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Behavioral Outcomes and Evidence of Psychopathology Among Very Low Birth Weight Infants at Age 20 Years

Maureen Hack, MB, ChB^*, Eric A. Youngstrom, PhD, Lydia Cartar, MA^*, Mark Schluchter, PhD^*, H. Gerry Taylor, PhD^*, Daniel Flannery, PhD, Nancy Klein, PhD^* and Elaine Borawski, PhD^||

^* Department of Pediatrics, Case Western Reserve University, Cleveland, Ohio
Department of Psychology, Case Western Reserve University, Cleveland, Ohio
Department of Justice Studies, Kent State University, Kent, Ohio
^|| Department of Epidemiology and Biostatistics, Case Western Reserve University, Cleveland, Ohio

Objective. Information on the mental health of very low birth weight (VLBW; <1500 g) children in young adulthood is sparse. We thus sought to examine gender-specific behavioral outcomes and evidence of psychopathology in a cohort of VLBW young adults at 20 years of age.

Methods. We compared a cohort of 241 survivors among VLBW infants who were born between 1977 and 1979 (mean birth weight: 1180 g; mean gestational age at birth: 29.7 weeks), 116 of whom were men and 125 of whom were women, with 233 control subjects from the same population in Cleveland who had normal birth weights (108 men and 124 women). Young adult behavior was assessed at 20 years of age with the Achenbach Young Adult Self-Report and the Young Adult Behavior Checklist for parents. In addition, the young adults and parents completed the ADHD Rating Scale for Adults. Gender-specific outcomes were adjusted for sociodemographic status.

Results. VLBW men reported having significantly fewer delinquent behaviors than normal birth weight (NBW) control subjects, but there were no differences on the Internalizing, Externalizing, or Total Problem Behavior scales. Parents of VLBW men reported significantly more thought problems for their sons than did parents of control subjects. VLBW women reported significantly more withdrawn behaviors and fewer delinquent behavior problems than control subjects. Their rates of internalizing behaviors (which includes anxious/depressed and withdrawn behaviors) above the borderline clinical cutoff were 30% versus 16% (odds ratio: 2.2; 95% confidence interval [CI]: 1.2-4.1). Parents of VLBW women reported significantly higher scores for their daughters on the anxious/depressed, withdrawn, and attention problem subscales compared with control parents. The odds ratios for parent-reported rates above the borderline-clinical cutoff among women for the anxious/depressed subscale was 4.4 (95% CI: 1.4-13.5), for thought problems was 3.7 (95% CI: 1.2-11.6), and for attention problems was 2.4 (95% CI: 1.0-5.5). There were no differences in the young adult self-report of attention-deficit/hyperactivity disorder (ADHD). Parents of VLBW men reported higher mean scores on the attention subtype of ADHD but not higher rates of ADHD.

Conclusion. The increase in psychopathology among VLBW survivors in young adulthood indicates a need for anticipatory guidance and early intervention that might help to prevent or ameliorate potential psychopathology.

Key Words: very low birth weight • psychopathology • behavior

Abbreviations: VLBW, very low birth weight • NBW, normal birth weight • YASR, Young Adult Self-Report • YABCL, Young Adult Behavior Checklist • CBCL, Child Behavior Checklist • ADHD, attention-deficit/hyperactivity disorder • DSM, Diagnostic and Statistical Manual of Mental Disorders • SGA, small for gestational age

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