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Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
Executive function and implications for the Preterm Behavioral Phenotype in very preterm children at age 9-10 years
Rachel E Lean1,2, Berenice Anaya3, Lisa Gorham3
1Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, 63110, USA. rachel.lean@wustl.edu.
Journal of Neurodevelopmental Disorders
|May 28, 2026
Summary
Children born very preterm (VPT) with white matter injury (WMI) face executive function (EF) challenges that contribute to behavioral issues. Early EF support is crucial for improving outcomes in these vulnerable children.
Area of Science:
- Neuroscience
- Developmental Psychology
- Pediatrics
Background:
- Children born very preterm (VPT) exhibit executive function (EF) challenges and behavioral differences (Preterm Behavioral Phenotype [PBP]).
- The impact of white matter injury (WMI) on EF and PBP in VPT children is not well understood.
- The neurocognitive mechanisms linking EF challenges to the PBP are unclear.
Purpose of the Study:
- To investigate executive function (EF) and Preterm Behavioral Phenotype (PBP) outcomes in very preterm (VPT) children, particularly those with white matter injury (WMI).
- To examine the role of EF challenges as a mediator for the PBP in VPT children with and without WMI.
Main Methods:
- Longitudinal study of 123 VPT infants (≤30 weeks gestation) and 79 full-term (FT) controls, with follow-up at ages 5 and 9-10 years.
- Assessment of executive function (EF) using composite scores at both timepoints.
- Evaluation of the Preterm Behavioral Phenotype (PBP) through parent and child reports at age 9-10 years.
- Serial mediation analysis to link VPT birth, WMI, EF, and PBP outcomes.
Main Results:
- VPT and WMI children showed significantly lower EF abilities compared to FT children at ages 5 and 9-10 years (p≤.02).
- VPT and WMI children exhibited higher PBP scores, including inattention and social communication-interaction difficulties (p≤.03).
- Lower EF at both timepoints correlated with increased PBP ratings (r -0.2 to -0.45, p<.05).
- EF development partially mediated the association between VPT birth/WMI and PBP outcomes.
Conclusions:
- VPT children, especially those with WMI, experience greater EF and PBP challenges than FT children.
- Executive function (EF) development plays a partial role in the emergence of the Preterm Behavioral Phenotype (PBP).
- Early and ongoing EF support and targeted interventions are recommended for VPT and WMI children to improve mental health and behavioral outcomes.
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