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Thinking & Learning Difficulties

Preemie Issues - a quick look

quick look preemiehelp

Preterm infants are at greater risk for both short and long term difficulties. The tinier and earlier a preemie is born the greater the risk for complications.


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Preemie Babies are not just tiny...

Premature babies are not just tiny; they are at risk for a number of health concerns, including breathing difficulties, brain injury, eye disorders, infection, bowel problems and heart dysfunction.
The issues surrounding preterm birth can be complex but we have tried to cover everything you may want to know. If you have any questions please ask them in our forums.


Select from the menu items for related information...

Thinking & Learning Difficulties

Most preemies will grow up without any major difficulties but the tiniest prems are at an increased risk for thinking and learning difficulties.

Thinking and Learning difficulty overview

Over the years many research teams have investigated the long-term outcomes of children born preterm. Results are not always consistent between studies and may differ for a variety of reasons, however it is common for premmies to show difficulties in a number of areas including, language, memory, attention, planning and organising (called executive function), as well as visual spatial processing.

Preterm infants who are born extremely early or extremely tiny are usually at greater risk for thinking and learning problems than babies born closer to term or who were heavier at birth.

It is important to remember that most premmies will not have serious difficulties with thinking or learning and children born at term sometimes have difficulties too. There are a number of factors that can affect how good we are at any number of skills and this is the same for preemies. Things like biological risks, genetic strengths and weaknesses, stimulating and nurturing environments, and parenting styles can all affect skills in lots of areas.

Less Risk for Thinking & Learning Problems Description
None or few biological risks

Biological vulnerability:

Chronic Lung Disease

Retinopathy of Prematurity

Brain injury

Extremely preterm

Extremely low birth weight

Required surgery in neonatal period

Stimulating environment

E.g. filled with safe objects to explore, allows freedom of movement, provide a variety of experience

Unstimulating environment

Access to resources

Teaching aids

Medical advice

Allied health professionals

No or Limited access to resources

Genetic make-up

Genetic make-up

Parenting style

e.g. Authoritative parenting- make reasonable demands, set limits, clear consequences, express warmth & affection, listen patiently, encourage participation.    Parenting style

Parenting style

e.g. Permissive parenting- nurturing & accepting, avoids making demands or imposing controls

Uninvolved parenting- undemanding & indifferent, emotionally detached, minimum effort in child rearing.

 

Language outcomes

Preterm children are at greater risk for language difficulties than children born full term. Research suggests that difficulties are more common in preterm children during their younger years. Up to 40% of preterm children have language delays at 12 months of age. The language outcomes of preterm children are influenced by how early the baby was born as well as whether or not they had any brain injury.

(Casiro et al., 1990; Salerni, Suttora, & D'Odorico, 2007; Vohr, Garcia Coll, & Oh, 1988).

preemies and language outcomes

Preschool Age

Research has shown that preterm preschool children

  • show less reactivity to social stimuli
  • have fewer vocalisations
  • less likely to understand simple questions, recognise objects when named, or to imitate or use words consistently
  • demonstrate delays in expressing themselves
  • show slight delays in developing vocabulary
(Casiro, et al., 1990; Salerni, et al., 2007; Sansavini et al., 2006; Vohr, et al., 1988)

School Age

  • • Research during school years is less consistent. Some research reports that there are no language differences between preterm children and full term children at 3 and 5 years of age.
    (Klein, Hack, Gallagher, & Fanaroff, 1985; Molfese, Holcomb, & Helwig, 1994)
  • These types of findings suggest that preterm children might “catch-up” to their peers after early language difficulties. A study investigating language changes over time found that language delays reduced from 39% at 1 year to 15% at age 3 years in a group of very low birth weight children.
    (Casiro, Moddemann, Stanwick, & Cheang, 1991)
  • Other studies have suggested that language difficulties in simpler tasks may reduce as preterm children get older but difficulties in more complex language tasks remain.
    (Jansson-Verkasalo et al., 2004)

What can parents do?

