Out of focus: Attentional functioning in children born preterm from infancy to early adolescence

Abstract

The overarching aim of this dissertation was to gain a better understanding of developmental outcomes, especially attentional functioning, in children born preterm from infancy to early adolescence. The present dissertation had four aims: 1) to evaluate differences in cognitive, behavioral, and attentional functioning at school-age between children born preterm and full term, 2) to assess distinct profiles of attentional functioning, 3) to investigate developmental patterns of attentional functioning, and 4) to examine which early childhood factors are predictors of later functioning and which measurement tools may serve as neurodevelopmental screening measures in infancy. 1. At school-age children born moderate-to-late preterm are more likely to show specific vulnerabilities than generalized poorer functioning. They exhibit poorer orienting attention, processing speed, and behavioral attention compared with children born full term. As these children form the majority of preterm births, more efforts should be made towards follow-up. 2. High variability was shown in attentional functioning of children born preterm, reflected by various distinct attention profiles. Compared with children born full term, children born preterm are 2-3 times more likely to show poorer attention profiles. Children born preterm also showed different profiles of poorer attention, with subaverage functioning across multiple attention domains or substantial attention difficulties in one or more domains. Different types of attention difficulties may impact other areas of functioning in daily life. 3. Toddlers’ poorer attention abilities are precursors for poorer attention at school-age, although the type of attention difficulties in children born preterm seems age-dependent. At toddler and school ages, attention difficulties were pronounced in selective and sustained attention. By early adolescence difficulties moved to shifting and divided attention; more complex attention abilities. Furthermore, children born preterm vary considerably in developmental attention patterns. One-thirds exhibited stable average attention, one quarter showed (partial) catch-up in attention abilities, while almost half exhibited poorer attention patterns over time. Thus, children born preterm exhibit varying developmental patterns, and distinct attention domains follow different developmental trajectory. 4. Children born preterm at highest risk of poorer outcomes can be identified early in life by several neonatal (degree of prematurity and early brain pathology), and contextual characteristics (lower parental education, family structure, and socioeconomic status). Other promising neonatal measures for detecting early problems are neurobehavioral assessments, brain imaging tools, and composite measures of perinatal complications. In toddlerhood, poorer orienting, alerting and language abilities predicted poorer cognition, behavior, and attention at school-age. Overall, this dissertation shows that children born preterm, even moderate-to-late preterm, are at increased risk for poorer attention across several attention domains. Children born preterm exhibit variability in presence, severity and type of attention difficulties. Over time, they also show varying developmental attention patterns. The type of attention difficulties also appears to be age-dependent, suggesting that distinct attention domains follow different developmental trajectories. Specific neonatal and contextual characteristics, and attention and language at toddler age are early predictors of later attention and could aid earlier identification of children at highest risk. These findings highlight the need for early monitoring and comprehensive attention assessment in children born preterm.