de Silva Aryanne, Neel Mary Lauren, Maitre Nathalie, Busch Tyler, Taylor H Gerry
Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA.
Department of Pediatrics, The Ohio State University, Columbus, OH, USA.
Clin Neuropsychol. 2021 Jul;35(5):904-924. doi: 10.1080/13854046.2020.1817565. Epub 2020 Sep 13.
The primary goal was to determine the prevalence and correlates of adaptive competence in 51 very preterm (VPT, gestational age ≤30 weeks) 4-year-old children compared to a group of 35 term-born (Term) children of the same age. Adaptive competence, or "resilience" in the VPT group, was defined as age-appropriate scores on tests of early literacy and numeracy and an absence of clinical elevations on parent ratings of problems in behavior and development. Analyses were conducted to compare groups in the prevalence of adaptive competence, determine how adaptively competent VPT children differed from children who were not adaptively competent (i.e. the "maladaptive" subset) and from adaptively competent Term children, and identify family factors related to competence independent of group. : Controlling for sociodemographic background, fewer VPT children compared to Term participants (31% vs. 71%) were adaptively competent ( = .026). Compared to the maladaptive subset of the VPT group, adaptive VPT children had higher scores on cognitive tests and more positive parent ratings of executive function and self-regulation. The adaptive VPT subset had outcomes similar to adaptive Term children on many measures but poorer outcomes in specific domains. Higher home stimulation for learning and lower parent distress were also related to adaptive competence. Although a substantial minority of VPT children display adaptive competence, these children may have weaknesses in cognitive skills and executive functioning that present developmental challenges. Associations of adaptive competence with supportive home environments suggest that early family intervention may improve outcomes in this population.
主要目标是确定51名极早产儿（VPT，胎龄≤30周）4岁儿童与35名同龄足月儿（Term）相比，适应性能力的患病率及其相关因素。VPT组的适应性能力，或“恢复力”，定义为早期读写和算术测试中达到适龄分数，且家长对行为和发育问题的评分无临床升高。进行分析以比较两组适应性能力的患病率，确定适应性良好的VPT儿童与适应性不佳的儿童（即“适应不良”亚组）以及适应性良好的足月儿有何不同，并确定与能力相关的独立于组别的家庭因素。在控制社会人口背景的情况下，与足月儿参与者相比，VPT儿童中适应性良好的比例更低（31%对71%）（P = 0.026）。与VPT组的适应不良亚组相比，适应性良好的VPT儿童在认知测试中得分更高，家长对执行功能和自我调节的评价更积极。适应性良好的VPT亚组在许多指标上的结果与适应性良好的足月儿相似，但在特定领域的结果较差。更高的家庭学习刺激和更低的家长困扰也与适应性能力有关。尽管相当一部分VPT儿童表现出适应性能力，但这些儿童在认知技能和执行功能方面可能存在弱点，这带来了发育挑战。适应性能力与支持性家庭环境之间的关联表明，早期家庭干预可能会改善这一人群的结局。
