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Published online August 1, 2006
PEDIATRICS Vol. 118 No. 2 August 2006, pp. e449-e459 (doi:10.1542/peds.2005-3024)
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ARTICLE

Emotional, Behavioral, Social, and Academic Outcomes in Adolescents Born With Very Low Birth Weight

Lauritz Bredrup Dahl, PhDa,b, Per Ivar Kaaresen, MDa,b, Jorunn Tunby, MPHa, Bjørn Helge Handegård, CScb, Siv Kvernmo, PhDa,b, John A. Rønning, PhDa,b

a Child and Adolescent Clinic, University Hospital of North-Norway, Tromsø, Norway
b Institute for Clinical Medicine, University of Tromsø, Tromsø, Norway

BACKGROUND. Very low birth weight survivors are at increased risk of developing emotional and behavioral problems and low social and academic competencies. Information on such problems in very low birth weight adolescents is still sparse.

OBJECTIVES. Our purpose for this work was to study gender-specific emotional and behavioral problems and social and academic competencies in a cohort of very low birth weight adolescents in north Norway.

METHODS. Families with very low birth weight adolescents aged 13 to 18 years, born between 1978 and 1989 (n = 162) were addressed by mail and asked to complete the Child Behavior Check List and the Youth Self-Report. Data were compared with 2 normative adolescent populations (Child Behavior Check List, n = 540; Youth Self-Report, n = 2522). Scores given by very low birth weight adolescents and their parents on identical items in Child Behavior Check List and Youth Self-Report (cross-informant syndrome constructs) were compared in pairs. To explore predictive effects, demographic and early medical characteristics were entered into a hierarchical multiple regression analysis.

RESULTS. There were 156 eligible families, and 99 (63.5%) responded. All completed the Child Behavior Check List, and 82 (52.6%) completed the Youth Self-Report. Very low birth weight boys reported less externalizing and internalizing behaviors and thought and attention problems and higher activity score, whereas very low birth weight girls reported less externalizing behavior and less social, thought, and attention problems and higher activity score compared with normative adolescents. Very low birth weight parents, however, reported more social and attention problems and less social and school competence in boys and more internalizing behavior and social and attention problems and less school competence in girls compared with normative parents. They scored high proportions of both genders within the borderline/clinical range on all of the scales, except for externalizing behavior and social problems in girls. Female very low birth weight adolescents, in contrast to males, reported more problems than parents when compared in pairs, and externalizing problems in particular were not recognized by parents.

CONCLUSIONS. From parents' point of view, significant proportions of very low birth weight adolescents experience more emotional and behavioral problems and less competence than normative adolescents. In contrast, very low birth weight adolescents state less problems and similar or higher competence than normative adolescents. Very low birth weight adolescent girls report more emotional and behavioral problems compared with their parents than very low birth weight adolescent boys do. Externalizing problems in very low birth weight adolescent girls are often not recognized by parents. To better understand these seemingly paradoxical findings and to develop adequate intervention programs, there is a need for prospective longitudinal studies.

Key Words: very low birth weight • adolescent • behavioral problems • emotional problems • competence • gender-specific • Child Behavior Check List • Youth Self-Report

Abbreviations: VLBW—very low birth weight • HRQoL—health-related quality of life • YSR—Youth Self-Report • CBCL—Child Behavior Check List • SES—socioeconomic status • SGA—small for gestational age • ELBW—extremely low birth weight • FGR—fetal growth restriction

Accepted Mar 31, 2006.


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