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OBJECTIVE. To determine the efficacy of behavioral management counseling in the treatment of persistent, excessive infant crying (> 3 hours per day). DESIGN. Two treatments, one no treatment control group. Infants were group-matched according to baseline fuss/cry levels, sociodemographic, and infant variables. Treatments were carried out sequentially by the same counselors. SETTING. Telephone counseling by volunteers (mothers) of CRY-SIS, a national support group for the parents of crying infants. PATIENTS AND INTERVENTIONS. Sequential sample of 27 mother-infant pairs receiving treatment 1 (Tr1, empathy: talking through the problem), 21 receiving treatment 2 (Tr2, behavioral management: specific care taking suggestions) and 44 receiving no treatment (C, controls). Infants were between 1 to 5 months of age. MEASUREMENTS AND RESULTS. Mother-infant pairs had a pretreatment baseline assessment and a posttreatment follow-up (3 months after baseline) using 1-week diaries. Total fuss/cry duration reduced significantly more in the behavioral management group (by 51%) than the empathy group (37%) or the control group (35%). This was mainly due to significantly reduced evening fussing/crying in Tr2 (67%) compared with Tr1 (45%) and C (42%). No differences in total number of fuss/cry bouts/day were found. However, the number of fuss/cry bouts reduced significantly more in the evening in Tr2 (by 55%) compared with Tr1 (27%) and C (32%). Behavioral management mothers evaluated the same counselors as more sympathetic, knowledgeable, and understanding. Tr2 was also perceived by mothers to have helped them more in reducing the crying problem, coping with the infant, and improving the relationship with their infant than Tr1. No effects of treatment on infant difficult temperament were found. CONCLUSIONS. Behavioral management was more effective in reducing fussing/crying than spending time with the mother talking through the problem or just waiting for spontaneous remission. Treatment by suitably but briefly trained lay counselors is an inexpensive and successful treatment option. [ABSTRACT FROM AUTHOR]

Background: Adults born preterm (<37 weeks) have lower educational attainment than those born term. Whether this relationship is modified by family factors such as socioeconomic background is, however, less well known. We investigated whether the relationship between gestational age and educational attainment in adulthood differed according to parents' educational level in 4 Nordic countries., Methods: This register-based cohort study included singletons born alive from 1987 up to 1992 in Denmark, Finland, Norway, and Sweden. In each study population, we investigated effect modification by parents' educational level (low, intermediate, high) on the association between gestational age at birth (25-44 completed weeks) and low educational attainment at 25 years (not having completed upper secondary education) using general estimation equations logistic regressions., Results: A total of 4.3%, 4.0%, 4.8%, and 5.0% singletons were born preterm in the Danish (n = 331 448), Finnish (n = 220 095), Norwegian (n = 292 840), and Swedish (n = 513 975) populations, respectively. In all countries, both lower gestational age and lower parental educational level contributed additively to low educational attainment. For example, in Denmark, the relative risk of low educational attainment was 1.84 (95% confidence interval 1.44 to 2.26) in adults born at 28 to 31 weeks whose parents had high educational level and 5.25 (95% confidence interval 4.53 to 6.02) in adults born at 28 to 31 weeks whose parents had low educational level, compared with a reference group born at 39 to 41 weeks with high parental educational level., Conclusions: Although higher parental education level was associated with higher educational attainment for all gestational ages, parental education did not mitigate the educational disadvantages of shorter gestational age., Competing Interests: FINANCIAL DISCLOSURE: The authors have indicated that they have no financial relationships relevant to this article to disclose., (Copyright © 2021 by the American Academy of Pediatrics.)

