title: Identifying very preterm children at educational risk using a school readiness framework.
abstract: OBJECTIVE
  Children born very preterm (VPT) are at high risk of educational delay, yet few guidelines exist for the early identification of those at greatest risk. Using a school readiness framework, this study examined relations between preschool neurodevelopmental functioning and educational outcomes to age 9 years.
  
  
  METHODS
  The sample consisted of a regional cohort of 110 VPT (≤ 32 weeks' gestation) and 113 full-term children born during 1998-2000. At corrected age 4 years, children completed a multidisciplinary assessment of their health/motor development, socioemotional adjustment, core learning skills, language, and general cognition. At ages 6 and 9, children's literacy and numeracy skills were assessed using the Woodcock-Johnson III Tests of Achievement.
  
  
  RESULTS
  Across all readiness domains, VPT children were at high risk of delay/impairment (odds ratios 2.5-3.5). Multiple problems were also more common (47% vs 16%). At follow-up, almost two-thirds of VPT children were subject to significant educational delay in either literacy, numeracy or both compared with 29% to 31% of full-term children (odds ratios 3.4-4.4). The number of readiness domains affected at age 4 strongly predicted later educational risk, especially when multiple problems were present. Receiver operating characteristic analysis confirmed ≥ 2 readiness problems as the optimal threshold for identifying VPT children at educational risk.
  
  
  CONCLUSIONS
  School readiness offers a promising framework for the early identification of VPT children at high educational risk. Findings support the utility of ≥ 2 affected readiness domains as an effective criterion for referral for educational surveillance and/or additional support during the transition to school.
authors.affiliation: Department of Psychology, Aberystwyth University, Wales, United Kingdom;
authors.forename: Verena E
authors.initials: VE
authors.lastname: Pritchard
authors.affiliation: Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts;
authors.forename: Samudragupta
authors.initials: S
authors.lastname: Bora
authors.affiliation: Neonatal Service, Christchurch Women's Hospital, Christchurch, New Zealand; Department of Pediatrics, University of Otago, Christchurch, New Zealand; and.
authors.forename: Nicola C
authors.initials: NC
authors.lastname: Austin
authors.affiliation: Department of Psychology, University of Canterbury, Christchurch, New Zealand.
authors.forename: Karelia J
authors.initials: KJ
authors.lastname: Levin
authors.affiliation: Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Department of Psychology, University of Canterbury, Christchurch, New Zealand ljwoodward@partners.org.
authors.forename: Lianne J
authors.initials: LJ
authors.lastname: Woodward
mesh_terms: D002648:Child; D002657:Child Development / Q000502:physiology*; D002675:Child, Preschool; D015331:Cohort Studies; D004521:Educational Measurement / Q000379:methods* / Q000592:standards; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature / Q000502:physiology / Q000523:psychology; D019102:Infant, Very Low Birth Weight / Q000502:physiology* / Q000523:psychology; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors
keywords: neurodevelopment; outcome; preschool; school readiness; very preterm