Search

Objectives: Retrospective harmonisation of data obtained through different instruments creates measurement error, even if the underlying concepts are assumed the same. We tested a novel method for item‐level data harmonisation of two widely used instruments that measure emotional and behavioural problems: the Child Behavior Checklist (CBCL) and the Strengths and Difficulties Questionnaire (SDQ). Methods: Item content of the CBCL and SDQ was mapped onto four dimensions: emotional problems, peer relationship problems, hyperactivity/inattention and conduct problems. A diverse test sample was drawn from four prospective longitudinal birth cohort studies in Australia and Europe who used one or both instruments. The pooled sample included 5188 data points assessing children and adolescents aged 6–13 years (N = 257–704 participants per cohort). Measurement invariance was assessed using latent variable multi‐group confirmatory factor analysis. Results: Fifteen items from the CBCL and SDQ were mapped onto four dimensions allowing for measurement invariance testing as part of a stepwise process. Partial strict invariance between CBCL and SDQ assessments was established for all four dimensions. Conclusions: The harmonised dimensions of emotional, peer relationship, hyperactivity/inattention and conduct problems are invariant across the CBCL and SDQ suggesting that these dimensions can be reliably compared with limited measurement error. [ABSTRACT FROM AUTHOR]

Background: Regulatory problems (RPs; excessive crying, sleeping, or feeding difficulties) that co‐occur (i.e., multiple) or are persistent have been associated with cognitive and behavioral problems in childhood. However, it remains unknown if multiple or persistent RPs are associated with cognitive and behavioral problems in adulthood. Methods: This large prospective longitudinal study (N = 759) was conducted in two cohorts in Germany (N = 342) and Finland (N = 417). RPs were assessed at 5, 20, and 56 months via the same standardized parental interviews and neurological examinations. In young adulthood, questionnaires were used to assess behavioral problems. Cognitive functioning was assessed with IQ tests. We examined the effects of multiple or persistent RPs on the outcomes via analysis of covariance tests and logistic regression controlled for the influence of cohort. Results: Of 163 participants with RPs, 89 had multiple and 77 had persistent RPs. Adults who had early multiple or persistent RPs (N = 151) reported more internalizing (p =.001), externalizing (p =.020), and total behavioral problems (p =.001), and, specifically, more depressive (p =.012), somatic (p =.005), avoidant personality (p <.001), and antisocial personality problems (p =.006) than those who never had RPs (N = 596). Participants with multiple or persistent RPs were more likely to receive any ADHD diagnoses (p =.017), particularly of hyperactive/impulsive subtype (p =.032). In contrast, there were no associations between multiple or persistent RPs and IQ scores in young adulthood. Conclusions: The results indicate long‐lasting associations between multiple or persistent RPs and behavioral problems. Thus, screening for early RPs could help to identify children who are at risk for later behavioral problems. [ABSTRACT FROM AUTHOR]

Aim: To investigate the strength of the independent associations of mathematics performance in children born very preterm (<32wks' gestation or <1500g birthweight) with attending postsecondary education and their current employment status in young adulthood. Method: We harmonized data from six very preterm birth cohorts from five different countries and carried out one‐stage individual participant data meta‐analyses (n=954, 52% female) using mixed effects logistic regression models. Mathematics scores at 8 to 11 years of age were z‐standardized using contemporary cohort‐specific controls. Outcomes included any postsecondary education, and employment/education status in young adulthood. All models were adjusted for year of birth, gestational age, sex, maternal education, and IQ in childhood. Results: Higher mathematics performance in childhood was independently associated with having attended any postsecondary education (odds ratio [OR] per SD increase in mathematics z‐score: 1.36 [95% confidence interval {CI}: 1.03, 1.79]) but not with current employment/education status (OR 1.14 per SD increase [95% CI: 0.87, 1.48]). Interpretation: Among populations born very preterm, childhood mathematics performance is important for adult educational attainment, but not for employment status. [ABSTRACT FROM AUTHOR]