Context: There is a lack of research on individual perceptions of social experiences and social relationships among very preterm (VP) adults compared with term-born peers., Objective: To investigate self-perceived social functioning in adults born VP (<32 weeks' gestation) and/or with very low birth weight (VLBW) (<1500g) compared with term-born adults (≥37 weeks' gestation) using an individual participant data (IPD) meta-analysis., Data Sources: Two international consortia: Research on European Children and Adults born Preterm and Adults Born Preterm International Collaboration., Study Selection: Cohorts with outcomes assessed by using the Adult Self-Report Adaptive Functioning scales (friends, spouse/partner, family, job, and education) in both groups., Data Extraction: IPD from 5 eligible cohorts were collected. Raw-sum scores for each scale were standardized as z scores by using mean and SD of controls for each cohort. Pooled effect size was measured by difference (Δ) in means between groups., Results: One-stage analyses (1285 participants) revealed significantly lower scores for relationships with friends in VP/VLBW adults compared with controls (Δ -0.37, 95% confidence interval [CI]: -0.61 to -0.13). Differences were similar after adjusting for sex, age, and socioeconomic status (Δ -0.39, 95% CI: -0.63 to -0.15) and after excluding participants with neurosensory impairment (Δ -0.34, 95% CI: -0.61 to -0.07). No significant differences were found in other domains., Limitations: Generalizability of research findings to VP survivors born in recent decades., Conclusions: VP/VLBW adults scored their relationship with friends lower but perceived their family and partner relationships, as well as work and educational experiences, as comparable to those of controls., Competing Interests: POTENTIAL CONFLICT OF INTEREST: Dr Marlow declares consultancy fees from RSM Consulting, Takeda, and Novartis in the past 3 years outside this study. The other authors have indicated they have no potential conflicts of interest to disclose., (Copyright © 2021 by the American Academy of Pediatrics.)

Background and Objectives: Children born extremely preterm (EP) (<26 weeks' gestation) have lower cognitive scores and an increased rate of cognitive impairment compared with their term-born peers. However, the neuropsychological presentation of these EP individuals in adulthood has not been described. The aim of this study was to examine neuropsychological outcomes in early adulthood after EP birth in the 1995 EPICure cohort and to investigate if the rate of intellectual impairment changed longitudinally., Methods: A total of 127 young adults born EP and 64 term-born controls had a neuropsychological assessment at 19 years of age examining general cognitive abilities (IQ), visuomotor abilities, prospective memory, and aspects of executive functions and language., Results: Adults born EP scored significantly lower than term-born controls across all neuropsychological tests with effect sizes (Cohen's d ) of 0.7 to 1.2. Sixty percent of adults born EP had impairment in at least 1 neuropsychological domain; deficits in general cognitive functioning and visuomotor abilities were most frequent. The proportion of EP participants with an intellectual impairment (IQ <70) increased by 6.7% between 11 and 19 years of age ( P = .02). Visuospatial functioning in childhood predicted visuomotor functioning at 19 years., Conclusions: Adults born EP continue to perform lower than their term-born peers in general cognitive abilities as well as across a range of neuropsychological functions, indicating that these young adults do not show improvement overtime. The prevalence of intellectual impairment increased from 11 years into adulthood., Competing Interests: POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose., (Copyright © 2020 by the American Academy of Pediatrics.)

Context: Preterm birth and/or low birth weight (PT/LBW) increases the risk of cognitive deficits, which suggests an association between PT/LBW and lower wealth in adulthood. Nevertheless, studies have revealed inconsistent findings so far., Objective: To systematically investigate whether PT/LBW is associated with markers of adulthood wealth., Data Sources: We searched Medline, PubMed, PsycINFO, Web of Science, and Embase., Study Selection: Prospective longitudinal and registry studies containing reports on selected wealth-related outcomes in PT/LBW-born adults compared with term-born controls., Data Extraction: Two independent reviewers extracted data on educational qualifications, employment rates, social benefits, and independent living., Results: Of 1347 articles screened, 23 studies met the inclusion criteria. PT/LBW was associated with decreased likelihood of attainment of higher education qualifications (odds ratio [OR] = 0.74; 95% confidence interval [CI] = 0.69-0.80), lower employment rate (OR = 0.83; 95% CI = 0.74-0.92), and increased likelihood of receiving social benefits (OR = 1.25; 95% CI = 1.09-1.42). A dose-response relationship according to gestational age was only found for education qualifications. PT/LBW-born adults did not differ significantly from those born at term in independent living., Limitations: There was high heterogeneity between studies. There were unequal numbers of studies from different regions in the world., Conclusions: PT/LBW is associated with lower educational qualifications, decreased rate of employment, and an increased rate of receipt of social benefits in adulthood. Low educational qualifications were most prevalent in those born very preterm and consistent across geographic regions. However, the findings are less clear for independent living., Competing Interests: POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose., (Copyright © 2018 by the American Academy of Pediatrics.)

