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PREEMIES LIKELY TO DEVELOP DISABILITIES LATER

September 25, 2000

Various medical problems have become expected in babies born prematurely, but a new study shows that these babies are also at greater risk to develop social, behavioral and cognitive disabilities later in childhood. Such disabilities often do not appear until the child reaches school age, making early intervention efforts more important than previously believed, Jeremie Barlow and Lawrence Lewandowski, of Syracuse University, argue.

While 23 percent of children carried to full term had shown low achievement or specific developmental disabilities by 10 years of age, 61 percent of prematurely born children were similarly classified. "We could not find a model to predict which pre-term children are most 'at risk' for school-related problems," Barlow and Lewandowski said in their Ten-Year Longitudinal Study of Pre-term Infants: Outcomes and Predictors. "However, the pervasive nature of problems in our sample suggests that it may be better to plan interventions for all pre-terms and closely monitor their academic progress."

Barlow and Lewandowski conducted their study in upstate New York and presented their findings in August at the American Psychological Association's annual convention in Washington. The researchers compared 118 infants born after 24 to 31 weeks of gestation with 119 infants born after 38 weeks, evaluating them at birth, 15 months, two years, four years, seven years and 10 years of age. The researchers used school-related cognitive functioning measures, including whether the students were classified as having learning disabilities, their academic achievement level, grade placement and grade retention. They also evaluated social, behavioral and clinical measures including ratings of various behaviors by the children's parents, teachers and psychologists.

Most notably, a higher rate of Attention Deficit Hyperactivity Disorder, learning disabilities and comorbidity of the two diagnoses emerged from the comparisons. In the pre-term group, 16 percent had ADHD, compared with a significantly lower portion, 5.4 percent, of the full-term group. Pre-term girls may be especially at risk for ADHD, the researchers said. The relatively common ratio of boys to girls among all children with ADHD, about 3 to 1, leveled to 1.3 to 1 among pre-term children. However, Barlow and Lewandowski noted, that discrepancy could be impacted by a general underdiagnosis of ADHD among girls compared to boys, as some researchers argue.

The overall higher frequency of ADHD in the study, according to Barlow and Lewandowski, indicates that "further research is necessary to explore the susceptibility of pre-term infants to ADHD and whether there are specific neurobiological underpinnings to this disorder."

Compared to children who went full-term before birth, pre-term children:

scored lower on intelligence, achievement tests

received lower ratings from parents, teachers for social and behavioral functions

required more educational support

were held back more often

were diagnosed with learning disabilities more frequently

were four times more likely to be diagnosed with ADHD

As was the case with ADHD, the incidence of learning disabilities was also higher among pre-term children. About 24 percent of pre-term children in the study had been identified as having a learning disability by their schools, while only 9 percent of full-term children had been designated LD. In addition, "A pattern of academic failure, characterized in part by elevated rates of grade retention, existed among pre-term infants," the researchers said. About 31 percent of pre-term children, compared to 15 percent of full-term children, had been held back in at least one grade.

Comorbidity rates between ADHD and learning disabilities were also higher among pre-term children. About 6.8 percent had both ADHD and LD, compared with 1.8 percent of the full-term group. Multiple disabilities beyond those two frequently linked disorders were also more prevalent, Barlow and Lewandowski found. Based on an "impairment index" they developed to compare multiple disabilities, the researchers found that pre-term children were more likely to have clinically significant impairment ratings on more than one measure and in more than one area. More than 40 percent of the pre-term children exhibited dysfunction in three or more areas, "suggesting a trend toward pervasive dysfunction within the pre-term group," they said.

"It may be that whatever biological compromise has occurred in some pre-terms, it is likely to render effects across areas of functioning, whether it be cognitive, academic or social skill development," Barlow and Lewandowski concluded.8