Executive function training in very preterm children: a randomized controlled trial

Carolien A Van Houdt,Cornelieke S H Aarnoudse-Moens,A R Céleste Laarman,Anton H Van Kaam,Jaap Oosterlaan,Aleid G Van Wassenaer-Leemhuis,Corine Koopman-Esseboom,Marsh Königs

doi:10.1007/s00787-020-01561-0

Abstract

Objective of the current study was to assess whether game-formatted executive function (EF) training, is effective in improving attention, EF and academic performance in very preterm and/or extremely low birthweight children aged 8–12 years. A multi-center, double-blind, placebo- and waitlist controlled randomized trial (NTR5365) in two academic hospitals in The Netherlands was performed. Eighty-five very preterm children with parent-rated attention problems on the Child Behavior Checklist were randomized to one of three treatment conditions: EF training, placebo training or waitlist condition. EF or placebo training was completed at home (6 weeks, 25 sessions of 30–45 min each). At baseline, 2 weeks after training or being on the waitlist, and five months after first follow-up visit, children underwent assessments of primary outcomes (parent and teacher ratings of attention) and secondary outcomes (parent and teacher ratings of daily-life EF, computerized EF tasks and academic performance). Linear mixed model analyses were performed for all outcome measures. There were no significant differences in improvement over time on parent- and teacher ratings of attention, parent- and teacher ratings of daily-life EF, computerized EF tasks, and academic performance (arithmetic and reading) between the EF training, placebo training and waitlist condition. In conclusion, game-formatted EF training does not improve attention, EF or academic performance in very preterm children with parent-rated attention problems.

Highlights

In Western countries, 0.7–1.4% of all live born children are born very preterm (gestational age (GA) < 32 weeks) [1]
Because executive function (EF) training is believed to improve attentional functioning through improving EFs, we examined whether gameformatted EF training improved EFs
As both attentional problems and EF deficits are strongly linked to worse academic performance in very preterm children [28, 29, 51,52,53,54], we investigated whether game-formatted EF training improves academic performance, arithmetic and reading performance

Summary

Introduction

In Western countries, 0.7–1.4% of all live born children are born very preterm (gestational age (GA) < 32 weeks) [1]. Very preterm children have a two to four times higher risk of a diagnosis of Attention Deficit/Hyperactivity Disorder (ADHD) [6, 7], the inattentive subtype [8], and an increased risk for an Autism Spectrum Disorder (ASD) diagnosis [8, 9]. Very preterm children’s behavioral attentional symptoms may resemble those of children with ADHD or ASD for some aspects, such as inattentive symptoms, the biological underpinnings seem to differ. The association between oppositional defiant disorder (ODD) and conduct disorder (CD) is much stronger in the general population than in children born extremely preterm [8]. Interventions that were ineffective in children with ADHD may be effective in very preterm children with attention problems and vice versa

Methods

Results

Discussion

Conclusion