Antecedents of Attention-Deficit/Hyperactivity Disorder Symptoms in Children Born Extremely Preterm.
To investigate antecedents of attention-deficit/hyperactivity disorder (ADHD) symptoms in children born extremely preterm (EP; <26-wk gestation).



The EPICure study recruited all babies born EP in the United Kingdom and Ireland in March-December 1995. Neurodevelopmental outcomes were assessed at 2.5 (n = 283; 90%), 6 (n = 160; 78%), and 11 (n = 219; 71%) years of age. Parents and teachers completed the DuPaul Rating Scale IV to assess inattention and hyperactivity/impulsivity symptoms at 11 years. Regression analyses were used to explore the association of neonatal, neurodevelopmental, and behavioral outcomes to 6 years with ADHD symptoms at 11 years.



Extremely preterm (EP) children had significantly more inattention (mean difference, 1.2 SD; 95% CI, 0.9-1.5) and hyperactivity/impulsivity (mean difference, 0.5 SD; 95% CI, 0.2-0.7) than controls, with a significantly greater effect size for inattention than hyperactivity/impulsivity. Significant independent predictors of inattention at 11 years included smaller head circumference, lower intelligence quotient (IQ), and pervasive peer relationship problems at 6 years, and motor development at 2.5 years. In contrast, significant independent predictors of hyperactivity/impulsivity included lower IQ, pervasive conduct problems and ADHD symptoms at 6 years, externalizing problems at 2.5 years, and non-white maternal ethnicity.



Extremely preterm children are at increased risk for ADHD symptoms, predominantly inattention, for which the antecedents differ by symptom domain. Attention deficits after EP birth were associated with poor brain growth and neurological function. Cognitive and behavioral assessments in early and middle childhood to identify neurodevelopmental and peer relationship problems may be beneficial for identifying EP children at risk for inattention.
*Department of Health Sciences, University of Leicester, Leicester, United Kingdom; †School of Medicine, University of Nottingham, Nottingham, United Kingdom; ‡Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom; §Institute for Women's Health, University College London, London, United Kingdom; ‖Department of Psychology and Health Sciences Research Institute, University of Warwick, Coventry, United Kingdom.
Samantha
S
Johnson
Puja
P
Kochhar
Enid
E
Hennessy
Neil
N
Marlow
Dieter
D
Wolke
Chris
C
Hollis
D001289:Attention Deficit Disorder with Hyperactivity / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology; D002648:Child; D002653:Child Behavior Disorders / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology; D002657:Child Development / Q000502:physiology*; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D005865:Gestational Age; D006801:Humans; D062071:Infant, Extremely Premature; D007231:Infant, Newborn; D007360:Intelligence / Q000502:physiology*; D007398:Interpersonal Relations; D007494:Ireland / Q000453:epidemiology; D008297:Male; D010379:Peer Group; D006113:United Kingdom / Q000453:epidemiology