Abstract
Is Association of Preterm Birth with Cognitive-Neurophysiological Impairments and ADHD Symptoms Consistent with a Causal Inference or Due to Familial Confounds?
Highlights
Preterm birth occurs in 8.6% of births in developed countries (Blencowe et al, 2012), and has many known risk factors such as low socio-economic status, low maternal educational status, maternal pre-existing health problems and maternal genetic risk (Goldenberg et al, 1996, 2008; Plunkett and Muglia, 2008; Blencowe et al, 2012)
Whether the association between preterm birth and the negative outcomes is due to the preterm birth insult per se, or due to other environmental or genetic risk factors that characterise families with preterm-born children, is difficult to disentangle as preterm-born children have often been compared to unrelated controls who may have differed on unmeasured risk factors (Thapar and Rutter, 2009)
attention-deficit/hyperactivity disorder (ADHD) symptoms [and on both inattentiveness (β = 0.34, 95% CI 0.07 to 0.60) and hyperactivity-impulsivity (β = 0.24, 95% CI 0.04 to 0.51) ADHD symptom sub-scales]; lower IQ, as well as decreased CNV amplitude and decreased Go-P3 amplitude on the continuous performance test (CPT)-OX task, decreased N2 amplitude and decreased Pe and ERN on the flanker task, increased mean reaction time (MRT) and reaction time variability (RTV) in the baseline condition of fast task, and decreased CNV amplitude and P3 amplitude on the fast-incentive condition of fast task, independent of familial factors (Table 2)
Summary
Preterm birth occurs in 8.6% of births in developed countries (Blencowe et al, 2012), and has many known risk factors such as low socio-economic status, low maternal educational status, maternal pre-existing health problems and maternal genetic risk (Goldenberg et al, 1996, 2008; Plunkett and Muglia, 2008; Blencowe et al, 2012). Our results suggest that the relationship between preterm birth with ADHD symptoms and specific cognitive-neurophysiological impairments (IQ, preparation-vigilance and error processing) is independent of family-level risk and consistent with a causal inference. Our results suggest that previously observed associations between preterm birth with executive control processes of inhibition and working memory are instead linked to background characteristics of families with a preterm-born child rather than preterm birth insult per se. These findings suggest that interventions need to target both pretermbirth specific and family-level risk factors
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