Pervasive behavior problems at 6 years of age in a total-population sample of children born at ≤25 weeks of gestation

OBJECTIVE. The goal was to test whether extremely preterm children have more pervasive behavior problems than classroom peers, by using parent and teacher consensus reports. Is there an excess number of extremely preterm boys with behavior problems? METHODS. A total-population study of all extremely preterm children in the United Kingdom and Ireland was performed. All children born at <= 25(6/7) weeks of gestation in the United Kingdom and Ireland between March and December 1995 were assessed at 76 months of age (range: 62-87 months) (EPICure study). Pervasive behavior problems were defined as scoring >90th percentile on parent and teacher reports with a standard behavior scale, the Strengths and Difficulties Questionnaire. Of the 241 of 308 survivors who responded (78% of survivors), 200 had full reports on behavior problems from teachers and parents; they were compared with 148 control children. RESULTS. A total of 19.4% of extremely preterm children (boys: 23.2%; girls: 15.6%), compared with 3.4% of control children (boys: 4.6%; girls: 2.5%) had total behavior scores in the clinical range. Hyperactivity (extremely preterm: 30.6%; control: 8.8%) and conduct problems (extremely preterm: 12.5%; control: 5.4%) could be accounted for by cognitive deficits, but attention (extremely preterm: 33.3%; control: 6.8%), peer (extremely preterm: 25.4%; control: 5.4%), and emotional (extremely preterm: 13.5%; control: 4.1%) problems were not explained by poor cognitive functioning. Extremely preterm boys had behavior problems in excess of gender differences found in the control group in hyperactivity, attention, and prosocial problems, and the impact on parents and teachers was greater for extremely preterm boys than girls. CONCLUSIONS. Pervasive behavior problems are more frequent in children born at the limits of viability than previously reported for larger preterm populations. Extremely preterm boys seem most vulnerable, and the impact on parents and teachers is considerable.