Background: Of all newborns, 1%‐2% are born very preterm (VP; <32 weeks) or with very low birthweight (VLBW; ≤1500 g). Advances in prenatal and neonatal care have substantially improved their survival, and the first generations who have benefited from these advances are now entering middle age. While most lead healthy lives, on average these adults are characterised by a number of adversities. These include cardiometabolic risk factors, airway obstruction, less physical activity, poorer visual function, lower cognitive performance, and a behavioural phenotype that includes inattention and internalising and socially withdrawn behaviour that may affect life chances and quality of life. Outcomes in later adulthood are largely unknown, and identifying trajectories of risk or resilience is essential in developing targeted interventions. Joint analyses of data and maintenance of follow‐up of cohorts entering adulthood are essential. Such analyses are ongoing within the Adults Born Preterm International Collaboration (APIC; www.apic-preterm.org). Joint analyses require data harmonisation, highlighting the importance of consistent assessment methodologies. Objective: To present an expert recommendation on Common Core Assessments to be used in follow‐up assessments of adults born preterm. Methods: Principles of Common Core Assessments were discussed at APIC meetings. Experts for each specific outcome domain wrote the first draft on assessments pertaining to that outcome. These drafts were combined and reviewed by all authors. Consensus was reached by discussion at APIC meetings. Results: We present a recommendation by APIC experts on consistent measures to be used in adult follow‐up assessments. Conclusions: The recommendation encompasses both "core" measures which we recommend to use in all assessments of adults born preterm that include the particular outcome. This will allow comparability between time and location. The recommendation also lists optional measures, focusing on current gaps in knowledge. It includes sections on study design, cardiometabolic and related biomarkers, biological samples, life style, respiratory, ophthalmic, cognitive, mental health, personality, quality of life, sociodemographics, social relationships, and reproduction. [ABSTRACT FROM AUTHOR]

This study investigated if crying, sleeping or feeding problems that co-occur (multiple regulatory problems [RPs]) or are persistent predict attention problems and diagnoses of attention deficit hyperactivity disorder (ADHD) in childhood and adulthood. Participants were 342 individuals who were assessed at 5, 20, and 56 months for crying, sleeping, and feeding (RPs) and at 6, 8, and 28 years for ADHD diagnoses, attention problems, and attention span. Infants/toddlers with multiple/persistent RPs had an increased risk of receiving an ADHD diagnosis both in childhood and adulthood compared to those who never had RPs. Multiple/persistent RPs were further associated with a high-decreasing attention problems trajectory from childhood to adulthood. Interventions to alleviate early RPs may prevent the development of attention problems. [ABSTRACT FROM AUTHOR]

Regulatory problems in infancy and toddlerhood have previously been associated with an increased risk of developing attention problems in childhood. We hypothesized that early regulatory problems are associated with attention problems via reduced inhibitory control. This prospective study assessed 1,459 children from birth to 8 years. Crying, feeding, and sleeping problems were assessed at 5 and 20 months via parent interviews and neurological examinations. At 20 months, inhibitory control was tested with a behavioral (snack delay) task. Attention regulation was assessed at 6 and 8 years using multiple instruments and informants. Detrimental effects of crying, feeding, and sleeping problems on attention regulation were partly mediated by children's ability to inhibit unwanted behaviors (β = −0.04, p = 0.013). Accounting for cognition diminished this indirect effect (β = −0.01, p = 0.209). Instead, the effects of crying, feeding, and sleeping problems on attention regulation were fully mediated by children's cognitive functioning (β = −0.10, p < 0.001). These results support that inhibitory control abilities partly mediate effects of crying, feeding, and sleeping problems. However, these effects may be accounted for by children's general cognitive abilities. Early regulatory problems may set infants on a course of under control of behavior into school age, and such trajectories are highly associated with general cognitive development. [ABSTRACT FROM AUTHOR]

Background Very preterm (<32 weeks' gestational age; VP) or very low-birth weight (<1,500 g; VLBW) birth has been associated with increased risk for anxiety and mood disorders and less partnering in adulthood. The aim was to test whether (a) VP/VLBW are at increased risk of any anxiety or mood disorders from 6 to 26 years compared with term-born individuals; (b) social support from romantic partners is associated with protection from anxiety and mood disorders; and (c) VP/VLBW adults' lower social support mediates their risk for any anxiety and mood disorders. Methods Data are from a prospective geographically defined longitudinal whole-population study in South Bavaria (Germany). Two hundred VP/VLBW and 197 term individuals were studied from birth to adulthood. Anxiety and mood disorders were assessed at 6, 8, and 26 years with standardized diagnostic interviews and social support via self-report at age 26. Results At age 6, VP/VLBW children were not at increased risk of any anxiety or mood disorder. At age 8, VP/VLBW more often had any anxiety disorder than term comparisons (11.8% vs. 6.6%, OR = 2.10, 95% CI [1.08-4.10]). VP/VLBW adults had an increased risk for any mood (27.5% vs. 18.8%, OR = 1.65 [1.02-2.67]) but not for any anxiety disorder (33.0% vs. 28.4%, OR = 1.27 [0.82-1.96]). None of the significant differences survived correction for multiple testing. Social support was associated with a lower risk of anxiety or mood disorders in both groups (OR = 0.81 [0.68-0.96]) and mediated the association of VP/VLBW birth with any anxiety or any mood disorders at age 26. Conclusions This study does not show a persistently increased risk for any anxiety or mood disorder after VP/VLBW birth. Low social support from a romantic partner mediates the risk for anxiety or mood disorders after VP/VLBW birth. [ABSTRACT FROM AUTHOR]

