Development of Preschool and Academic Skills in Children Born Very Preterm

doi:10.1016/j.jpeds.2010.06.052

The Journal of Pediatrics

Volume 158, Issue 1, January 2011, Pages 51-56

https://doi.org/10.1016/j.jpeds.2010.06.052 Get rights and content

Objective

To examine performance in preschool and academic skills in very preterm (gestational age ≤30 weeks) and term-born comparison children aged 4 to 12 years.

Study design

Very preterm children (n = 200; mean age, 8.2 ± 2.5 years) born between 1996 and 2004 were compared with 230 term-born children (mean age, 8.3 ± 2.3). The Dutch National Pupil Monitoring System was used to measure preschool numerical reasoning and early linguistics, and primary school simple and complex word reading, reading comprehension, spelling, and mathematics/arithmetic. With univariate analyses of variance, we assessed the effects of preterm birth on performance across grades and on grade retention.

Results

In preschool, very preterm children performed comparably with term-born children in early linguistics, but perform more poorly (0.7 standard deviation [SD]) in numerical reasoning skills. In primary school, very preterm children scored 0.3 SD lower in complex word reading and 0.6 SD lower in mathematics/arithmetic, but performed comparably with peers in reading comprehension and spelling. They had a higher grade repeat rate (25.5%), although grade repeat did not improve their academic skills.

Conclusions

Very preterm children do well in early linguistics, reading comprehension, and spelling, but have clinically significant deficits in numerical reasoning skills and mathematics/arithmetic, which persist with time.

Section snippets

Methods

The Figure describes the inclusion procedure of very preterm children. The final study sample of 200 very preterm (≤30 weeks) children was derived from all (n = 706) very preterm surviving singletons admitted between 1996 and 2004 to the neonatal intensive care unit (NICU) of the Erasmus University Medical Center-Sophia Children's Hospital in Rotterdam, The Netherlands. Twins were excluded because inclusion of these children would violate the assumption of independence of data. Disabilities

Results

Table I presents information on sample characteristics for the very preterm (n = 200) and comparison groups (n = 230). The very preterm group had a significantly lower mean IQ (F = 111.5, P < .001), lower mean level of parental education (χ² = 50.4, P < .001), and more minor disabilities (χ² = 27.8, P < .001) than the comparison group. There were no group differences for age at assessment (F = .09, P = .8) or sex (χ² = 1.1, P = .3). Table II lists the perinatal characteristics of very preterm

Discussion

In our meta-analysis, we showed that academic areas of weakness in very preterm children encompass reading, mathematics/arithmetic, and spelling.² Information on preschool skills in these children, however, was lacking, and it remained unknown whether very preterm children already perform more poorly than peers at an early school age when they enter primary school or as they grow older.

This study shows that in preschool very preterm children do well in early linguistics, but have significant

References (33)

S. Saigal et al.
What matters in the long-term: reflections on the context of adult outcomes versus detailed measures in childhood
Semin Fetal Neonatal Med
(2007)
K. Krajewski et al.
Exploring the impact of phonological awareness, visual-spatial working memory, and preschool quantity-number competencies on mathematics achievement in elementary school: findings from a 3-year longitudinal study
J Exp Child Psychol
(2009)
V.E. Pritchard et al.
Early school-based learning difficulties in children born very preterm
Early Hum Dev
(2009)
C.S. Aarnoudse-Moens et al.
Meta-analysis of neurobehavioral outcomes in very preterm and/or very low birth weight children
Pediatrics
(2009)
W. Schneider et al.
Pathways to school achievement in very preterm and full term children
Eur J Psychol Educ
(2004)
N.C. Jordan et al.
Early math matters: kindergarten number competence and later mathematics outcomes
Dev Psychol
(2009)
H.W. Kilbride et al.
Preschool outcome of less than 801-gram preterm infants compared with full-term siblings
Pediatrics
(2004)
N.S. Wood et al.
Neurologic and developmental disability after extremely preterm birth. EPICure Study Group
N Engl J Med
(2000)
CITO: www.cito.com/monitoring_and_evaluation_system.aspx. In. Arnhem, The Netherlands.;...
K.F.M. Vlug
Because every pupil counts: the succes of the pupil monitoring system in The Netherlands
Educ Informat Technol
(1997)

Staphorsius G, Kleintjes, F.G.M. en Verhelst, N. Clibtoetsen, kalibratie-, validerings- en normeringsonderzoek...

