Association of preterm birth with ADHD-like cognitive impairments and additional subtle impairments in attention and arousal malleability

James, S.-N.; Rommel, A.-S.; Cheung, C.; McLoughlin, G.; Brandeis, D.; Banaschewski, T.; Asherson, P.; Kuntsi, J. · 2017 · Crossref

DOI: 10.1017/s0033291717002963

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Summary

This study investigates the cognitive and neurophysiological profile of adolescents born preterm, specifically examining whether their impairments mirror those of term-born adolescents with attention-deficit/hyperactivity disorder (ADHD) or represent a distinct pattern of deficits. While preterm birth is a known risk factor for ADHD, direct comparisons between preterm-born individuals and those with ADHD are scarce. The research aims to determine if preterm-born adolescents exhibit identical cognitive-neurophysiological impairments to those with ADHD, identify any additional subtle impairments unique to the preterm group, and assess whether these deficits correlate with ADHD symptom severity. The study utilized a comparative design involving three groups: 186 preterm-born adolescents, 69 term-born adolescents with ADHD, and 135 term-born controls, all aged 11–23 years. Participants performed the "Fast Task," a four-choice reaction time task with baseline (slow, unrewarded) and fast-incentive (fast, rewarded) conditions. The researchers measured cognitive performance (mean reaction time and reaction time variability), event-related potentials (ERPs) including contingent negative variation (CNV) for response preparation and P3 amplitude for attention allocation, and skin conductance level (SCL) for peripheral arousal. Data were analyzed using random intercept models to account for sibling clustering, with controls for age, gender, and IQ. Results indicated that preterm-born adolescents shared specific impairments with the ADHD group, including increased mean reaction time and reaction time variability in the baseline condition, and attenuated CNV amplitude in the fast-incentive condition. However, the preterm group exhibited additional deficits not seen in the ADHD group: they failed to show significant within-group adjustments in P3 amplitude and SCL when moving from baseline to the fast-incentive condition. In contrast, both the ADHD and control groups demonstrated significant improvements in these measures under incentive conditions. Dimensional analyses revealed that ADHD symptom scores correlated significantly with mean reaction time, reaction time variability, and CNV amplitude, but not with the lack of malleability in P3 and SCL observed in the preterm group. The findings suggest that while preterm birth is associated with ADHD-like cognitive and brain function impairments linked to ADHD symptoms, it also involves additional subtle deficits in the malleability of attention and arousal regulation. These specific impairments in neurophysiological flexibility extend at least into adolescence and are not directly explained by ADHD symptomatology. The study highlights the need for future research to track these trajectories into adulthood and suggests that interventions for preterm-born individuals may need to address broader neurophysiological rigidity beyond standard ADHD treatments.

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