Aim: To identify neonatal predictors to allow a developmental prognosis of the cognitive abilities of survivors born very preterm/very low birthweight (VLBW) into adult life.Method: The Bavarian Longitudinal Study is a prospective whole-population study that followed 260 infants born very preterm/VLBW from birth to adulthood. Regression analyses examined which neonatal factors predicted adult IQ.Results: Neonatal morbidity, neonatal treatment, and early social environment of infants born very preterm/VLBW explained 37.6% of the variance in adult IQ. Seven unique early-life predictors of lower adulthood IQ were found: respiratory distress syndrome, intraventricular haemorrhage, problems with mobility, mechanical ventilation, less parenteral nutrition, low/middle socioeconomic status, and poor early parent-infant relationships. Specifically, modifiable factors such as mechanical ventilation predicted a drop of 0.43 IQ points for each day of treatment, adjusted for initial respiratory problems. Good early parent-infant relationships predicted an approximately 5-point increase in adult IQ, adjusted for other significant predictors such as socioeconomic status.Interpretation: Mechanical ventilation, parenteral feeding, and early parenting were identified as significant modifiable factors that were strongly related to adult IQ. Mechanical ventilation policies have changed but there is scope for early interventions that focus on positive parenting, which may reduce the adverse effects of very preterm/VLBW birth on cognitive abilities. [ABSTRACT FROM AUTHOR]

Background Very preterm ( VP; gestational age <32 weeks) and very low birth weight ( VLBW; <1500 grams) is related to attention problems in childhood and adulthood. The stability of these problems into adulthood is not known. Methods The Bavarian Longitudinal Study is a prospective cohort study that followed 260 VP/ VLBW and 229 term-born individuals from birth to adulthood. Data on attention were collected at 6, 8, and 26 years of age, using parent reports, expert behavior observations, and clinical ADHD diagnoses. Results At each assessment, VP/ VLBW individuals had significantly more attention problems, shorter attention span, and were more frequently diagnosed with ADHD than term-born comparisons. In both VP/ VLBW and term-born individuals, overall, attention span increased and attention problems decreased from childhood to adulthood. Attention problems and attention span were more stable over time for VP/ VLBW than term-born individuals. Similarly, ADHD diagnoses showed moderate stability from childhood to adulthood in VP/ VLBW, but not in term-born individuals. However, when those with severe disabilities were excluded, differences between VP/ VLBW and term-born individuals reduced. Conclusions Despite improvement in attention regulation from childhood to adulthood, children born very preterm remained at increased risk for attention problems in adulthood. In contrast, term-born children with clinical attention problems outgrew these by adulthood. As inattentive behavior of VP/ VLBW children may be overlooked by teachers, it may be necessary to raise awareness for school intervention programs that reduce attention problems in VP/ VLBW children. [ABSTRACT FROM AUTHOR]

Background Children born very preterm ( VP <32 weeks gestation) and/or with very low birth weight ( VBLW <1500 g; subsequently VP/ VLBW) have been previously reported to have more cognitive impairment and specific executive functioning problems than term children; however, it remains unclear whether these problems persist into adulthood. This study aimed to examine general intelligence ( IQ) and executive functioning ( EF) of adults born VP/ VLBW in comparison to term controls. Additionally, the effects of smallness for gestational age ( SGA) and family socioeconomic status ( SES) at birth were investigated. Methods The Bavarian Longitudinal Study is a geographically defined prospective cohort study of neonatal at-risk children born in 1985/86 in Southern Germany. A total of 217 VP/ VLBW and 197 controls completed the battery of IQ and EF tests at 26 years of age. Results VP/ VLBW adults scored significantly lower than controls in IQ and EF. There was a 1.16 standard deviation ( SD) unit difference between the VP/ VLBW and controls in Full-Scale IQ. VP/ VLBW adults were found to have general and multiple cognitive problems rather than specific deficits in EF. SGA was not a significant predictor of cognitive impairment. Family SES had a significant impact on general intelligence in both VP/ VLBW and term controls. The SES effects amounted to 1.13 SD units between individuals born into high versus low SES. Conclusions No narrowing of cognitive deficits between VP/ VLBW and term control adults to previous childhood assessments at 6 years of age was found. VP/ VLBW adults do not outgrow their cognitive problems despite many receiving special educational support in childhood. Low family SES at birth has similar additive adverse effects on cognitive performance in VP/ VLBW and term offspring. [ABSTRACT FROM AUTHOR]

