Preemies can have adjustment problems as teenagers

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Children born very prematurely continue to have emotional, attentional and social problems during their teen years, according to the results of a UK study.

Yet, these teens do not seem to have more serious problems with their conduct than those who were full-term at birth, and they may be less likely than their peers to engage in delinquent behavior, or drug or alcohol use.

"I think that it is quite encouraging that so many of these children, despite a life threatening degree of prematurity, are functioning very well in normal schools, in many cases with only relatively minor problems,” lead study author Dr. Frances Gardner, of the University of Oxford told Reuters Health.

Extremely preterm babies are known to be at greater risk for physical and behavioral problems during childhood, but few studies have investigated whether such problems remain evident during adolescence.

In what is perhaps the first follow-up study of such infants into their later teen years, Gardner and her colleagues examined the behavioral and emotional adjustment of 150 teenagers in mainstream schools who were born at 24 to 29 weeks and compared them to full-term students of their same age and gender.

Parents, teachers, and the students themselves completed questionnaires that assessed the students’ conduct, hyperactivity, emotional and peer problems and other potential psychiatric symptoms.

According to parental and teacher reports, the 15- and 16-year-olds who were born preterm had more psychological problems, including hyperactivity, emotional and peer relationship problems, than did the full-term teenagers, the investigators report in the September issue of Pediatrics.

Eight percent of the preterm teenagers, for example, received scores from their parents that were in the “abnormal” range for hyperactivity versus one percent of the full-term teens, and 18 percent received scores in the abnormal range for emotional problems versus seven percent of their peers.

Also, 19 percent of the preterm group were scored in the abnormal range for peer relationship problems, whereas only five percent of full-term teens were rated as such.

The reason for such problems is “probably due mainly to effects on brain development of being born extremely early,” Gardner said. “This leads to some behavior and learning problems in many of the children, and to physical and sensory disability in a smaller number.”

However, the preterm teenagers did not seem to agree with their parents’ and teachers’ assessments, the report indicates. They did not consider themselves to have more problems with their peers or more hyperactivity in comparison to the full-term teenagers, although a higher proportion of the pre-term group did rate themselves as having emotional problems, such as nervousness and worries.

On the other hand, the preterm teens rated themselves as less delinquent and less likely to use alcohol, cannabis or other drugs than did their peers in the comparison group. Further, conduct problems were similar among both groups of teenagers, the report indicates.

“Perhaps this is a testament to the very good parenting that many children will have received,” Gardner said.”

Considering their increased risk for psychological and emotional and peer problems, however, “it is not clear what the implications of these difficulties will be for adult life,” the researchers write—“although we might speculate that in the absence of antisocial behavior, the prognosis is relatively good.”

Still, they add, “it may be appropriate to offer early interventions that target problems that seem to persist into adolescence, including parenting interventions for improving peer relationships and emotional difficulties.”

SOURCE: Pediatrics, September 2004.

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