Background and Objectives: Parents of preterm children experience increased distress early in their children's lives. Whether the quality of life of parents of preterm children is comparable to that of parents of term children by the time their offspring reach adulthood is unknown. What precursors in their offspring's childhood predict parental quality of life?, Methods: A prospective whole-population study in Germany followed very preterm (VP) (<32 weeks gestation) or very low birth weight (VLBW) (<1500 g) ( N = 250) and term-born individuals ( N = 230) and their parents (VP or VLBW: N = 219; term: N = 227) from birth to adulthood. Parental quality of life was evaluated with the World Health Organization Quality of Life assessment and the Satisfaction with Life questionnaire when their offspring were adults (mean age 27.3 years, 95% confidence interval [CI]: 27.2 to 27.3). Childhood standard assessments of VP or VLBW and term offspring included neurosensory disability, academic achievement, mental health, and parent-child and peer relationships., Results: Overall quality of life of parents of VP or VLBW adults was found to be comparable to parents of term individuals ( P > .05). Parental quality of life was not predicted by their children being born VP or VLBW, experiencing disability, academic achievement, or the parent-child relationship in childhood but by their offspring's mental health (B = 0.15, 95% CI: 0.08 to 0.22) and peer relationships (B = 0.09, 95% CI: 0.02 to 0.16) in childhood., Conclusions: As a testament to resilience, parents of VP or VLBW adults had quality of life comparable to parents of term adults. Support and interventions to improve mental health and peer relationships in all children are likely to improve parents' quality of life., Competing Interests: POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose., (Copyright © 2017 by the American Academy of Pediatrics.)

Context: Preterm birth increases the risk for mental disorders in adulthood, yet findings on self-reported or subclinical mental health problems are mixed., Objective: To study self-reported mental health problems among adults born preterm at very low birth weight (VLBW; ≤1500 g) compared with term controls in an individual participant data meta-analysis., Data Sources: Adults Born Preterm International Collaboration., Study Selection: Studies that compared self-reported mental health problems using the Achenbach Young Adult Self Report or Adult Self Report between adults born preterm at VLBW ( n = 747) and at term ( n = 1512)., Data Extraction: We obtained individual participant data from 6 study cohorts and compared preterm and control groups by mixed random coefficient linear and Tobit regression., Results: Adults born preterm reported more internalizing (pooled β = .06; 95% confidence interval .01 to .11) and avoidant personality problems (.11; .05 to .17), and less externalizing (-.10; -.15 to -.06), rule breaking (-.10; -.15 to -.05), intrusive behavior (-.14; -.19 to -.09), and antisocial personality problems (-.09; -.14 to -.04) than controls. Group differences did not systematically vary by sex, intrauterine growth pattern, neurosensory impairments, or study cohort., Limitations: Exclusively self-reported data are not confirmed by alternative data sources., Conclusions: Self-reports of adults born preterm at VLBW reveal a heightened risk for internalizing problems and socially avoidant personality traits together with a lowered risk for externalizing problem types. Our findings support the view that preterm birth constitutes an early vulnerability factor with long-term consequences on the individual into adulthood., Competing Interests: POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose., (Copyright © 2017 by the American Academy of Pediatrics.)

Background: This study investigated change of health-related quality of life (HRQL) in very preterm/very low birth weight (VP/VLBW; born at <32 weeks' gestation and/or <1500 g birth weight) individuals from adolescence to adulthood. Are perceptions similar by different informants (self, parents) and is HRQL related to economic and social functioning?, Methods: In a prospective whole-population sample in South Germany, 260 VP/VLBW and 229 term born individuals were assessed from birth to adulthood. HRQL was evaluated by self and parent report at age 13 and 26 years with the Health Utilities Index Mark 3 (HUI3), and economic and social functioning from interview and standard assessments at 26 years., Results: At both time points, HUI3 scores of VP/VLBW were reported to be lower compared with term born controls by participants and parents. Except for adolescent self-reports (P = .13) these differences were all significant (P < .05). In contrast to participants themselves, parents reported VP/VLBW individuals' HRQL to be worsening over time (change of mean HUI3 scores: 0.88-0.86, P = .03). Parents, particularly, reported negative changes in emotion and pain for VP/VLBW individuals over time. Participant and parent-perceived HRQL was negatively related to economic and social functioning outcomes such as receiving social benefits, unemployment, dating romantic partner or having friends., Conclusions: VP/VLBW individuals and their parents perceive HRQL to be lower compared with term controls in adolescence and in adulthood. Lower HRQL was related to economic and social functioning problems in adulthood. No evidence for improvement of HRQL into adulthood was found in this geographical sample in Germany., (Copyright © 2016 by the American Academy of Pediatrics.)

