Association of preterm birth with ADHD-like cognitive impairments and additional subtle impairments in attention and arousal malleability.

S.-N James,T Banaschewski,J Kuntsi,D Brandeis,G Mcloughlin,C Cheung,A.-S Rommel,P Asherson

doi:10.1017/s0033291717002963

Abstract

Whilst preterm-born individuals have an increased risk of developing attention-deficit/hyperactivity disorder (ADHD), and are reported to have ADHD-like attention and arousal impairments, direct group comparisons are scarce. We directly compared preterm-born adolescents (n = 186) to term-born adolescents with ADHD (n = 69), and term-born controls (n = 135), aged 11-23, on cognitive-performance, event-related potential and skin conductance level (SCL) measures associated with attention and arousal. The measures are from baseline and fast-incentive conditions of a four-choice reaction time task, previously shown to discriminate between the individuals with ADHD and controls. We aimed to establish whether preterm-born adolescents show: (a) identical cognitive-neurophysiological impairments to term-born adolescents with ADHD (b) possible additional impairments, and whether (c) the observed impairments correlate with ADHD symptom scores. The preterm group, like the term-born ADHD group, showed increased mean reaction time (MRT) and reaction time variability (RTV) in the baseline condition, and attenuated contingent negative variation (CNV) amplitude (response preparation) in the fast-incentive condition. The preterm group, only, did not show significant within-group adjustments in P3 amplitude (attention allocation) and SCL (peripheral arousal). Dimensional analyses showed that ADHD symptoms scores correlated significantly with MRT, RTV and CNV amplitude only. We find impairments in cognition and brain function in preterm-born adolescents that are linked to increased ADHD symptoms, as well as further impairments, in lack of malleability in neurophysiological processes. Our findings indicate that such impairments extend at least to adolescence. Future studies should extend these investigations into adulthood.

Highlights

The incidence of preterm birth (
We recently reported findings from a comparison between preterm-born adolescents and term-born attentiondeficit/hyperactivity disorder (ADHD) adolescents on the cued continuous performance test (CPT): while we observed response preparation [the event-related potentials (ERPs) index of contingent negative variation (CNV)] and response inhibition (NoGo-P3) impairments in both groups, compared witth a term-born control group, the preterm group showed an additional impairment in executive response control (GoP3), which was not associated with ADHD symptoms, suggestive of more wide-ranging neurophysiological deficits in the preterm group (Rommel et al 2017)
The results for comparisons involving the preterm group are new and the focus here, but, for ease of comparison and completeness, we report the statistics from the ADHD-control comparisons (previously reported for the full sample in (James et al 2016; Cheung et al 2017) for reaction time variability (RTV), P3, CNV and skin conductance level (SCL))

Summary

Introduction

Whilst survival rates are improving (Goldenberg et al 2008), preterm birth places an individual at an increased risk for a range of negative long-term outcomes (Bhutta et al 2002; D’Onofrio et al 2013) One such outcome is attention-deficit/hyperactivity disorder (ADHD) (Bhutta et al 2002; Halmøy et al 2012; D’Onofrio et al 2013; Sucksdorff et al 2015). Whilst direct comparisons between preterm-born individuals and fullterm born individuals with ADHD are sparse, they can address whether the impairments reported in preterm groups are truly identical to those observed in ADHD groups or part of more wide-ranging impairments This could help to identify biomarkers for the underlying processes linked to the increased risk for ADHD among those born preterm, and help to plan effective, targeted interventions. Whilst preterm-born individuals have an increased risk of developing attentiondeficit/hyperactivity disorder (ADHD), and are reported to have ADHD-like attention and arousal impairments, direct group comparisons are scarce.

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