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Published on: August 25, 2014
Inattention in very preterm children: implications for screening and detection
Ellen Brogan1, Lucy Cragg2, Camilla Gilmore3
1Leicester Children's Hospital, University Hospitals of Leicester NHS Trust, Leicester, UK.
Insights
Very preterm children show higher inattention symptoms than typically developing peers. These attention difficulties may go unnoticed in school, highlighting the need for increased teacher awareness for early intervention.
Area of Science:
- Neuroscience
- Developmental Psychology
- Pediatrics
Background:
- Children born very preterm (VP) are at increased risk for attention deficit/hyperactivity disorders (ADHD).
- ADHD in VP children can present differently, potentially leading to under-detection in educational settings.
- Assessing ADHD symptoms in VP children is crucial for timely intervention.
Purpose of the Study:
- To investigate ADHD symptoms in very preterm children compared to term-born controls.
- To determine if VP children's attention and hyperactivity difficulties are detected in school settings.
Main Methods:
- Parents and teachers of 117 VP and 77 term-born children completed the Strengths and Difficulties Questionnaire and the Du Paul ADHD Rating Scale-IV.
- Special Educational Needs (SEN) were assessed via teacher report.
- Statistical analyses adjusted for socio-economic factors.
Main Results:
- VP children exhibited significantly higher hyperactivity/inattention scores and clinically significant hyperactivity/inattention difficulties as reported by parents and teachers.
- Parents and teachers rated VP children with more inattention symptoms, with parents identifying more clinically significant inattention.
- Even after excluding children with identified SEN, VP children still showed higher inattention scores, but not hyperactivity/impulsivity.
Conclusions:
- Very preterm children face a greater risk for inattention symptoms compared to hyperactivity/impulsivity.
- Increased inattention in VP children without identified SEN suggests these issues may be missed in school.
- Enhancing teacher awareness of inattention symptoms can aid in identifying VP children needing support.
Objective:
Children born very preterm (VP; <32 weeks) are at risk for attention deficit/hyperactivity disorders (ADHD). ADHD in VP children have a different clinical presentation to ADHD in the general population, and therefore VP children with difficulties may not come to the teacher's attention in school. We have assessed ADHD symptoms to determine whether VP children's difficulties may go undetected in the classroom.
Design:
Parents and teachers of 117 VP and 77 term-born children completed the Strengths and Difficulties Questionnaire to assess hyperactivity/inattention, emotional, conduct and peer problems, and the Du Paul ADHD Rating Scale-IV to assess inattention and hyperactivity/impulsivity symptoms. Special Educational Needs (SEN) were assessed using teacher report. Group differences in outcomes were adjusted for socio-economic deprivation.
Results:
Parents and teachers rated VP children with significantly higher mean Strengths and Difficulties Questionnaire hyperactivity/inattention scores, and parents rated them with more clinically significant hyperactivity/inattention difficulties than term-born controls (Relative Risk (RR) 4.0; 95% CI 1.4 to 11.4). Examining ADHD dimensions, parents and teachers rated VP children with significantly more inattention symptoms than controls, and parents rated them with more clinically significant inattention (RR 4.8; 95% CI 1.4 to 16.0); in contrast, there was no excess of hyperactivity/impulsivity. After excluding children with SEN, VP children still had significantly higher inattention scores than controls but there was no excess of hyperactivity/impulsivity.
Conclusions:
VP children are at greater risk for symptoms of inattention than hyperactivity/impulsivity. Inattention was significantly increased among VP children without identified SEN suggesting that these problems may be difficult to detect in school. Raising teachers' awareness of inattention problems may be advantageous in enabling them to identify VP children who may benefit from intervention.