G. Rasch

Probalistic models for some intelligence and attainment tests

(1960)

J.J. Van Kuyk

Ordenen, Observatie-en hulpprogramma voor kleuters in de basisschool [Reasoning]

(2001)

J.J. Van Kuyk

Taal voor Kleuters [Early Linguistics]

(1996)

J. Janssen et al.

Rekenen-Wiskunde 2002 [Arithmetic and Mathematics]

(2002)

L. Van der Bosch et al.

Schaal Vorderingen in de Spellingsvaardigheid [Scale for Spelling Achievement]

(1997)

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Mathematic skills in low birth weight or preterm birth: A meta-analysis
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Citation Excerpt :
Looking at school performance, the preterm born children in our study population had lower performances in reading comprehension, spelling and mathematics, with the biggest proportion of preterm children experiencing difficulties in mathematics. Already in preschool, before the age of six, it is noticed that preterm born children have more difficulties with numerical reasoning skills [6]. Mathematical difficulties are associated with poorer internal representation of numbers, which starts early on in life [23].
To determine classroom-evaluated school performance nine years after preterm birth, predicted by perinatal risk factors and neonatal brain abnormalities.
Children were recruited from a consecutive cohort of 113 preterm infants (<32 weeks' gestation), participating in a longitudinal prospective study, investigating brain injury and neurodevelopmental outcome. Data on perinatal risk factors, presence of brain injury at term-equivalent age, and maternal education were collected. Information on school performance included enrollment in special (primary) education, grade repetition and school results from the nationwide standardized Dutch Pupil Monitoring System regarding reading comprehension, spelling, and mathematics.
Information on school enrollment was available for 87 children (77%), of whom 7 (8%) were in special primary education and 19 (22%) repeated a grade. This was significantly higher compared to national rates (p ≤ .05). Results on school performance were available for 74 children (65%) and showed clearly below average scores in reading comprehension (p = .006), spelling (p = .014) and mathematics (p < .001). Univariate analysis showed that lower performance in reading comprehension was predicted by male sex and low maternal education; spelling by male sex; and mathematics by Bronchopulmonary Dysplasia, white matter injury and maternal education. In a multivariate model, male sex and maternal education were predictive for reading comprehension and white matter injury for mathematics.
Preterm born children more often need special primary education and have higher grade repeat rates. They perform poorer on reading comprehension, spelling and mathematics. Regular follow-up remains important for preterm born children during school age.
The profile of very preterm children on academic achievement. A cross-population comparison with children with specific learning disorders
2019, Research in Developmental Disabilities
Very preterm (VPT) children showed delays in reading, spelling and maths, but their academic achievement profile is not clearly understood.
VPT children were compared with children with specific learning disorders (SLD) and typically developing (TD) children on academic achievement, considering cognitive and linguistic phenotypic markers. A learning profile analysis was also performed.
We included 170 10-year old monolingual Italian-speaking children (37 VPT, 28 SLD, 105 TD) assessing cognitive, linguistic and academic skills.
On academic achievements VPT children fell behind TD peers in some reading (text speed, comprehension), spelling (non-word), and math (number knowledge, written calculations and problem-solving) tasks. SLD children underperformed in all academic tasks with respect to VPT and TD peers. Concerning cognitive and linguistic phenotypic markers, compared to TD peers, VPT children showed lower scores in verbal IQ and phonological fluency, SLD children in phonological processing and rapid automatized naming. VPT children showed a higher rate of at-risk performance in reading compared to TD group, but a minor percentage of impaired profiles and comorbidity among learning areas compared to SLD group.
The academic achievement profile of VPT children shows persistent delays, but it differs to that of SLD children, since delays are less widespread and severe, and differences were found in phenotypic markers and comorbidity. Follow-up programs and effective interventions are needed for VPT children.
Development of executive functions from childhood to adolescence in very preterm-born individuals - A longitudinal study
2019, Early Human Development
Preterm-born individuals are at risk for poorer executive functions. Longitudinal studies investigating whether preterm-born individuals present persistent cognitive deficits, or a transient delay of development are scarce. We assessed developmental trajectories of executive functions (inhibition, working memory, cognitive flexibility) in 29 very preterm-born individuals (<32 weeks' gestation) and 25 term-born controls longitudinally over two time points, namely in childhood (7–12 years of age, TP1) and adolescence (13–16 years of age, TP2). Individual changes in executive functions were examined using relative difference scores (TP2 − TP1) / TP1). There was a significantly stronger improvement of inhibition (U = 477, p = .024) and cognitive flexibility (U = 312, p = .029) between childhood and adolescence in very preterm-born individuals than in term-born controls. Preterm-born individuals improved their performance in the domain of cognitive flexibility significantly more often (76%) between childhood and adolescence than controls (31%, χ² = 8.6, p = .003). Controls worsened significantly more often (36%) in the domain of inhibition than the preterm group (14%, χ² = 4.8, p = .028). Results indicate that healthy preterm-born individuals show prolonged development of executive functions throughout childhood up into adolescence.
Visual perceptive skills account for very preterm children's mathematical difficulties in preschool
2019, Early Human Development
Already in preschool, very preterm (VP) children perform worse than term born-children on preschool mathematical skills tests. Strong associations have been found between preschool mathematical skills, cognition and visual-motor integration.
To compare VP children and their term-born peers on preschool mathematical achievement at the corrected age of five years, and determine whether cognitive, visual-perceptive, visual-motor, and motor-coordination skills, account for any significant differences observed.
Single-center, consecutive cohort study with a term-born comparison group.
54 five-year-old VP children and 28 term-born comparison children.
Standardized test for preschool mathematical skills (Dutch pupil monitoring system), cognitive skills (Wechsler Preschool and Primary Scale for Intelligence - third edition), visual-perception, visual-motor integration, and motor-coordination (Beery Visual-Motor Integration test - sixth edition). Group differences were analyzed with ANCOVAs, adjusting for maternal education, preschool grade, and time of assessment. Sobel's mediation analyses tested for possible mediation effects.
Preschool mathematical skills and visual perceptive skills were significantly lower in VP children than in term-born children (Cohen's d = 0.63, p = 0.01; Cohen's d = 0.84, p < 0.01, respectively). Sobel's test indicated a significant mediating effect of visual perceptive skills on the association between VP birth and preschool mathematical skills.
At preschool age, VP children have poorer preschool mathematical skills compared to term-born peers; deficits that were fully accounted for by poor visual perceptive skills. Our findings indicate the relevance of screening visual perceptive skills at preschool age, enabling timely identification of children at risk for mathematical difficulties.
Low and very low birthweight disadvantage in compulsory education achievement and the transition to upper secondary education in the Finnish birth cohorts of 1987 to 1997
2024, Child: Care, Health and Development