  • Infants prefer familiar voices as early as 34 weeks’ gestation, and hearing their mother’s voice may be related to eventual language acquisition, so it is a great idea to talk to your baby often, even in the NICU.
    (Krueger, Holditch-Davis, Quint, & DeCasper, 2004; Moon & Fifer, 2000)
  • Language abilities are also influenced by environmental factors, such as parental education and socioeconomic status. So, environments that are more stimulating for preterm children can be protective against long-term difficulties.
    (Briscoe, Gathercole, & Marlow, 1998)
  • You can keep a note of how your baby communicates with you from a very young age, see if they try to imitate you, and keep an eye on whether your baby is reaching their milestones.
  • Check in with your paediatrician if you have any concerns. You may need a referral to a neuropsychologist for an assessment or for extra assistance, such as a speech therapist.
  • Click here to visit the solutions section of the site Strategies for phonological difficulties
  • Extra resources and links to neuropsychologists will be available online at preemiehelp.com soon.

Memory and Learning Outcomes

Memory is a complex set of processes that includes taking in information, understanding the content, and then being able to remember it in the short and long term.

Some preterm children experience memory and learning difficulties. There does not seem to be a clear pattern of difficulties in this area for preterm children though, and it is unclear whether children have greater difficulty with visual or auditory based tasks.

Difficulties are more common in younger preterm children, whereas adolescents appear to demonstrate fewer memory problems, and deficits are typically evident in more complex memory tasks. Some researchers suggest that preterm children are developmentally slower than children born at term but as they grow they may catch-up to the same or similar levels as their peers. Many researchers suggest that more studies are needed in this area, so if preemies are susceptible to problems, early intervention programs can target their specific needs.

(Woodward, Edgin, Thompson, & Inder, 2005) (Ross, Lipper, & Auld, 1991) (Luciana, Lindeke, Georgieff, Mills, & Nelson, 1999; Vicari, Caravale, Carlesimo, Casadei, & Allemand, 2004) (Saavalainen et al., 2007)

Memory is a complex set of processes that includes taking in information, understanding the content, and then being able to remember it in the short and long term.  Read more about Thinking & Learning Difficulties by preemiehelp.com

What can parents do?

  • Check in with your paediatrician if you have any concerns. You may need a referral to a neuropsychologist for an assessment or for extra assistance in the classroom.
  • Click here to visit the solutions section of the site Strategies for memory difficulties
  • Extra resources and links to neuropsychologists will be available online at preemiehelp.com soon.
  • Check in with your paediatrician if you have any concerns. You may need a referral to a neuropsychologist for an assessment or for extra assistance, such as a speech therapist.

Information Processing Outcomes

Processing speed refers to how quickly someone can take in and make sense of information, it refers to abilities like reaction time, how long it takes to decide on an answer, and how long it takes to look at an object or scene and make a decision or undertake an action. For example, someone with slow processing speed may take longer to read through and work out an answer to a multiple choice question, or they may have more difficulty “keeping up” with a story when read aloud or while taking dictation. Increases in processing speed are an important part of intellectual development throughout childhood

(Hale, 1990)

Slower processing has been associated with preterm birth and there is evidence of difficulties, especially at younger ages, although very few studies have specifically assessed this aspect of information processing.

Read more (research)

Processing speed has been associated with respiratory distress syndrome, prolonged mechanical ventilation, and white matter brain abnormalities. How these factors affect processing speed in preterm children is not well understood and may be a secondary consequence of other learning problems, such as difficulty with visual perception or initiating motor actions.

 

What can parents do?

  • Check in with your paediatrician if you have any concerns. You may need a referral to a neuropsychologist for an assessment or for extra assistance in the classroom.
  • Click here to visit the solutions section of the site Strategies for processing speed difficulties
  • Extra resources and links to neuropsychologists will be available online at www.preemiehelp.com soon.

Attention Outcomes

Attention is often a difficult skill to describe and is commonly associated with behavioural difficulties such as attention deficit disorder (ADD) or attention deficit hyperactivity disorder (ADHD).

It is important to note that children can have attentional difficulties without being suspected of having, or diagnosed with ADD or ADHD. This section will deal with these issues. Attentional difficulties associated with behavioural problems such as ADD are discussed in Behavior & Preemies.

Infancy

An infant’s ability to achieve a balance between engaging and shifting attention appears during the first few months of life and become increasingly more functional up to 6 months of age.

