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Resilience and vulnerability in very preterm 4-year-olds
Aryanne de Silva1,2, Mary Lauren Neel1,2, Nathalie Maitre1,2
1Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA.
Insights
Fewer very preterm (VPT) children achieve adaptive competence compared to term-born peers. Supportive home environments and lower parental distress are linked to better outcomes in VPT children, suggesting intervention potential.
Area of Science:
- Developmental Pediatrics
- Neonatal Follow-up
- Child Psychology
Background:
- Very preterm (VPT) birth is associated with increased risk for developmental challenges.
- Adaptive competence, or resilience, is crucial for positive child development.
- Understanding factors influencing adaptive competence in VPT children is essential for targeted interventions.
Purpose of the Study:
- To determine the prevalence of adaptive competence in 4-year-old very preterm (VPT) children compared to term-born (Term) children.
- To identify correlates of adaptive competence within the VPT group and compare adaptively competent VPT children to their maladaptive counterparts and to adaptively competent Term children.
- To explore family factors associated with adaptive competence independent of birth status.
Main Methods:
- Study included 51 very preterm (VPT, gestational age ≤30 weeks) and 35 term-born (Term) 4-year-old children.
- Adaptive competence was defined by age-appropriate literacy/numeracy scores and absence of clinical behavioral/developmental problems.
- Analyses compared adaptive competence prevalence between groups and examined cognitive, executive function, and family factors.
Main Results:
- Significantly fewer VPT children (31%) demonstrated adaptive competence compared to Term children (71%) (p = .026), after controlling for sociodemographics.
- Adaptively competent VPT children exhibited higher cognitive scores and better executive function/self-regulation ratings than their maladaptive VPT peers.
- While sharing similarities, adaptively competent VPT children had some domain-specific weaknesses compared to adaptively competent Term children; higher home stimulation and lower parent distress correlated with competence.
Conclusions:
- A notable minority of VPT children achieve adaptive competence, but they may still face cognitive and executive functioning challenges.
- Supportive home learning environments and reduced parental distress are associated with better adaptive competence in VPT children.
- Early family interventions focusing on home stimulation and parental well-being may enhance developmental outcomes for very preterm infants.
Objective:
The primary goal was to determine the prevalence and correlates of adaptive competence in 51 very preterm (VPT, gestational age ≤30 weeks) 4-year-old children compared to a group of 35 term-born (Term) children of the same age. Methods: Adaptive competence, or "resilience" in the VPT group, was defined as age-appropriate scores on tests of early literacy and numeracy and an absence of clinical elevations on parent ratings of problems in behavior and development. Analyses were conducted to compare groups in the prevalence of adaptive competence, determine how adaptively competent VPT children differed from children who were not adaptively competent (i.e. the "maladaptive" subset) and from adaptively competent Term children, and identify family factors related to competence independent of group. Results: Controlling for sociodemographic background, fewer VPT children compared to Term participants (31% vs. 71%) were adaptively competent (p = .026). Compared to the maladaptive subset of the VPT group, adaptive VPT children had higher scores on cognitive tests and more positive parent ratings of executive function and self-regulation. The adaptive VPT subset had outcomes similar to adaptive Term children on many measures but poorer outcomes in specific domains. Higher home stimulation for learning and lower parent distress were also related to adaptive competence. Conclusion: Although a substantial minority of VPT children display adaptive competence, these children may have weaknesses in cognitive skills and executive functioning that present developmental challenges. Associations of adaptive competence with supportive home environments suggest that early family intervention may improve outcomes in this population.
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