Behavioural and educational outcomes following extremely preterm birth : current controversies and future directions

As a consequence of improved survival rates for extremely preterm (EP; <28 weeks of gestation) births, there is a growing body of evidence detailing the impact of extreme prematurity on outcomes throughout childhood and adolescence. Historically, attention first focused on documenting rates of sensory impairments and severe neurodevelopmental disabilities. However, over recent years, there has been growing interest in the impact of EP birth on long term mental health and educational outcomes. In this chapter we review literature relating to the impact of EP birth on attention, social and emotional problems, psychiatric disorders and educational outcomes. We also outline current controversies in the field. In particular, we present emergent research exploring developmental trajectories to determine whether the sequelae associated with EP birth represent a developmental delay or persistent deficit, and we consider what approaches to intervention may be most fruitful in improving behavioural and educational outcomes in this population

Preventing academic difficulties in preterm children:A randomised controlled trial of an adaptive working memory training intervention - IMPRINT study

BACKGROUND: Very preterm children exhibit difficulties in working memory, a key cognitive ability vital to learning information and the development of academic skills. Previous research suggests that an adaptive working memory training intervention (Cogmed) may improve working memory and other cognitive and behavioural domains, although further randomised controlled trials employing long-term outcomes are needed, and with populations at risk for working memory deficits, such as children born preterm. In a cohort of extremely preterm (<28 weeks’ gestation)/extremely low birthweight (<1000 g) 7-year-olds, we will assess the effectiveness of Cogmed in improving academic functioning 2 years’ post-intervention. Secondary objectives are to assess the effectiveness of Cogmed in improving working memory and attention 2 weeks’, 12 months’ and 24 months’ post-intervention, and to investigate training related neuroplasticity in working memory neural networks 2 weeks’ post-intervention. METHODS/DESIGN: This double-blind, placebo-controlled, randomised controlled trial aims to recruit 126 extremely preterm/extremely low birthweight 7-year-old children. Children attending mainstream school without major intellectual, sensory or physical impairments will be eligible. Participating children will undergo an extensive baseline cognitive assessment before being randomised to either an adaptive or placebo (non-adaptive) version of Cogmed. Cogmed is a computerised working memory training program consisting of 25 sessions completed over a 5 to 7 week period. Each training session takes approximately 35 minutes and will be completed in the child’s home. Structural, diffusion and functional Magnetic Resonance Imaging, which is optional for participants, will be completed prior to and 2 weeks following the training period. Follow-up assessments focusing on academic skills (primary outcome), working memory and attention (secondary outcomes) will be conducted at 2 weeks’, 12 months’ and 24 months’ post-intervention. DISCUSSION: To our knowledge, this study will be the first randomised controlled trial to (a) assess the effectiveness of Cogmed in school-aged extremely preterm/extremely low birthweight children, while incorporating advanced imaging techniques to investigate neural changes associated with adaptive working memory training, and (b) employ long-term follow-up to assess the potential benefit of improved working memory on academic functioning. If effective, Cogmed would serve as a valuable, available intervention for improving developmental outcomes for this population. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ACTRN12612000124831

Nature and origins of mathematics difficulties in very preterm children: A different etiology than Developmental Dyscalculia

Background. Children born very preterm (<32 weeks) are at high risk for mathematics learning difficulties that are out of proportion to other academic and cognitive deficits. However, the aetiology of mathematics difficulties in very preterm children is unknown. We sought to identify the nature and origins of preterm children’s mathematics difficulties. Methods. 115 very preterm children aged 8-10 years were assessed in school with a control group of 77 term-born classmates. Achievement in mathematics, working memory, visuospatial processing, inhibition and processing speed were assessed using standardised tests. Numerical representations and specific mathematics skills were assessed using experimental tests. Results. Very preterm children had significantly poorer mathematics achievement, working memory and visuo-spatial skills than term-born controls. Although preterm children had poorer performance in specific mathematics skills, there was no evidence of imprecise numerical representations. Difficulties in mathematics were associated with deficits in visuospatial processing and working memory. Conclusions. Mathematics difficulties in very preterm children are associated with deficits in working memory and visuo-spatial processing not numerical representations. Thus very preterm children’s mathematics difficulties are different in nature from those of children with developmental dyscalculia. Interventions targeting general cognitive problems, rather than numerical representations, are needed to improve very preterm children’s achievement