Published online July 2, 2007
PEDIATRICS Vol. 120 No. 1 July 2007, pp. 118-133 (doi:10.1542/10.1542/peds.2006-2988)

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ARTICLE

Mental Health and Social Competencies of 10- to 12-Year-Old Children Born at 23 to 25 Weeks of Gestation in the 1990s: A Swedish National Prospective Follow-up Study

Aijaz Farooqi, MD, PhD^a, Bruno Hägglöf, MD, PhD^b, Gunnar Sedin, MD, PhD^c, Leif Gothefors, MD, PhD^a and Fredrik Serenius, MD, PhD^a

^a Divisions of Pediatrics
^b Child and Adolescent Psychiatry, Department of Clinical Sciences, University Hospital, Umeå, Sweden
^c Section for Pediatrics, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden

OBJECTIVE. We investigated a national cohort of extremely immature children with respect to behavioral and emotional problems and social competencies, from the perspectives of parents, teachers, and children themselves.

METHODS. We examined 11-year-old children who were born before 26 completed weeks of gestation in Sweden between 1990 and 1992. All had been evaluated at a corrected age of 36 months. At 11 years of age, 86 of 89 survivors were studied and compared with an equal number of control subjects, matched with respect to age and gender. Behavioral and emotional problems, social competencies, and adaptive functioning at school were evaluated with standardized, well-validated instruments, including parent and teacher report questionnaires and a child self-report, administered by mail.

RESULTS. Compared with control subjects, parents of extremely immature children reported significantly more problems with internalizing behaviors (anxiety/depression, withdrawn, and somatic problems) and attention, thought, and social problems. Teachers reported a similar pattern. Reports from children showed a trend toward increased depression symptoms compared with control subjects. Multivariate analysis of covariance of parent-reported behavioral problems revealed no interactions, but significant main effects emerged for group status (extremely immature versus control), family function, social risk, and presence of a chronic medical condition, with all effect sizes being medium and accounting for 8% to 12% of the variance. Multivariate analysis of covariance of teacher-reported behavioral problems showed significant effects for group status and gender but not for the covariates mentioned above. According to the teachers’ ratings, extremely immature children were less well adjusted to the school environment than were control subjects. However, a majority of extremely immature children (85%) were functioning in mainstream schools without major adjustment problems.

CONCLUSIONS. Despite favorable outcomes for many children born at the limit of viability, these children are at risk for mental health problems, with poorer school results.

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Key Words: extremely immature • mental health • social competencies

Abbreviations: EI—extremely immature • ELBW—extremely low birth weight • VLBW—very low birth weight • ADHD—attention deficit/hyperactivity disorder • CBCL—Child Behavior Checklist • TRF—Teacher Report Form • DSM-IV-R—Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Revised • DSRS—depression self-rating scale • SES—socioeconomic status • MANCOVA—multivariate analysis of covariance • ANCOVA—univariate analysis of covariance • ES—effect size • OR—odds ratio • NSI—neurosensory impairment • CP—cerebral palsy

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Accepted Mar 3, 2007.

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