title: Executive function mediates effects of gestational age on functional outcomes and behavior in preschoolers.
abstract: OBJECTIVE
  To investigate the role of executive function (EF) skills, measured by parent-rating and performance-based instruments, as mediators of the effects of gestational age (GA) on functional outcomes and behavior symptoms in preterm (PT) and full-term (FT) preschoolers.
  
  
  METHODS
  Children born PT (n = 70; mean GA, 29.6 weeks; mean birth weight, 1365 g) were compared to children born FT (n = 79) on composite measures of EF (using the Behavior Rating Inventory of Executive Function and a performance-based EF battery), adaptive function, prereading skills, and behavior symptoms. For the entire sample, mediation analyses examined the effect of GA on the outcomes with EF as mediator.
  
  
  RESULTS
  Compared to children born FT, children born PT had significantly higher parent-rated EF scores and lower performance-based EF scores, both indicating more problems; furthermore, children born PT had lower adaptive function and prereading scores and more problematic behavior. GA contributed to adaptive function, prereading skills, and behavior symptoms for all children. EF acted as a mediator of GA for all 3 outcomes; different patterns emerged for parent-rated and performance-based EF evaluations. For adaptive function, both EF measures significantly mediated the effects of GA; for prereading skills, only performance-based EF was significant; for behavior symptoms, only parent-rated EF was significant.
  
  
  CONCLUSIONS
  We propose standard assessment of EF, using both parent-rating and performance-based EF measures, in young PT children and other children at the risk of EF impairments. EF skills are measurable, mediate important functional outcomes, and may serve as intervention targets.
authors.affiliation: Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA.
authors.forename: Irene M
authors.initials: IM
authors.lastname: Loe
authors.forename: Heidi M
authors.initials: HM
authors.lastname: Feldman
authors.forename: Lynne C
authors.initials: LC
authors.lastname: Huffman
mesh_terms: D016022:Case-Control Studies; D002652:Child Behavior; D002657:Child Development; D002675:Child, Preschool; D056344:Executive Function; D005260:Female; D005865:Gestational Age; D006801:Humans; D007234:Infant, Premature / Q000523:psychology; D007361:Intelligence Tests; D008297:Male; D009483:Neuropsychological Tests