title: Very preterm adolescents show impaired performance with increasing demands in executive function tasks.
abstract: BACKGROUND
  Very preterm birth is often associated with executive function deficits later in life. The transition to adolescence increases personal autonomy, independence and, in parallel, the demands placed on executive functions at home and in school.
  
  
  OBJECTIVE
  To assess the impact of increasing demands on executive function performance in very preterm children and adolescents with normal intellectual and motor functions.
  
  
  METHODS
  Forty-one very preterm children and adolescents with normal intellectual and motor functions and 43 healthy term-born peers were assessed at a mean age of 13.0 years (SD: 1.9; range: 10.0-16.9). A comprehensive battery of performance-based executive function measures with different demand levels as well as a parent-rating questionnaire evaluating executive functions relevant for everyday life was applied. Standardized mean differences between groups of d ≥ .41 were regarded as clinically relevant.
  
  
  RESULTS
  No group differences were found at the lowest demand levels of working memory (d=.09), planning (d=-.01), cognitive flexibility (d=-.21) and verbal fluency (d=-.14) tasks, but very preterm participants scored significantly below their term-born peers in the most demanding levels (d=-.50, -.59, -.43 and -.55, respectively). These differences were clinically relevant. Executive functions relevant for everyday life were strongly impaired in very preterm participants, e.g., global executive composite (d=-.66).
  
  
  CONCLUSIONS
  Very preterm children and adolescents with normal intellectual and motor functions are at high risk for executive function deficits that may only become apparent with increasing demands, potentially leading to academic and other deficits.
authors.affiliation: Department of Neonatology, University Hospital Zurich, Switzerland; Child Development Center, University Children's Hospital Zurich, Switzerland; University of Zurich, Switzerland.
authors.forename: Flavia M
authors.initials: FM
authors.lastname: Wehrle
authors.affiliation: General Hospital, Department of Psychiatry and Psychotherapy A, Hall in Tyrol, Austria.
authors.forename: Liane
authors.initials: L
authors.lastname: Kaufmann
authors.affiliation: Faculty of Medicine, University of Zurich, Switzerland.
authors.forename: Laura D
authors.initials: LD
authors.lastname: Benz
authors.affiliation: Child Development Center, University Children's Hospital Zurich, Switzerland; Children's Research Center, University Children's Hospital Zurich, Switzerland; University Clinics for Child and Adolescent Psychiatry, Zurich, Switzerland.
authors.forename: Reto
authors.initials: R
authors.lastname: Huber
authors.affiliation: Children's Research Center, University Children's Hospital Zurich, Switzerland; Center for MR Research, University Children's Hospital Zurich, Switzerland; Zurich Center for Integrative Human Physiology, University of Zurich, Switzerland.
authors.forename: Ruth L
authors.initials: RL
authors.lastname: O'Gorman
authors.affiliation: Child Development Center, University Children's Hospital Zurich, Switzerland; Children's Research Center, University Children's Hospital Zurich, Switzerland.
authors.forename: Beatrice
authors.initials: B
authors.lastname: Latal
authors.affiliation: Department of Neonatology, University Hospital Zurich, Switzerland; Child Development Center, University Children's Hospital Zurich, Switzerland. Electronic address: cornelia.hagmann@usz.ch.
authors.forename: Cornelia F
authors.initials: CF
authors.lastname: Hagmann
mesh_terms: D000203:Activities of Daily Living; D000293:Adolescent; D041923:Adolescent Development; D016022:Case-Control Studies; D002648:Child; D056344:Executive Function; D005260:Female; D006801:Humans; D062071:Infant, Extremely Premature / Q000254:growth & development*; D007231:Infant, Newborn; D008297:Male; D008570:Memory, Short-Term; D009048:Motor Skills
keywords: Very preterm birth; child development; executive function; task demand