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Emotional and Behavioral Problems of Preterm and Full-Term Children at School Entry
Jorijn Hornman1, Andrea F de Winter2, Jorien M Kerstjens3
1Departments of Health Sciences, University Medical Center Groningen, University of Groningen, Netherlands and j.hornman@umcg.nl.
Insights
Preterm children face higher risks of emotional and behavioral problems (EB-problems) that can persist or change by school entry. Individual stability of these EB-problems is hard to predict solely by prematurity, highlighting the need for ongoing monitoring.
Area of Science:
- Child psychology
- Developmental pediatrics
- Behavioral science
Background:
- Preterm children exhibit increased risk for emotional and behavioral problems (EB-problems) compared to term-born children.
- The prevalence and stability of EB-problems in preterm children may vary based on the degree of prematurity and age at assessment.
- Understanding the trajectory of EB-problems is crucial for timely intervention and support.
Purpose of the Study:
- To assess the individual stability of emotional and behavioral problems (EB-problems) in preterm versus term children.
- To examine how EB-problems change from before school entry to 1 year after school entry.
- To investigate variations in EB-problem stability within the preterm group based on gestational age.
Main Methods:
- Longitudinal cohort study involving 401 early preterm, 653 moderately preterm, and 389 term children.
- Emotional and behavioral problems (EB-problems) classified using the Child Behavior Checklist at ages 4 and 5.
- Categorization into: consistently normal, emerging, resolving, and persistent EB-problems.
Main Results:
- All preterm groups showed higher rates of persistent, emerging, and resolving EB-problems than term children.
- Early preterm children had the highest rates of persistent and emerging problems.
- Predictive value for stable EB-problems was ~50% (except for early preterm at 60%), indicating significant changeability.
Conclusions:
- Preterm children are at higher risk for persistent and changing emotional and behavioral problems (EB-problems) upon school entry.
- Individual stability of EB-problems in preterm children is challenging to predict based solely on prematurity.
- Continuous monitoring and tailored support are essential for preterm children experiencing EB-problems.
Background And Objectives:
Preterm children, compared with term children, are at increased risk of emotional and behavioral problems (EB-problems). Prevalences of EB-problems seem to vary with degree of prematurity and age at assessment. We therefore assessed individual stability of EB-problems in preterm compared with term children first before school entry and again 1 year after school entry, and variation in stability within the preterm group.
Methods:
We used data of 401 early preterm (25-31 weeks' gestational age), 653 moderately preterm (32-35 weeks' gestational age), and 389 term children from the Longitudinal Preterm Outcome Project cohort study. We classified EB-problems based on the Child Behavior Checklist at ages 4 and 5; this resulted in 4 categories: consistently normal (2 normal scores), emerging (normal score at age 4 and clinical/subclinical score at age 5), resolving, and persistent EB-problems.
Results:
All preterm children had higher rates than term children of persistent (7.2% vs 3.6%), emerging (4.3% vs 2.3%), and resolving (7.5% vs 3.6%) EB-problems. Early preterm children had the highest rates of persistent (8.2%) and emerging (5.2%) problems, and moderately preterm children had the highest rates of resolving problems (8.7%). In both preterm and term children, predictive values of normal scores at age 4 for normal scores at age 5 were ∼96%, and of clinical/subclinical scores at age 4 for clinical/subclinical scores at age 5 were ∼50%, except for early preterm children (60%).
Conclusions:
Compared with term children, all preterm children are at risk for persistent and changing EB-problems at school entry; individual stability, however, is difficult to predict based solely on the factor of preterm-birth.
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