Background: Very preterm (VP; gestational age <32 weeks) and very low birth weight (VLBW; <1500 g) births are related to impaired cognitive function across the life span. It is not known how stable cognitive functions are from childhood to adulthood for VP/VLBW compared with term-born individuals and how early adult cognitive function can be predicted., Methods: The Bavarian Longitudinal Study is a prospective geographically defined cohort study that followed 260 VP/VLBW and 229 term-born individuals from birth to adulthood. Data on cognitive function were assessed with developmental and IQ tests at 5 and 20 months and at 4, 6, 8, and 26 years of age., Results: Across all assessments, VP/VLBW individuals had significantly lower IQ scores than term-born controls, even when individuals with severe cognitive impairment (n = 69) were excluded. IQ scores were found to be more stable over time for VP/VLBW than term-born individuals, yet differences in stability disappeared when individuals with cognitive impairment were excluded. Adult IQ could be predicted with fair certainty (r > 0.50) from age 20 months onward for the whole VP/VLBW sample (n = 260) and from 6 years onward for term-born individuals (n = 229)., Conclusions: VP/VLBW individuals more often suffer from cognitive problems across childhood into adulthood and these problems are relatively stable from early childhood onward. VP/VLBW children's risk for cognitive problems can be reliably diagnosed at the age of 20 months. These findings provide strong support for the timing of cognitive follow-up at age 2 years to plan special support services for children with cognitive problems., (Copyright © 2015 by the American Academy of Pediatrics.)

Background and Objectives: Preterm birth is a significant stressor for parents and may adversely impact maternal parenting behavior. However, findings have been inconsistent. The objective of this meta-analysis was to determine whether mothers of preterm children behave differently (eg, less responsive or sensitive) in their interactions with their children after they are discharged from the hospital than mothers of term children., Methods: Medline, PsychInfo, ERIC, PubMed, and Web of Science were searched from January 1980 through May 2014 with the following keywords: "premature", "preterm", "low birth weight" in conjunction with "maternal behavio*r", "mother-infant interaction", "maternal sensitivity", and "parenting". Both longitudinal and cross-sectional studies that used an observational measure of maternal parenting behavior were eligible. Study results relating to parenting behaviors defined as sensitivity, facilitation, and responsivity were extracted, and mean estimates were combined with random-effects meta-analysis., Results: Thirty-four studies were included in the meta-analysis. Mothers of preterm and full-term children did not differ significantly from each other in terms of their behavior toward their children (Hedges' g = -0.07; 95% confidence interval: -0.22 to 0.08; z = -0.94; P = .35). The heterogeneity between studies was significant and high (Q = 156.42; I(2) = 78.9, P = .001) and not explained by degree of prematurity, publication date, geographical area, infant age, or type of maternal behavior., Conclusions: Mothers of preterm children were not found to be less sensitive or responsive toward their children than mothers of full-term children., (Copyright © 2015 by the American Academy of Pediatrics.)

Background: Perinatal complications predict increased risk for morbidity and early mortality. Evidence of perinatal programming of adult mortality raises the question of what mechanisms embed this long-term effect. We tested a hypothesis related to the theory of developmental origins of health and disease: that perinatal complications assessed at birth predict indicators of accelerated aging by midlife., Methods: Perinatal complications, including both maternal and neonatal complications, were assessed in the Dunedin Multidisciplinary Health and Development Study cohort (N = 1037), a 38-year, prospective longitudinal study of a representative birth cohort. Two aging indicators were assessed at age 38 years, objectively by leukocyte telomere length (TL) and subjectively by perceived facial age., Results: Perinatal complications predicted both leukocyte TL (β = -0.101; 95% confidence interval, -0.169 to -0.033; P = .004) and perceived age (β = 0.097; 95% confidence interval, 0.029 to 0.165; P = .005) by midlife. We repeated analyses with controls for measures of family history and social risk that could predispose to perinatal complications and accelerated aging, and for measures of poor health taken in between birth and the age-38 follow-up. These covariates attenuated, but did not fully explain the associations observed between perinatal complications and aging indicators., Conclusions: Our findings provide support for early-life developmental programming by linking newborns' perinatal complications to accelerated aging at midlife. We observed indications of accelerated aging "inside," as measured by leukocyte TL, an indicator of cellular aging, and "outside," as measured by perceived age, an indicator of declining tissue integrity. A better understanding of mechanisms underlying perinatal programming of adult aging is needed., (Copyright © 2014 by the American Academy of Pediatrics.)

