Behavior Problems and Executive Function Impairments in Preterm Compared to Full Term Preschoolers

Background: Children born preterm (PT) are at high risk for behavior problems and deficits in executive function (EF), a set of cognitive processes that guide goal-directed behaviors. Behavior differences have been found as early as 2 years in PT children; EF differences have been found in infancy. Whether behavior problems and EF deficits co-occur at young ages has not been fully investigated.

Aims: To determine whether (1) PT children have more behavior problems and EF impairment than full term (FT) children and (2) larger proportions of PT children show behavior problems or EF impairments.

Design/methods: PT (≤34 wks, n = 82) and FT (n = 79) preschoolers (mean age 4.4 years) completed an EF battery. Parents completed rating scales of behavior problems and EF skills. Mean scores and proportions with impairment were compared between groups. Logistic regression predicting to impairment defined odds ratios for PT/FT groups.

Results: PT compared to FT had more problems on most behavior and EF scales and poorer EF scores on all tasks and greater proportion with impairments on most behavior scales, all EF ratings, and all EF tasks, p < .05. PT had elevated odds for impaired performance-based EF, parent-rated EF and CBCL scores compared to FT, p < .05. Within the PT group, EF impairments were twice as common as behavior impairment.

Conclusions: We recommend early identification of EF impairments in PT children. Future research should evaluate whether EF impairments serve as better early markers for later functional difficulties compared to behavior problems, as well as targets for intervention.