Impairments in error processing and their association with ADHD symptoms in individuals born preterm.

Anna-Sophie Rommel,Jonna Kuntsi,Gráinne Mcloughlin,Philip Asherson,Daniel Brandeis,Sarah-Naomi James,Tobias Banaschewski,Giorgia Michelini,Celestino Rodríguez

doi:10.1371/journal.pone.0214864

Abstract

Preterm birth is associated with heightened risk for attention-deficit/hyperactivity disorder (ADHD)-like symptoms and neurocognitive impairments, including impairments in performance monitoring. Here, we investigate the cognitive and neurophysiological processes from a performance-monitoring task in preterm-born adolescents and examine whether these processes in preterm-born adolescents reflect identical neurophysiological impairments to those observed in term-born adolescents with ADHD. We compared 186 preterm-born individuals to 69 term-born individuals with ADHD and 135 term-born controls on cognitive-performance measures and event-related potentials (ERPs) of conflict monitoring (N2) and error processing (ERN, Pe) from a flanker task. Preterm-born adolescents demonstrated reduced N2, ERN and Pe amplitudes, compared to controls, and similar ERN and Pe impairments to term-born adolescents with ADHD. While ADHD symptoms correlated with ERN amplitude at FCz among the preterm-born, ERN amplitude at Fz, N2 and Pe amplitude were not associated with ADHD symptoms. Preterm-born individuals show impairments on neurophysiological indices of conflict monitoring (N2) and error processing (ERN and Pe). Early neurophysiological error processing may be a marker underlying the processes linked to the increased risk for ADHD among preterm-born individuals. Error detection processes are malleable and potential targets for non-pharmacological interventions. Preterm-born individuals are likely to benefit from early interventions.

Highlights

An estimated 15 million babies worldwide are born preterm every year, with a mean preterm birth rate of 8.6% in the developed world [1]
Post-hoc analyses found that the preterm group had significantly reduced N2 and error processing (ERN) amplitude at FCz, as well as reduced DSB and Pe amplitude compared to the control group, with medium-to-large effect sizes (Table 2)
In this first large-scale comparison of neurophysiological performance monitoring in pretermborn individuals, term-born individuals with attention-deficit/hyperactivity disorder (ADHD) and term-born controls, we demonstrated that preterm-born individuals were impaired on the event-related potentials (ERPs) indices of performance monitoring, including conflict monitoring (N2) and neurophysiological error processing (ERN and Pe)

Summary

Introduction

An estimated 15 million babies worldwide are born preterm (before 37 completed weeks of gestation) every year, with a mean preterm birth rate of 8.6% in the developed world [1]. Advances in neonatal intensive care have improved survival rates among pretermborn individuals [2], the survivors are at heightened risk of adverse long-term outcomes [3,4] because preterm birth entails biological immaturity for extrauterine life. While pregnancy duration and fetal growth are interrelated, a biologic continuum exists, and similar fetal sizes may not indicate similar levels of maturity. Gestational age, which denotes the duration of the pregnancy, is used as a proxy [5]. Preterm birth has been identified as biological insult [6], elevating risk for developing ADHD 1.3 to 5-fold [3,4]

Objectives

Methods

Results

Discussion

Conclusion