Cognitive functions mediate the effect of preterm birth on mathematics skills in young children.

Children born preterm are at risk for cognitive deficits and lower academic achievement. Notably, mathematics achievement is generally most affected. Here, we investigated the cognitive functions mediating early mathematics skills and how these are impacted by preterm birth. Healthy children born preterm (gestational age at birth < 33 weeks; = 51) and children born full term ( = 27) were tested at ages 5, 6, and 7 years with a comprehensive battery of tests. We categorized items of the TEMA-3: Test for Early Mathematics Abilities Third Edition into number skills and arithmetic skills. Using multiple mediation models, we assessed how the effect of preterm birth on mathematics skills is mediated by spatial working memory, inhibitory control, visual-motor integration, and phonological processing. Both number and arithmetic skills showed group differences, but with different developmental trajectories. The initial performance gap observed in the preterm children decreased over time for number skills but increased for arithmetic skills. Phonological processing, visual-motor integration, and inhibitory control were poorer in children born preterm. These cognitive functions, particularly phonological processing, had a mediating effect on both types of mathematics skills. These findings help define and chart the trajectory of the specific cognitive skills directly influencing math deficit phenotypes in children born very preterm. This knowledge provides guidance for targeted evaluation and treatment implementation.