Aim: Recent reports suggest that delayed school entry (DSE) may be beneficial for children with developmental delays. However, studies of the effects of DSE are inconclusive. This study investigated the effects of DSE versus age-appropriate school entry (ASE) on children's academic achievement and attention in middle childhood.Method: In total, 999 children (492 females, 507 males; 472 born preterm) were studied as part of a prospective population-based longitudinal study in Germany. Using a natural experimental design, propensity score matching was applied to create two matched groups who differed only in terms of DSE versus ASE. Teacher ratings of achievement in mathematics, reading, writing, and attention were obtained in Year 1, and standardized tests were administered at 8 years of age.Results: There was no evidence of a difference in the odds of DSE versus ASE children being rated as above average by teachers in Year 1. In contrast, the standardized mean test scores for DSE children were lower than ASE children's mean scores in all domains (mathematics: B=-0.28 [-0.51 to -0.06)], reading: B=-0.39 [-0.65 to -0.14], writing: B=-0.90 [-1.07 to -0.74], and attention: B=-0.58 [-0.79 to -0.36]).Interpretation: DSE did not affect teacher-rated academic performance. However, missing 1 year of learning opportunities was associated with poorer average performance in standardized tests at 8 years of age. Future research is needed to determine the long-term effect of DSE on academic achievement. [ABSTRACT FROM AUTHOR]

Background Differential Susceptibility Theory ( DST) postulates that some children are more affected - for better and for worse - by developmental experiences, including parenting, than others. Low birth weight ( LBW, 1,500-2,499 g) may not only be a predictor for neurodevelopmental impairment but also a marker for prenatally programmed susceptibility. The aim was to test if effects of sensitive parenting on LBW and very LBW ( VLBW, <1,500 g) versus normal birth weight ( NBW, ≥2,500 g) children's academic achievement are best explained by a differential susceptibility versus diathesis-stress model of person-X-environment interaction. Methods Nine hundred and twenty-two children ranging from 600 g to 5,140 g birth weight were studied as part of a prospective, geographically defined, longitudinal investigation of neonatal at-risk children in South Germany (Bavarian Longitudinal Study). Sensitive parenting during a structured mother-child interaction task was observed and rated at age 6 years. Academic achievement was assessed with standardized mathematic, reading, and spelling/writing tests at age 8 years. Results Maternal sensitivity positively predicted the academic achievement of both LBW ( n = 283) and VLBW ( n = 202) children. Confirmatory-comparative and model-fitting analysis (testing LBW vs. NBW and VLBW vs. NBW) indicated that LBW and VLBW children were more susceptible than NBW to the adverse effects of low-sensitive, but not beneficial effects of high-sensitive parenting. Conclusions Findings proved more consistent with the diathesis stress than differential-susceptibility model of person-X-environment interaction: LBW and VLBW children's exposure to positive parenting predicted catch-up to their NBW peers, whereas exposure to negative parenting predicted much poorer functioning. [ABSTRACT FROM AUTHOR]

Aim The knowledge and information needs of education professionals were assessed to determine how prepared they feel to support the growing number of preterm children entering schools today. Method In a national survey, 585 teachers and 212 educational psychologists completed the Preterm Birth-Knowledge Scale ( PB- KS) to assess knowledge of outcomes following preterm birth. Total scores (range 0-33) were compared between groups and the impact of demographic characteristics on knowledge was analysed. Training and information needs were also assessed. Results Teaching staff (mean 14.7, SD 5.5) had significantly lower knowledge scores than educational psychologists (mean 17.1, SD 5.0; p<0.001); both had significantly lower scores than neonatal clinicians surveyed previously (mean 26.0, SD 3.6; p<0.001). Education professionals' poorest areas of knowledge related to the most frequent adverse outcomes following preterm birth. Only 16% of teaching staff had received training about preterm birth and more than 90% requested more information. Having a special educational needs role and being employed at least 16 years were associated with higher knowledge scores. Interpretation Education professionals have poor knowledge of the needs of children born preterm and most feel ill-equipped to support them in school. As teachers have primary responsibility for providing long-term support for children born preterm, this is of significant public health and educational concern. [ABSTRACT FROM AUTHOR]