Background and Objectives: Environmental factors such as serious trauma or abuse and related stress can lead to nightmares or night terrors. Being bullied can be very distressing for children, and victims display long-term social, psychological, and health consequences. Unknown is whether being bullied by peers may increase the risk for experiencing parasomnias such as nightmares, night terrors, or sleepwalking., Methods: A total of 6796 children of the Avon Longitudinal Study of Parents and Children (ALSPAC) birth cohort were interviewed at elementary school age (8 and 10 years) about bullying experiences with a previously validated bullying interview and at secondary school age (12.9 years) about parasomnias such as nightmares, night terrors and sleepwalking by trained postgraduate psychologists., Results: Even after adjusting for pre-existing factors related to bullying and parasomnias, being bullied predicted having nightmares (8 years odds ratio [OR], 1.23; 95% confidence interval [CI], 1.05-1.44; 10 years OR, 1.62; 95% CI, 1.35-1.94) or night terrors (8 years OR, 1.39; 95% CI, 1.10-1.75; 10 years OR, 1.53; 95% CI, 1.18-1.98) at age 12 to 13 years. Especially being a chronic victim was associated with both nightmares (OR, 1.82; 95% CI, 1.46-2.27) and night terrors (OR, 2.01; 95% CI, 1.48-2.74). Being a bully/victim also increased the risk for any parasomnia at ages 8 or 10 years (8 years OR, 1.42; 95% CI, 1.08-1.88; 10 years OR, 1.75; 95% CI, 1.30-2.36). In contrast, bullies had no increased risk for any parasomnias., Conclusions: Being bullied increases the risk for having parasomnias. Hence, parents, teachers, school counselors, and clinicians may consider asking about bullying experiences if a child is having parasomnias., (Copyright © 2014 by the American Academy of Pediatrics.)

Objectives: Being the victim of peer bullying is associated with increased risk of psychopathology, yet it is not known whether similar experiences of bullying increase risk of psychiatric disorder when the perpetrator is a sibling. We tested whether being bullied by a sibling is prospectively associated with depression, anxiety, and self-harm in early adulthood., Methods: We conducted a longitudinal study using data from >6900 participants of a UK community-based birth cohort (Avon Longitudinal Study of Parents and Children) who reported on sibling bullying at 12 years. Our main outcome measures were depression, anxiety, and self-harm, assessed using the Clinical Interview Schedule-Revised during clinic assessments when participants were 18., Results: Children who were frequently bullied were approximately twice as likely to have depression (odds ratio [OR] = 2.16; 95% confidence interval [CI], 1.33-3.51; P < .001), self-harm (OR = 2.56; 95% CI, 1.63-4.02; P < .001), and anxiety (OR = 1.83; 95% CI, 1.19-2.81; P < .001) as children who were not bullied by siblings. The ORs were only slightly attenuated after adjustment for a range of confounding individual, family, and peer factors. The population-attributable fractions suggested that 13.0% (95% CI, 1.0%-24.7%) of depression and 19.3% (95% CI, 7.6%-29.6%) of self-harm could be explained by being the victim of sibling bullying if these were causal relationships., Conclusions: Being bullied by a sibling is a potential risk factor for depression and self-harm in early adulthood. Our results suggest that interventions designed to target sibling bullying should be devised and evaluated., (Copyright © 2014 by the American Academy of Pediatrics.)

