Executive Function in Very Preterm Children at Early School Age

Aarnoudse-Moens, Cornelieke S. H.; Smidts, Diana P.; Oosterlaan, Jaap; Duivenvoorden, Hugo J.; Weisglas-Kuperus, Nynke · 2009 · Crossref

DOI: 10.1007/s10802-009-9327-z

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Summary

This study investigates whether very preterm children (born ≤30 weeks gestation) exhibit executive function (EF) impairments at early school age that are independent of IQ and processing speed, and whether demographic or neonatal risk factors predict these deficits. The research addresses a gap in literature regarding the specific nature of EF weaknesses in this population, particularly concerning domains like verbal fluency and concept generation, and seeks to disentangle the contributions of general intelligence, processing speed, and medical history to neurocognitive outcomes. The researchers compared a consecutive sample of 50 very preterm children (mean age 5.9 years) with 50 age-matched full-term controls. Participants completed a comprehensive EF battery assessing inhibition (Go/NoGo, Day-Night task, Shape School), working memory (Word Span), switching (Shape School), verbal fluency, and concept generation (Object Classification Task for Children). IQ was estimated using four subtests of the Wechsler Primary and Preschool Scale of Intelligence-Revised. Statistical analyses employed random regression modeling to account for multiple births, controlling for maternal education, IQ, and processing speed where appropriate. Hierarchical regression was used to examine the impact of demographic variables (gender, maternal education) and neonatal risks (gestational age, Neurobiological Risk Score). Results indicated that the very preterm group performed significantly poorer than controls on nearly all EF domains, including inhibition, working memory, switching, verbal fluency, and concept generation. These deficits persisted even after statistically controlling for IQ, suggesting that EF impairments are distinct from general intellectual ability. Processing speed was found to be only marginally related to EF performance, indicating that slower processing does not fully account for executive dysfunction. Regarding risk factors, lower maternal education and younger gestational age were significantly associated with poorer EF performance. The study found that 26% of very preterm children had neurosensory impairments, and while this subset was analyzed, the overall pattern of EF deficits remained consistent across the group. The findings conclude that very preterm birth is associated with pervasive executive function impairments at early school age that are independent of IQ. This suggests that EF deficits represent a specific neurocognitive vulnerability in this population rather than a byproduct of lower general intelligence or slow processing speed alone. The association with maternal education and gestational age highlights the importance of considering both socioeconomic and biological risk factors in predicting outcomes. These results underscore the need for early identification and targeted interventions addressing executive functions to mitigate potential school difficulties and behavioral problems in very preterm children.

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• cognitive capacity variation