Risk factors for executive function difficulties in preschool and early school-age preterm children

Aim: To investigate the relationship between executive functioning and social and perinatal risk factors in four- to five-year-old preterm children. Methods: Using standardised measures of general intelligence and performance-based executive function (EF) tests prior to starting kindergarten, 141 children born preterm (<33 weeks of gestation) and 77 term comparison children were assessed. Parental and teacher reports of executive functioning were completed when the children commenced kindergarten. The preterm and the term comparison groups were compared on measures of intelligence and EFs using independent-groups t-tests, and multivariate regression analyses were performed to identify factors predictive of intelligence and executive functioning in the preterm group. Results: The preterm group performed significantly more poorly than the comparison group on all intelligence and EF tests. The parental reports of the preterm and term comparison children's EF did not differ significantly, but the teachers reported elevated EF difficulties for the preterm group. Higher social risk, in particular lower educational level of the main caregiver, was the strongest predictor for the preterm children's intelligence and EF results. Conclusion: Social risk factors are strongly associated with impaired early EF outcomes in preterm children.