Preterm

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When is a baby classed as preterm?
If the baby is born before 37 weeks, very preterm if born between 28-31 weeks and extremely preterm if born before 28 weeks.
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What percentage of babies are born preterm?
9%
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What is the gestational gradient?
Earlier the child is born the greater their difficulties will be
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What are developed in the last trimester of pregnancy, and therefore more susceptible to damage?
Collapsed lung/ alveoli and brain (smaller)
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What cognitive deficits could a preterm child be more susceptible to?
Executive function deficits: working memory, motor problems, learning difficulties, visuospatial difficulties
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Mackay ét al (2010)
The more pre-term a child is, the more likely they are to have special educational needs
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Quigley et al (2012)
Studied the percentage of children who did not receive a good level of overall achievement by the age of 5. compared 51% of those born at full term, 55% of those born early, 59% moderately preterm, 63% late preterm and 66% very preterm
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What does this emphasise?
That Children born preterm have poorer educational needs than their full term peers
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Kovachy et al (2012)
Children born preterm are at risk of developing deficits in reading ability
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What was his method?
Meta-analysis conducted, pre-term children had significantly lower scores for reading comprehension and decoding
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What did the meta-regression show?
Lower gestational age was associated with larger differences in decoding and reading comprehension
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What do these findings suggest?
Preterm children should receive more ongoing monitoring for reading difficulties throughout their education
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What are impaired in dyslexics according to Snowling (2015)
Phonological skills
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What did a study by Heinon (2015) find?
poor phonological skills predicted later impaired word recognition in 919 children born late preterm
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Johnson et al (2010)
20 children born preterm had a specific math difficulty compared to only 2 controls in their study
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What maths difficulty have been found?
Developmental dyscalculia
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What is it associated with?
Impairment in the approximate number system, a cognitive system that allows representation and manipulation of quantity information (Von Aster et al (2007)
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What tasks are preterm children particularly impaired in?
Strategy and counting tasks
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What are these tasks mediated by?
Visuospatial memory and working memory
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Pritchard et al (2009)
PT children were 2-3 times more likely to show delays in math, written language, language comprehension, handwriting, spelling and physical education
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What is ADHD defined by?
Inattention, hyperactivity/impulsivity
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Johnson et al (2010)
Children born pre-term are more likely receive a diagnosis of ADHD, very preterm 2-3 times increased risk of ADHD and extrremely 4 times increased risk
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Johnson and Marlow (2014)
More likely to be diagnosed with inattentive subtype: Dont listen but not disruptive
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What is the cognitive profile of EP?
Core deficits in working memory and visa-spatial skills which have been shown to mediate performance on EF and intelligence tests. These core deficits may also be implicated in the inattention difficulties observe in EP children especially with ADHD
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Scott et al (2013)
Compared extremely preterm and full term children on reports of psychiatric symptoms obtained from parent interviews, parent and teacher ratings of behaviour and social functioning
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What was found?
Rates of ADHD were around twice as high for preterm and also had higher rates of teacher identified disorders in attention, behaviour self regulation and social functioning. These were associated with deficits on tests of EF.
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De Kieviet et al (2012)
found extremely PT to be considerably worse than controls in executive function tasks in visuospatial working memory tasks (backwards span task)
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What did parents complete?
Questionnaires rating the children's behaviour and attention
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What did these find?
- These found that parents and teachers rated preterm children as more inattentive but not more hyperactive, so seems that these problems in executive function could relate to ADHD symptoms of preterm
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James et al (2018)
Directly compared PT ADHD with full term ADHD
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What did they find?
Found PT with ADHD had some similarities to those born full term with ADHD, e.g. reaction time, however there were some differences- they had unusual lack of malleability in attention allocation
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What was the reason for this?
Given that the last trimester is crucial for growth and development of brain networks, it is feasible that giving birth prematurely could disrupt this process and result in aberrant networks associated with ADHD
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What is ASD?
Developmental disorder with particular difficulties in social interaction, communication and imagination as well as presence of restricted interests and repetitive behaviours (Wing and Gould, 1979)
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Johnson et al (2010)
compared extremely preterm children at age 11 and matched controls on parent completed social communication questionnaire and a diagnostic interviews
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What was found?
16 preterm children obtained diagnosis of autism compared to 0 controls and had higher SCQ scores • PT was also found to have increased ASD symptoms even if didn’t get the full diagnosis
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What was particularly impaired?
Social interaction and communication
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What does this study suggest?
If you are born preterm you are more likely to develop ASD
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Leavey et al (2013)
Investigated the effect of gestation time and risk of ASD. They studied various PT children at different ages at birth ranging from 23 weeks to 40 weeks (Full term
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What did they find?
A gradual increase in risk of ASD with shorter gestation
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What was the cut off point?
40 weeks, after this point they found no significant difference; no effects of being late, this didn’t cause a decreased risk of ASD
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What does this suggest?
Lack of brain development that causes the symptoms of ASD
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What does this suggest?
PT, ASD might've different origins to normal ASD
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What does all this data suggest?
gestation gradient and shows how gestation age can be a risk factor in ASD, those that are born more preterm should be screened earlier for ASD so can intervene
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What are the implications for education?
Underlying cause for reading difficulties appears to be the same in preterm and full term populations, it would be expected that the same types of reading interventions would be effective
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For example?
Making links between reading and phonology and improving letter-sound knowledge, Hatcher et al, 2006
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However for math difficulties?
different interventions and teaching strategies should be applied for those born preterm, potentially focusing on improving their working memory and visuospatial skills and providing alternative learning strategies
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what are important factors to consider?
- Those born preterm are also at greater risk of ADHD and autism (Moster et al, 2008) which also contribute to learning difficulties and need to be addressed when planning interventions.
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What percentage of babies are born preterm?

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9%

Card 3

Front

What is the gestational gradient?

Back

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Card 4

Front

What are developed in the last trimester of pregnancy, and therefore more susceptible to damage?

Back

Preview of the front of card 4

Card 5

Front

What cognitive deficits could a preterm child be more susceptible to?

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