Background: The Parent Report of Children's Abilities-Revised (PARCA-R) is a questionnaire for assessing cognitive and language development in very preterm infants. Given the increased risk of developmental delay in infants born late and moderately preterm (LMPT; 32-36 weeks), this study aimed to validate this questionnaire as a screening tool in this population., Methods: Parents of 219 children born LMPT completed the PARCA-R questionnaire and the Brief Infant Toddler Social and Emotional Assessment when children were 24 months corrected age (range, 24 months-27 months). The children were subsequently assessed by using the cognitive and language scales of the Bayley Scales of Infant and Toddler Development, Third Edition (Bayley-III)., Results: An average Bayley-III, cognitive and language (CB-III) score and a total PARCA-R Parent Report Composite (PRC) score were computed. There was a large association between PRC and CB-III scores (r = 0.66, P < .001) indicating good concurrent validity. Using Youden index, the optimum PARCA-R cutoff for identifying children with moderate/severe developmental delay (CB-III scores < 80) was PRC scores < 73. This gave sensitivity 0.90 (95% confidence interval: 0.75-1.00) and specificity 0.76 (95% confidence interval: 0.70-0.82), indicating good diagnostic utility. Approximately two-thirds of the children who had a PRC score < 73 had false-positive screens. However, these children had significantly poorer cognitive and behavioral outcomes than children with true negative screens., Conclusions: The PARCA-R has good concurrent validity with a gold standard developmental test and can be used to identify LMPT infants who may benefit from a clinical assessment. The PARCA-R has potential for clinical use as a first-line cognitive screening tool for this sizeable population of infants in whom follow-up may be beneficial., (Copyright © 2014 by the American Academy of Pediatrics.)

Background: To assess functional disability in children born before 26 weeks of gestation at 11 years of age and the stability of findings in individuals between 6 and 11 years of age., Methods: Of 307 surviving children born in 1995, 219 (71%) were assessed at 11 years of age alongside 153 classmates. Children were evaluated by using standardized tests of cognitive ability and clinical condition at both ages., Results: Using classmate data to determine reference ranges, serious cognitive impairment (score of less than -2 SD) was present in 40% of extremely preterm children and 1.3% of classmates (odds ratio [OR]: 50 [95% confidence interval (CI): 12-206]) at 11 years of age. Overall, 38 (17%) extremely preterm children had cerebral palsy; moderate or severe impairment of neuromotor function, vision, and hearing was present in 10%, 9%, and 2% of these children, respectively. Combining impairment across domains, 98 (45%) extremely preterm children had serious functional disability compared with 1% of the classmates (OR: 61 [95% CI: 15-253]); this was more common in boys than girls (OR: 1.8 [95% CI: 1.0-3.1]) and in those born at 23 or 24 weeks' gestation compared with those born at 25 weeks' gestation (OR: 1.8 [95% CI: 1.0-3.1]). The prevalence of serious functional disability was 46% at 6 years of age and 45% at 11 years of age. Using multiple imputation to correct for selective dropout, it is estimated that 50% (95% CI: 44%-57%) of extremely preterm children are free of serious disability at 11 years of age., Conclusions: Extremely preterm children remain at high risk for neurodevelopmental disability at 11 years of age compared with term peers. The prevalence of disability remained stable between 6 and 11 years of age, and large individual shifts in classification of disability were unusual.

Objective: The goal was to compare health-related quality of life of 12- to 16-year-old adolescents born at an extremely low birth weight in regional cohorts from Ontario (Canada), Bavaria (Germany), and the Netherlands., Methods: Patients were extremely low birth weight survivors from Canada, Germany, and the Netherlands. Health-related quality of life was assessed with Health Utilities Index 3. Missing data were substituted by proxy reports. Differences in mean Health Utilities Index 3 scores were tested by using analysis of variance. Differences in the numbers of children with affected attributes were tested by using logistic regression analyses., Results: Survival rates were similar; response rates varied between 71% and 90%. Significant differences in health-related quality of life were found between the cohorts, with Dutch children scoring highest on Health Utilities Index 3 and German children scoring lowest, independent of birth weight, gestational age, and cerebral palsy. Differences in mean utility scores were mainly attributable to differences in the cognition health attribute. Most of the results were corroborated by logistic regression analyses., Conclusions: There were significant differences between the 3 cohorts in health-related quality of life, not related to differences in birth weight, gestational age, or cerebral palsy. Survival and response rates alone cannot explain these differences.