Background Predictors of attention problems remain uncertain. Here we distinguish prematurity from small (birth weight) for gestational age ( SGA). Method A total of 1437 children were studied between 0 and 6 years. Gender differences and indirect perinatal effects (via 20-month head circumference and cognition) were considered for age 6 attention problems. Results Boys, preterms, and SGA children were all at increased risk for attention problems. Indirect perinatal effects differed between boys and girls. Conclusions The routes leading to attention problems seem to differ for SGA and preterm children. SGA appears to reduce brain volume while prematurity alters brain function. Although less frequent, female attention problems are more strongly predicted by prematurity and cognitive dysfunction. [ABSTRACT FROM AUTHOR]

Aim Mothers of very preterm children have been reported to behave less sensitively and to be more controlling. It is unknown whether this is the result of maternal factors or due to maternal adaptation to children's cognitive problems. Method We investigated a geographically defined prospective whole-population sample of very low birthweight (<1500g) or very preterm (<32wks' gestation; VLBW/VP) children ( n=267, 124 females, 143 males) and a comparison group born at term ( n=298, 146 females, 152 males) in Germany. Mother-child interactions were videotaped during a play situation and analysed with a standardized coding system at children's mean ages of 6 years 3 months and 8 years 5 months. Results At both 6 years 3 months and 8 years 5 months, VLBW/VP children were less task persistent and socially active ( p<0.001) whereas their mothers behaved less sensitively and were more controlling than term mother-child dyads ( p<0.001). Cross-sectional group differences in maternal behaviour remained when scores where adjusted for social factors but disappeared once adjusted for child IQ. High maternal sensitivity predicted higher task persistence ( p<0.001), in particular in those children with cognitive problems. Interpretation Mothers of VLBW/VP children adapt their behaviour to their children's level of cognitive functioning. High maternal sensitivity is particularly beneficial for task persistence in children with cognitive deficits. [ABSTRACT FROM AUTHOR]

This commentary is on the original article by Darlow et al. on pages 1423–1428 of this issue. [ABSTRACT FROM AUTHOR]

Friendships are crucial to children's socioemotional development and quality of life. Children born preterm (<37 weeks gestation) have an increased risk for social relationship difficulties, including fewer friends, but the mechanisms underlying the link between lower gestational age and fewer friendships are not clear. The prospective Bavarian Longitudinal Study investigated potential cascading effects on N = 1,181 children's friendships at 8 years. Path modelling indicated that higher gestational age predicted good early parent–infant relationship quality, good inhibitory control, and higher friendship scores. Good parent–infant relationship quality predicted good inhibitory control, which subsequently predicted low social inhibition at 6 years and higher friendship scores at 8 years. There is evidence of cascading effects from gestational age to early parent–infant relationships, to toddlers' inhibitory control, and to social inhibition, which partially explain differences in children's friendships at 8 years of age. Highlights: Preterm children are at risk for social problems and fewer friends, but the mechanisms underlying this risk are not known.Path modelling showed that gestational age predicted good early parent–infant relationship and inhibitory control, which subsequently predicted low social inhibition and higher friendship scores.Cascading effects from gestational age to parent–infant relationships, to inhibitory control, and to social inhibition partially explain differences in friendships at 8 years. [ABSTRACT FROM AUTHOR]

Children born preterm or with low birth weight ( LBW) grow up with an increased risk for a range of neurodevelopmental, cognitive, socioemotional, and academic problems. While long-term effects of preterm and LBW birth have traditionally been studied from a deficit perspective, Treyvaud et al. correctly state that the increased risk for impairments in this population urgently requires identification of protective factors. Their new findings add to empirical evidence from observational studies showing that sensitive parenting can protect preterm children from negative developmental outcomes. In order to identify strategies that support preterm children's life chances, well-designed longitudinal studies, such as the one by Treyvaud et al., are indispensable. Next, we will need large randomized trials to test the causality between intervention-induced parenting changes and preterm children's long-term outcomes. We need interdisciplinary and international collaboration to study preterm parent-child dyads within multimethod frameworks and uncover the highly complex mechanisms that shape individual developmental trajectories. [ABSTRACT FROM AUTHOR]