title: Identification of executive function difficulties in preterm preschool and kindergarten children
Creators: name: O'Meagher, SH
Publisher: name: University of Tasmania
Year: 2018

description: `Background:` It is known that individuals born preterm are at risk of developing executive function and behavioural difficulties. Nevertheless, most studies in this field have focussed on school-age children, as investigation of executive functions of younger preschool and early school-age children (under six years old) has only recently gained attention. Consequently, there is little knowledge about social and perinatal risk factors contributing to executive function difficulties in young preterm children and how to best identify those at risk of developing executive function difficulties. The overall aims of the present thesis were to explore the relationship between executive functioning and social and perinatal risk factors in four- to five-year-old preterm children, and how to best identify children most at risk of executive function difficulties prior to starting formal schooling. This thesis integrates three published or submitted articles, each addressing a separate research question related to the overarching thesis aims. All articles incorporate information regarding a sample of 141 children born preterm (&lt; 33 weeks of gestation) and 77 term comparison children who were assessed using standardized measures of general intelligence and performance-based executive function tests prior to starting kindergarten at the age of four years. Parental and teacher reports of executive functioning and behaviour were completed when the children commenced kindergarten at four to five years of age. `Study` `1` Aim: To establish whether four- to five-year-old preterm children had more executive function difficulties than their term peers, and if so, to identify the social and perinatal risk factors associated with such discrepancy. Methods: The preterm and term groups were compared on measures of intelligence and executive functions using independent group t-tests, and multivariate regression analyses were performed to identify social and medical risk factors predictive of intelligence and executive functioning in the preterm group. Results: The preterm group performed significantly more poorly than the term group on all intelligence and performance-based executive function assessments. The parental reports relating to executive function for preterm and term children did not significantly differ, but the teachers reported more executive function difficulties for the preterm group than the term group. Overall, higher social risk, and in particular lower educational level of the main caregiver, was the strongest predictor for the preterm children’s intelligence and executive function difficulties. `Study` `2` Aim: To determine whether specific performance-based executive function assessment tools were associated with executive functioning in everyday life as reported by parents and teachers of four- to five-year-old preterm and term children. Methods: The associations between performance-based intelligence, executive function assessments, and executive function questionnaires were explored by using multiple regression analyses. `Study` `3` Aim: To investigate the congruency of parent and teacher reporting of executive functions and behaviour of kindergarten-age preterm and term children. Methods: Parent and teacher reporting of executive function and behaviour were compared using 2x2 mixed ANOVA and Kappa statistics. Results: Parents reported higher levels of executive function and behavioural difficulties than the teachers for both groups combined (preterm and term). The parent and teacher reports of behaviour and executive function differed significantly and were not in agreement relating to which children exhibited clinically significant executive function and behavioural problems. `Conclusion:` Formal guidelines relating to surveillance of young preterm children’s executive function and behaviour difficulties are needed, especially relating to selection criteria for follow-up (i.e., based solely on gestational age or also other factors), recommended assessment batteries, and the timing of the assessments. To assist in achieving these outcomes, it is recommended that future studies focus on improving the ecological validity of psychometric assessments of preterm children. Increased accuracy in early identification of at-risk preterm children could enable timely executive function and behavioural support and intervention, which could lead to narrowing the current gap in developmental and educational outcomes between preterm and term children.