Developmental trajectories of attention and executive functioning in infants born preterm: The influence of perinatal risk factors and maternal interactive styles

Abstract

Infants born preterm (born before 37 weeks of gestation) are at a heightened risk for developmental delay and learning disabilities. Even children born preterm who have intellectual abilities within the normal range at school age often require special educational services. The preterm population is a heterogeneous one, however, and not all infants born preterm develop such problems. Current developmental screening instruments often focus on global cognitive outcome and are not very sensitive in identifying infants at risk for these specific and more subtle cognitive problems. Early identification is necessary however, to be able to provide early intervention to these infants and their families. When we consider that attention and executive functions (e.g., working memory and inhibition) are important prerequisites for early childhood development and school achievement, such as learning mathematics and reading, and the finding that children born preterm have more difficulties with attention and executive functioning (EF) at school age than children born at term, this indicates that difficulties in these functions may underlie preterm infants’ heightened risk for developmental delay and learning disabilities. Therefore, the first objective of this thesis was to examine the predictive value of perinatal risk factors for individual differences in developmental trajectories of attention and EF within a preterm sample of infants at 7, 10 and 14 months corrected age (CA). Also, the relationship between these trajectories and subsequent global cognitive functioning were investigated. The main outcomes of this thesis reveal that intra-individual differences over time in sustained attention and EF development in infants born preterm are not very stable between 7 and 14 months CA, which indicates that development of these functions is very dynamic during this period. Inter-individual differences in the rate of developmental change of sustained attention and EF however, are related to variations in perinatal risk, and predictive of subsequent global cognitive development. The finding that early differences in sustained attention and EF are predictive of subsequent global cognitive functioning suggests that screening instruments that tap into such specific functions could help to identify infants who are at risk for delays in these areas of functioning. Since many early intervention programs are aimed at facilitating the development of infants born preterm focus on increasing the quality of parenting behaviors, the second objective of this thesis was to examine the predictive value of two maternal interactive styles (sensitive responsiveness and directiveness) for individual differences in development trajectories of attention and EF in infants born preterm. The results from this thesis showed that a structured approach by mothers (i.e., directiveness) seems to facilitate the development of EF abilities in infants born preterm between 7 and 14 months CA, irrespective of differences in infant self-regulation. No evidence was found for a facilitative effect of a sensitive responsive approach, although we have argued that it is the combination of the two maternal interactive styles that probably matters. These results indicate that it may be more effective to coach parents in how to combine a sensitive responsive interactive style with a more directive, structured approach in order to facilitate development in infants born preterm.