Beyond protective factors and normal IQ in preterm children: More executive disorders than expected

Executive functions (EF) are vulnerable in preterm children. Owing to methodological issues, inconsistent findings have left some questions unresolved. This study implemented a theory-guided, integrative EF assessment in preterm children. We also examined the impact of perinatal and sociodemographic features on EF disorder. A quasi-experimental sample of 56 preterm children (28-34 weeks' gestation) aged 7-9 underwent a multidimensional EF assessment, combining performance-based (Child Executive Functions Battery-CEF-B) and daily life measures (Behavior Rating Inventory of Executive Functions-BRIEF, parent and teacher versions). EF disorder were defined as congruent impairments in both the CEF-B Impairment index and the BRIEF Global Executive Composite index (parent or teacher), relative to French norms (scores ≥90th percentile). EF disorder were identified in 30.4% of preterm children, despite an above-average mean intellectual quotient (107 ± 12.5). CEF-B revealed a high prevalence of EF difficulties (19.6% to 51.8% depending on component: inhibition, working memory, flexibility or planning). In everyday life, difficulties are reported overall by parents (23.2%) and teachers (16.4%). CEF-B and BRIEF scores showed low-to-moderate correlations and poor-to-fair congruence. Higher paternal education (OR: 6.73, p = .049) and higher education in both parents (OR: 8.22, p = .033) were protective against EF disorder. Perinatal variables (sex, gestational age, birth weight) and family income showed no significant impact. Findings confirm the high risk of EF difficulties in preterm children. Further work should identify high-risk children for follow-up and support, while raising EF awareness.