Loe Irene M, Heller Nicole A, Chatav Maya
Division of Developmental-Behavioral Pediatrics, Department of Pediatrics, Stanford University School of Medicine, 1265 Welch Road, MSOB X109, MC 5415, Stanford, CA 94305, USA.
Division of Developmental-Behavioral Pediatrics, Department of Pediatrics, Stanford University School of Medicine, 1265 Welch Road, MSOB X109, MC 5415, Stanford, CA 94305, USA.
Early Hum Dev. 2019 Mar;130:87-95. doi: 10.1016/j.earlhumdev.2019.01.014. Epub 2019 Jan 29.
Children born preterm (PT) are at high risk for behavior problems and deficits in executive function (EF), a set of cognitive processes that guide goal-directed behaviors. Behavior differences have been found as early as 2 years in PT children; EF differences have been found in infancy. Whether behavior problems and EF deficits co-occur at young ages has not been fully investigated.
To determine whether (1) PT children have more behavior problems and EF impairment than full term (FT) children and (2) larger proportions of PT children show behavior problems or EF impairments.
DESIGN/METHODS: PT (≤34 wks, n = 82) and FT (n = 79) preschoolers (mean age 4.4 years) completed an EF battery. Parents completed rating scales of behavior problems and EF skills. Mean scores and proportions with impairment were compared between groups. Logistic regression predicting to impairment defined odds ratios for PT/FT groups.
PT compared to FT had more problems on most behavior and EF scales and poorer EF scores on all tasks and greater proportion with impairments on most behavior scales, all EF ratings, and all EF tasks, p < .05. PT had elevated odds for impaired performance-based EF, parent-rated EF and CBCL scores compared to FT, p < .05. Within the PT group, EF impairments were twice as common as behavior impairment.
We recommend early identification of EF impairments in PT children. Future research should evaluate whether EF impairments serve as better early markers for later functional difficulties compared to behavior problems, as well as targets for intervention.
早产（PT）儿童出现行为问题和执行功能（EF）缺陷的风险很高，执行功能是一组指导目标导向行为的认知过程。早在PT儿童2岁时就发现了行为差异；在婴儿期就发现了EF差异。行为问题和EF缺陷在幼年时是否同时出现尚未得到充分研究。
确定（1）PT儿童是否比足月（FT）儿童有更多的行为问题和EF损害，以及（2）PT儿童中出现行为问题或EF损害的比例是否更高。
设计/方法：PT（≤34周，n = 82）和FT（n = 79）学龄前儿童（平均年龄4.4岁）完成了一套EF测试。家长完成了行为问题和EF技能的评分量表。比较了两组之间的平均得分和受损比例。逻辑回归预测受损情况，确定PT/FT组的优势比。
与FT相比，PT在大多数行为和EF量表上存在更多问题，在所有任务中的EF得分更低，在大多数行为量表、所有EF评分和所有EF任务中受损的比例更高，p < 0.05。与FT相比，PT在基于表现的EF、家长评定的EF和CBCL得分受损的几率更高，p < 0.05。在PT组中，EF损害的发生率是行为损害的两倍。
我们建议尽早识别PT儿童的EF损害。未来的研究应评估与行为问题相比，EF损害是否是后期功能困难的更好早期标志物，以及是否可作为干预目标。
