Risk factors for executive function difficulties in preschool and early school-age preterm children.

AIM: To investigate the relationship between executive functioning and social and perinatal risk factors in four- to five-year-old preterm children. METHODS: Using standardised measures of general intelligence and performance-based executive function (EF) tests prior to starting kindergarten, 141 children born preterm (<33 weeks of gestation) and 77 term comparison children were assessed. Parental and teacher reports of executive functioning were completed when the children commenced kindergarten. The preterm and the term comparison groups were compared on measures of intelligence and EFs using independent-groups t-tests, and multivariate regression analyses were performed to identify factors predictive of intelligence and executive functioning in the preterm group. RESULTS: The preterm group performed significantly more poorly than the comparison group on all intelligence and EF tests. The parental reports of the preterm and term comparison children's EF did not differ significantly, but the teachers reported elevated EF difficulties for the preterm group. Higher social risk, in particular lower educational level of the main caregiver, was the strongest predictor for the preterm children's intelligence and EF results. CONCLUSION: Social risk factors are strongly associated with impaired early EF outcomes in preterm children.

Parent and teacher reporting of executive function and behavioral difficulties in preterm and term children at kindergarten.

The aim of the study was to compare parent and teacher ratings of executive function and behavioral difficulties of kindergarten-age preterm and term children. Parents of 82 and kindergarten teachers of 105 preterm (<33 weeks' gestation) children and parents of 49 and kindergarten teachers of 46 term four- to five-year-old children completed executive function (EF) and behavior questionnaires. The preterm children were rated to have more EF difficulties than the term children by parents and teachers. On the behavior scales, the preterm children were reported as having more attention control difficulties than the term group, but no other behavioral problems. The parents reported higher levels of EF and behavioral difficulties than the teachers when both child groups were combined. The overall interrater reliability between parents and teachers in terms of children being in the clinical vs. non-clinical range for EF and behavioral problems was low for the preterm and term groups. Conclusion: Based on this study, some young preterm children need EF supports when commencing kindergarten, and preterm children should be screened for EF difficulties. Noncongruent parent and teacher reporting nevertheless make it challenging to identify the preterm children most at need of such supports. Further studies are needed to determine the factors impacting on reporting patterns, and also the best combination of EF and behavior assessment tools.

Examining the relationship between performance-based and questionnaire assessments of executive function in young preterm children: Implications for clinical practice.

The aim of this study was to determine whether specific performance-based executive function assessment tools were associated with executive functioning in everyday life as reported by parents and teachers of four- to five-year-old preterm and term children. At the age of 4 years, 141 preterm children born <33 weeks' gestation and 77 term children were assessed using performance-based intelligence (WPPSI-III) and executive function (EF) assessment tools (NEPSY-II, Day-Night and Shape School tasks). The assessment results were compared with the parent and teacher completed questionnaires of EF (BRIEF-P) when the children started kindergarten at the age of 4 to 5 years. The performance-based intelligence and EF assessment results were not consistently associated with the parent and teacher reports of EF in everyday life for either preterm or term groups. Clinical implications of using and interpreting performance-based EF assessment tools and EF questionnaires are discussed with a particular focus on young preterm children at the commencement of formal schooling.