Psychiatric Disorders in Extremely Preterm Children: Longitudinal Finding at Age 11 Years in the EPICure Study

Institute for Women's Health, University College London and the School of Clinical Sciences, University of Nottingham, UK.
Journal of the American Academy of Child and Adolescent Psychiatry (Impact Factor: 7.26). 05/2010; 49(5):453-63.e1. DOI: 10.1016/j.jaac.2010.02.002
Source: PubMed


To investigate the prevalence and risk factors for psychiatric disorders in extremely preterm children.
All babies born <26 weeks gestation in the United Kingdom and Ireland from March through December 1995 were recruited to the EPICure Study. Of 307 survivors at 11 years of age, 219 (71%) were assessed alongside 153 term-born classmates. Parents completed a structured psychiatric interview about their child, and teachers completed a corresponding questionnaire from which DSM-IV diagnoses were assigned for 219 (100%) extremely preterm children and 152 (99%) classmates. An IQ test and a physical evaluation were also administered. Longitudinal data were available for extremely preterm children.
Extremely preterm children were more than three times more likely to have a psychiatric disorder than classmates (23% vs. 9%; odds ratio [OR] = 3.2; 95% confidence interval [CI] = 1.7, 6.2). Risk was significantly increased for: attention-deficit/hyperactivity disorder (ADHD; 11.5% vs. 2.9%; OR = 4.3; CI = 1.5 to 13.0), with increased risk for ADHD inattentive subtype (OR = 10.5; CI = 1.4 to 81.1) but not ADHD combined subtype (OR = 2.1; CI = 0.5 to 7.9); emotional disorders (9.0% vs. 2.1%; OR = 4.6; CI = 1.3 to 15.9), with increased risk for anxiety disorders (OR = 3.5; CI = 1.0 to 12.4); and autism spectrum disorders (8.0% vs. 0%; p = .000). Psychiatric disorders were significantly associated with cognitive impairment (OR = 3.5; CI = 1.8 to 6.4). Parent-reported behavioral problems at 2.5 and 6 years were independent predictors of psychiatric disorders at 11 years.
Extremely preterm children are at increased risk for ADHD, emotional disorders, and autism spectrum disorders at 11 years of age. The mechanism of association with psychiatric disorder may include both cognitive impairment and early traumatic experiences that have an impact on both child and parent. Early screening for cognitive and behavioral problems may identify those at greatest risk.

Download full-text


Available from: Dieter Wolke
  • Source
    • "These ADHD problems were predominantly of the inattentive (ADHD-IA) and combined (ADHD-C) subtypes consistent with previous reports of VP/ VLBW children (Elgen, Sommerfelt, & Markestad, 2002). Specifically, previous studies reported a 15%–23% prevalence of ADHD in VP/VLBW children (Elgen et al., 2002; Johnson et al., 2010) similar to the 21.9% prevalence of childhood ADHD in our VP/VLBW sample, which equates to a 2–3 fold increased risk (Bhutta et al., 2002). Furthermore , the 7%–23% prevalence of ADHD (Johnson & Wolke, 2013) in VLBW adolescents previously reported is fairly consistent with our VP/VLBW adult sample's 9.8% prevalence. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Background Very preterm (VP; gestational age <32 weeks) and very low birth weight (VLBW; <1500 grams) is related to attention problems in childhood and adulthood. The stability of these problems into adulthood is not known.Methods The Bavarian Longitudinal Study is a prospective cohort study that followed 260 VP/VLBW and 229 term-born individuals from birth to adulthood. Data on attention were collected at 6, 8, and 26 years of age, using parent reports, expert behavior observations, and clinical ADHD diagnoses.ResultsAt each assessment, VP/VLBW individuals had significantly more attention problems, shorter attention span, and were more frequently diagnosed with ADHD than term-born comparisons. In both VP/VLBW and term-born individuals, overall, attention span increased and attention problems decreased from childhood to adulthood. Attention problems and attention span were more stable over time for VP/VLBW than term-born individuals. Similarly, ADHD diagnoses showed moderate stability from childhood to adulthood in VP/VLBW, but not in term-born individuals. However, when those with severe disabilities were excluded, differences between VP/VLBW and term-born individuals reduced.Conclusions Despite improvement in attention regulation from childhood to adulthood, children born very preterm remained at increased risk for attention problems in adulthood. In contrast, term-born children with clinical attention problems outgrew these by adulthood. As inattentive behavior of VP/VLBW children may be overlooked by teachers, it may be necessary to raise awareness for school intervention programs that reduce attention problems in VP/VLBW children.
    Full-text · Article · Aug 2015 · Journal of Child Psychology and Psychiatry
  • Source
    • "under 750 g) had moderate to severe neurocognitive disability, and longer follow-up studies (up to age 11) documented an increased risk of psychiatric disorders compared with term-born classmates (Johnson et al. 2010a). Although the EPICure study included a small number of infants born in Ireland in 1995, to protect anonymity, none of the Irish data has been presented separately and therefore we do not have any data on the MH outcomes of children growing up in Ireland. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Aim To compare mental health (MH) outcomes of and service use by children born under 1500 g in Ireland with a matched control group. Method Using a retrospective cohort design, semi-structured and standardised MH assessments were conducted with parents, teachers and youth. Results A total of 64 of 127 surviving children from a very low birth weight (VLBW) cohort from a National Maternity Hospital participated at a mean age of 11.6 years ( s.d. 1.0), along with 51 matched controls. More VLBW children received clinical or borderline scores when rated by parents [ χ 2 (1, n =114)=7.3, p =0.007] or youths [ χ 2 (1, n =114)=4.83, p =0.028], but not by teachers [ χ 2 (1, n =114)=1.243, p =0.463]. There was no increase in the use of MH services. A main effect of birth weight remained on the parent Strengths and Difficulties Questionnaire [ F (1, 88)=5.07, p <0.05) after controlling for intelligence quotient (IQ) and socio-economic status (SES), but only on hyperactivity in males. SES, rather than IQ or birth weight, predicted identification of problems by teachers [ F (1, 82)=6.99, p =0.01). Interpretations Teachers miss MH difficulties and are influenced more by SES than by IQ or birth weight. This has implications for MH service access. Initial perinatal investment needs to be matched with ongoing surveillance and psychoeducation to ensure that disorders are recognised early and offered appropriate interventions.
    Full-text · Conference Paper · Jul 2015
  • Source
    • "Delayed specialization would prolong this process of perceptual narrowing, leading to the prediction that infants who go on to be diagnosed with autism will show an enhanced ability to discriminate faces, phonemes, and voices from unfamiliar categories (e.g., nonnative speakers) in the second year of life and delayed onset of other-race effects. It is interesting that delayed perceptual narrowing has recently been observed in premature infants (Jansson-Verkasalo et al., 2010), a group who have a substantially higher risk of autism (Johnson et al., 2010). Further, a key indicator of the sensitive period for ocular dominance plasticity is the window within which treatments for amblyopia are most effective. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Resilience and adaptation in the face of early genetic or environmental risk has become a major interest in child psychiatry over recent years. However, we still remain far from an understanding of how developing human brains as a whole adapt to the diffuse and widespread atypical synaptic function that may be characteristic of some common developmental disorders. The first part of this paper discusses four types of whole-brain adaptation in the face of early risk: redundancy, reorganization, niche construction, and adjustment of developmental rate. The second part of the paper applies these adaptation processes specifically to autism. We speculate that key features of autism may be the end result of processes of early brain adaptation, rather than the direct consequences of ongoing neural pathology.
    Full-text · Article · May 2015 · Development and Psychopathology
Show more