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: The authors declare no conflicts of interest.

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Original ArticleDevelopment of Preschool and Academic Skills in Children Born Very Preterm

Objective

Study design

Results

Conclusions

Section snippets

Methods

Results

Discussion

Semin Fetal Neonatal Med

J Exp Child Psychol

Early Hum Dev

Meta-analysis of neurobehavioral outcomes in very preterm and/or very low birth weight children

Pediatrics

Pathways to school achievement in very preterm and full term children

Eur J Psychol Educ

Early math matters: kindergarten number competence and later mathematics outcomes

Dev Psychol

Preschool outcome of less than 801-gram preterm infants compared with full-term siblings

Pediatrics

Neurologic and developmental disability after extremely preterm birth. EPICure Study Group

N Engl J Med

Because every pupil counts: the succes of the pupil monitoring system in The Netherlands

Educ Informat Technol

Probalistic models for some intelligence and attainment tests

Ordenen, Observatie-en hulpprogramma voor kleuters in de basisschool [Reasoning]

Taal voor Kleuters [Early Linguistics]

Rekenen-Wiskunde 2002 [Arithmetic and Mathematics]

Schaal Vorderingen in de Spellingsvaardigheid [Scale for Spelling Achievement]

Original Article
Development of Preschool and Academic Skills in Children Born Very Preterm