Background: Studies of very preterm infants have demonstrated impairments in multiple neurocognitive domains. We hypothesized that neuromotor and executive-function deficits may independently contribute to school failure., Methods: We studied children who were born at < or = 25 completed weeks' gestation in the United Kingdom and Ireland in 1995 at early school age. Children underwent standardized cognitive and neuromotor assessments, including the Kaufman Assessment Battery for Children and NEPSY, and a teacher-based assessment of academic achievement., Results: Of 308 surviving children, 241 (78%) were assessed at a median age of 6 years 4 months. Compared with 160 term classmates, 180 extremely preterm children without cerebral palsy and attending mainstream school performed less well on 3 simple motor tasks: posting coins, heel walking, and 1-leg standing. They more frequently had non-right-hand preferences (28% vs 10%) and more associated/overflow movements during motor tasks. Standardized scores for visuospatial and sensorimotor function performance differed from classmates by 1.6 and 1.1 SDs of the classmates' scores, respectively. These differences attenuated but remained significant after controlling for overall cognitive scores. Cognitive, visuospatial scores, and motor scores explained 54% of the variance in teachers' ratings of performance in the whole set; in the extremely preterm group, additional variance was explained by attention-executive tasks and gender., Conclusions: Impairment of motor, visuospatial, and sensorimotor function, including planning, self-regulation, inhibition, and motor persistence, contributes excess morbidity over cognitive impairment in extremely preterm children and contributes independently to poor classroom performance at 6 years of age.

Objective: The aim of this study was to determine whether learning and school problems in extremely low birth weight (ELBW) and reference children differ between cohorts in different countries., Methods: Participants were 4 international population-based cohorts of ELBW survivors who were 500 to 1000 g birth weight from New Jersey, central-west Ontario, Bavaria, and Holland (n = 532) and were followed longitudinally from birth. Psychometric data were collected independently and prospectively and included at least 1 measure of cognitive status and 1 measure of achievement administered to the children between the ages of 8 and 11 years. Adjustments were made for comparison of all measures based on reference norms within each country. Information on special educational assistance and grade repetition was obtained from the parents., Results: The overall follow-up rate was 84% (range: 74%-90%; n = 436). The proportion of children who performed within the normal range (> or =85) were as follows: IQ between 44% and 62%; reading between 46% and 81%; arithmetic between 31% and 76%; and spelling between 39% and 65%. Children from New Jersey had the lowest rates of cognitive and achievement deficits, and Bavarian children did less well in achievement scores relative to their peers and other cohorts. Despite these differences, more than half of all cohorts required special educational assistance and/or repeated a grade., Conclusions: School difficulties were found to be a serious sequelae of ELBW in all 4 countries, an observation that has social and economic implications.

Objective: To investigate whether persistent infant crying is associated with an increased risk for externalizing behavior problems in childhood., Methods: Sixty-four infants who were referred for persistent crying in infancy (PC; mean age: 3.8 +/- 1.3 months) were reassessed at 8 to 10 years of age and compared with 64 classroom controls (CC). The major outcome measure was pervasive hyperactivity or conduct problems defined as parent, child, and teacher ratings that across informants were within the borderline/clinical range according to the Strengths and Difficulties Questionnaire (SDQ). Ratings of other behavior problems, parent ratings of temperament, and teacher assessment of academic achievement were also obtained., Results: Ten (18.9%) of 53 PC had pervasive hyperactivity problems (child, parent, and teacher reported) compared with 1 (18.9%) of 62 CC (odds ratio: 14.19 [1.75-114.96]). Parents (29 [45.3%] of 64 vs 11 [17.2%] of 64; 4.00 [1.77-9.01]) and children (30 [46.9%] of 64 vs 17 [26.6%] of 64; 2.44 [1.16-5.12]) but not the teachers reported more conduct problems. Parents of PC rated the temperament of their children to be more negative in emotionality (PC mean: 3.0 +/- 1.0; CC: 2.4 +/- 1.0; effect size: 0.6) and difficult-demanding (PC mean: 5.2 +/- 1.3; CC: 6.3 +/- 0.9; effect size: 1.0). Academic achievement was reported by teachers to be significantly lower for PC than CC, in particular for those children with pervasive hyperactivity problems., Conclusions: Infants who are referred for PC problems and associated sleeping or feeding problems are at increased risk for hyperactivity problems and academic difficulties in childhood.