Predictive Value of the Global School Adaptation Questionnaire at 5 Years of Age and Educational Support at 7 Years of Age in Very Preterm Children

Abstract

To assess the Global School Adaptation (GSA) questionnaire of children's abilities and classroom behavior administered to teachers of very preterm children at 5years of age as a predictor of the need for educational support (grade retention, special class, learning support) at age7. We assessed 858 very preterm children (<33weeks of gestation) at 5years of age using the GSA and again at 7years to determine the use of educational support. We examined the association between the GSA score and educational support at 7years and performed a receiver operating characteristic curve analysis. At 7years of age, 130 children had educational support (15.2%). Children with a nonoptimal GSA score (<45) at 5years required educational support more often (57.7%) than children with a GSA score of 45 or greater (15.4%) (OR, 7.5; 95% CI, 5.02-11.21). The need for educational support was associated with male sex; a low parent socioeconomic level; lower birth weight, birth head circumference, or gestational age (28-30weeks of gestation); severe neurologic complications; patent ductus arteriosus ligation; and the use of therapy services at 5years of age. After adjustment, only the GSA score was associated with educational support at 7years of age (OR, 0.86; 95% CI, 0.84-0.88). A receiver operating characteristic curve analysis of the GSA performance revealed an optimal cut-off at 48, with a sensitivity of 70.8%, a specificity of 73.5%, and an area under the curve of 0.79. Using a cut-off score of 48, the GSA at 5years of age may be a useful tool to identify children born preterm at risk of school-based learning difficulties.