term peers. Tau and visuospatial working memory were significant predictors of parent (R(2) = .161, P < .001 and R(2) = .071, P = .001; respectively) and teacher (R(2) = .152, P < .001 and R(2) = .064, P = .002; respectively) ratings of inattention, and completely explained the effects of very preterm birth on attention problems.
Conclusions:
Increased lapses of attention and poorer visuospatial working memory fully account for the attention problems in very premature children at school-age.
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