Trajectories of attention problems in preschoolers born very preterm

Abstract

Background: Children born preterm are at heightened risk for neurodevelopmental impairment, including specific deficits in attention. Few studies have investigated change over time in attention problems prior to school entry. The current study aims to describe trajectories of attention problems from age 2 through 5 years in a cohort of children born <30 weeks of gestational age (GA), identify sociodemographic, medical, and neurobehavioral characteristics associated with attention trajectories, and test whether attention problem trajectories predict the risk of a reported attention-deficit/hyperactivity disorder (ADHD) diagnosis.

Methods: We studied 608 infants from the Neonatal Neurobehavior and Outcomes in Very Preterm Infants (NOVI) Study, a prospective, multisite study of infants born <30 weeks of GA. Parents reported on child attention problems at ages 2, 3, 4, and 5 years using the Child Behavior Checklist and the Behavior Assessment System for Children. Sociodemographic and medical characteristics were assessed via maternal interview and medical record review. Neurobehavioral characteristics were determined using neonatal and 2-year assessments. Parent report of child ADHD diagnosis was obtained. We used latent growth curve (LGC) modeling to test our study aims.

Results: A linear LGC model provided the best fit to the data. The average trajectory of attention problems evidenced low initial levels of symptoms and little change over time, yet there was significant heterogeneity in both initial levels and change over time. Individual differences in trajectory parameters were associated with sociodemographic, medical, environmental, and neurobehavioral characteristics. Children with higher initial levels of attention problems as well as steeper increases in attention problems over time were more likely to have a reported ADHD diagnosis.

Conclusions: There is significant heterogeneity in trajectories of attention problems from age 2 to 5 in children born <30 weeks of GA and these differences have clinical relevance. These data could inform follow-up guidelines for preterm infants.

Keywords: Attention problems; attention deficit hyperactivity disorder; preschool; preterm; trajectories.

Figure 1

Study flowchart. NICU, neonatal intensive care unit

Figure 2

Model‐implied trajectories. Model‐implied trajectories are shown for a random sample of 50 participants, based on parameters from the linear latent growth curve model. For descriptive purposes, we classified individuals as having stable (within 1 SD of the mean slope; blue line), increasing (>1 SD above the mean slope; green line), or decreasing (<1 SD below the mean slope; red line) trajectories. The black line depicts the average trajectory across the entire sample (N = 608). The threshold for clinically elevated scores (T ≥ 65) is shaded in gray