Results suggest that preterm infants may display an early advantage in some aspects of attention due to the early exposure to the outside world; however it is less clear whether this advantage remains or gets worse over the first few years of life.

(Dubowitz, Dubowitz, Morante, & Verghote, 1980; Hunnius, Geuze, Zweens, & Bos, 2008; Hunt & Rhodes, 1977)

Preschool years

The few studies investigating attention during preschool years have been reasonably consistent, showing reduced periods of attention in preterm children

(Caravale, Tozzi, Albino, & Vicari, 2005; Vicari, et al., 2004).

School age

Several school-aged studies have shown that preterm children have poorer attentional outcomes in comparison with children born full term. The early advantage reported for preterm infants appears to have disappeared by school-age, with most studies supporting this finding.

(Breslau, Chilcoat, DelDotto, Andreski, & Brown, 1996; Robson & Pederson, 1997; Taylor, Hack, & Klein, 1998)

Adolescence

The long term attentional outcomes into adolescence are not well known mostly because follow up studies of attention difficulties into adolescence are extremely limited.

Some of the brain regions involved in attention-based tasks are also some of those areas vulnerable in preterm infants and with the advances in brain scanning technology, future research may add to our understanding of these relationships.

(Hunnius, et al., 2008)

What can parents do?

  • Check in with your paediatrician if you have any concerns. You may need a referral to a neuropsychologist for an assessment or for extra assistance in the classroom.
  • Click here to visit the solutions section of the site Strategies for attention difficulties
  • Extra resources and links to neuropsychologists will be available online at preemiehelp.com soon.
  • Click here for information on behavioural problems.

Executive Function

Executive function (EF) refers to a collection of processes that are responsible for purposeful, goal-directed behaviour, such as planning, setting goals, initiating, using problem-solving strategies, and monitoring thoughts and behaviour. Executive functioning is important for a child's intellectual development, behaviour, emotional control, and social interaction.

(Anderson & Doyle, 2004)

Different aspects of EF develop at different ages, ranging from motor inhibition and impulse control, which are already developing during the second year of life, to more complex functions such as attention, and smooth production of abstract content, which continue to develop into adolescence.

(Bohm, Smedler, & Forssberg, 2004)

As with most other elements of cognition, preterm children tend to perform more poorly on measures of EF.

Research

The most comprehensive study on this topic assessed school-aged children who were extremely low birth weight and/or extremely preterm and these children demonstrated difficulties across a range of different EF tasks.

(Anderson & Doyle, 2004)

What can parents do?

  • Check in with your paediatrician if you have any concerns. You may need a referral to a neuropsychologist for an assessment or for extra assistance in the classroom.
  • Click here to visit the solutions section of the site Strategies for executive function difficulties
  • Extra resources and links to neuropsychologists will be available online at preemiehelp.com soon.
  •  


