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The Role of Executive and General Cognitive Functioning in the Attention Problems of Very and Extremely Preterm
Robert Eves1, Adrian von Mühlenen1, Marina Mendonça1
1Department of Psychology and Division of Mental Health & Wellbeing, University of Warwick, Coventry, United Kingdom.
Insights
Adults born very preterm/very low birth weight (VP/VLBW) and extremely preterm (EP) face higher risks of attention problems. These attention deficits are linked to early childhood cognitive ability and adult executive functioning.
Area of Science:
- Neuroscience
- Developmental Psychology
- Pediatrics
Background:
- Preterm birth, including very preterm/very low birth weight (VP/VLBW) and extremely preterm (EP) birth, is a significant global health concern.
- Attention problems are frequently observed in individuals born preterm, but the underlying cognitive mechanisms require further elucidation.
Purpose of the Study:
- To investigate the association between attention problems in adults born VP/VLBW or EP and specific executive or general cognitive deficits.
- To determine if childhood intelligence and adult executive functions mediate the relationship between preterm birth and attention issues.
Main Methods:
- Longitudinal study design comparing VP/VLBW (Bavarian Longitudinal Study) and EP (EPICure Study) cohorts with their respective control groups.
- Assessment of adult attention deficit hyperactivity disorder (ADHD) symptoms via self-report, parent-report (BLS), and observer-rated attention spans.
- Hierarchical regression analyses to examine the influence of executive functioning (inhibitory control, working memory), childhood IQ, and sex on attention problems.
Main Results:
- VP/VLBW and EP individuals exhibited lower observer-rated attention spans compared to controls.
- Parent-rated inattention was higher in VP/VLBW adults, but self-reported ADHD symptoms did not differ significantly between preterm and control groups.
- In the BLS cohort, inhibitory control and childhood IQ were associated with parent-rated inattention, while working memory and childhood IQ were linked to observer-rated attention spans.
Conclusions:
- Adults born VP/VLBW and EP are at an elevated risk for observer-rated attention problems.
- These attention difficulties are primarily associated with general cognitive ability deficits identified in early childhood, with a secondary contribution from adult executive functioning.
Objective:
To determine whether the attention problems in adults born very preterm/very low birth weight (VP/VLBW; <32 weeks' gestation/<1500 g) or extremely preterm (EP; <26 weeks' gestation) are associated with specific executive or general cognitive deficits.
Method:
Cohorts of VP/VLBW (the Bavarian Longitudinal Study [BLS]) and EP (the EPICure Study) participants were followed from birth to early adulthood, each also following a respective control group. Adult attention deficit hyperactivity disorder (ADHD) symptoms were assessed via self-report in both cohorts and additionally by parent report in the BLS. Participants in both cohorts also had their attention span rated by trained observers. Performed separately in each cohort, hierarchical regression analyses were used to assess whether the association between preterm birth status and attention problems remained after accounting for executive functioning (inhibitory control and working memory) in adulthood, childhood intelligence score (IQ), or sex.
Results:
In the discovery cohort of the BLS, significant differences were found between VP/VLBW adults and controls for parent-rated inattention (p < 0.001). However, for self-reported measures of ADHD, no significant differences were found in the BLS or in the EPICure replication cohort. In both cohorts, observer-rated attention spans were lower for VP/VLBW and EP participants in comparison to their respective control groups (p < 0.001). In final models for the BLS, inhibitory control and childhood IQ were significantly associated with parent-rated inattention symptoms (p < 0.006), whereas working memory and childhood IQ were significantly associated with observer-rated attention span (p < 0.001). The effect of childhood IQ on observer-rated attention span was replicated in EPICure.
Conclusion:
VP/VLBW and EP adults are at increased risk of observer-rated attention problems. These problems were predominantly associated with poorer general cognitive ability in early childhood and somewhat with adult executive functioning.
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