    Technical Reference List

    Anderson, P. J., & Doyle, L. W. (2004). Executive functioning in school-aged children who were born very preterm or with extremely low birth weight in the 1990s. Pediatrics, 114(1), 50-57. Bohm, B., Smedler, A. C., & Forssberg, H. (2004). Impulse control, working memory and other executive functions in preterm children when starting school. Acta Paediatrica, 93(10), 1363-1371. Breslau, N., Chilcoat, H., DelDotto, J., Andreski, P., & Brown, G. (1996). Low birth weight and neurocognitive status at six years of age. Biol Psychiatry, 40(5). Briscoe, J., Gathercole, S. E., & Marlow, N. (1998). Short-term memory and language outcomes after extreme prematurity at birth. Journal of Speech, Language, and Hearing Research, 41(3), 654-666. Caravale, B., Tozzi, C., Albino, G., & Vicari, S. (2005). Cognitive development in low risk preterm infants at 3-4 years of life. Arch Dis Child Fetal Neonatal Ed, 90(6). Casiro, O. G., Moddemann, D. M., Stanwick, R. S., & Cheang, M. S. (1991). The natural history and predictive value of early language delays in very low birth weight infants. Early Human Development, 26(1), 45-50. Casiro, O. G., Moddemann, D. M., Stanwick, R. S., Panikkar-Thiessen, V. K., Cowan, H., & Cheang, M. S. (1990). Language development of very low birth weight infants and fullterm controls at 12 months of age. Early Human Development, 24(1), 65-77. Dubowitz, L. M., Dubowitz, V., Morante, A., & Verghote, M. (1980). Visual function in the preterm and fullterm newborn infant. Developmental Medicine and Child Neurology, 22(4), 465-475. Hale, S. (1990). A global developmental trend in cognitive processing speed. Child Development, 61(3), 653-663. Hunnius, S., Geuze, R. H., Zweens, M. J., & Bos, A. F. (2008). Effects of preterm experience on the developing visual system: a longitudinal study of shifts of attention and gaze in early infancy. Dev Neuropsychol, 33(4), 521-535. Hunt, J. V., & Rhodes, L. (1977). Mental development of preterm infants during the first year. Child Development, 48(1), 204-210. Jansson-Verkasalo, E., Valkama, M., Vainionpaa, L., Paakko, E., Ilkko, E., & Lehtihalmes, M. (2004). Language development in very low birth weight preterm children: a follow-up study. Folia Phoniatrica et Logopedica, 56(2), 108-119. Klein, N., Hack, M., Gallagher, J., & Fanaroff, A. A. (1985). Preschool performance of children with normal intelligence who were very low-birth-weight infants. Pediatrics, 75(3), 531-537. Krueger, C., Holditch-Davis, D., Quint, S., & DeCasper, A. (2004). Recurring auditory experience in the 28- to 34-week-old fetus. Infant Behavioral Development, 27(4), 537-543. Luciana, M., Lindeke, L., Georgieff, M., Mills, M., & Nelson, C. A. (1999). Neurobehavioral evidence for working-memory deficits in school-aged children with histories of prematurity. Dev Med Child Neurol, 41(8), 521-533. Mirsky, A. F., Anthony, B. J., Duncan, C. C., Ahearn, M. B., & Kellam, S. G. (1991). Analysis of the elements of attention: a neuropsychological approach. Neuropsychology Review, 2(2), 109-145. Molfese, V. J., Holcomb, L., & Helwig, S. (1994). Biomedical and social-environmental influences on cognitive and verbal abilities in children 1 to 3 years of age. International Journal of Behavioral Development, 17(2), 271-287. Moon, C. M., & Fifer, W. P. (2000). Evidence of transnatal auditory learning. Journal of Perinatology, 20(8 Pt 2), S37-44. Robson, A. L., & Pederson, D. R. (1997). Predictors of individual differences in attention among low birth weight children. Journal of Developmental and Behavioral Pediatrics, 18(1), 13-21. Ross, G., Lipper, E. G., & Auld, P. A. (1991). Educational status and school-related abilities of very low birth weight premature children. Pediatrics, 88(6), 1125-1134. Saavalainen, P., Luoma, L., Bowler, D., Maatta, S., Kiviniemi, V., Laukkanen, E., et al. (2007). Spatial span in very prematurely born adolescents. Dev Neuropsychol, 32(3), 769-785. Salerni, N., Suttora, C., & D'Odorico, L. (2007). A comparison of characteristics of early communication exchanges in mother-preterm and mother-full-term infant dyads. First Language, 27(4), 329-346. Sansavini, A., Guarini, A., Alessandroni, R., Faldella, G., Giovanelli, G., & Salvioli, G. (2006). Early relations between lexical and grammatical development in very immature Italian preterms. Journal of Child Language, 33(1), 199-216. Taylor, H. G., Hack, M., & Klein, N. K. (1998). Attention deficits in children with < 750 gm birth weight. Child Neuropsychology, 4(1), 21-34. Vicari, S., Caravale, B., Carlesimo, G. A., Casadei, A. M., & Allemand, F. (2004). Spatial working memory deficits in children at ages 3-4 who were low birth weight, preterm infants. Neuropsychology, 18(4), 673-678. Vohr, B. R., Garcia Coll, C., & Oh, W. (1988). Language development of low-birthweight infants at two years. Developmental Medicine and Child Neurology, 30(5), 608-615. Woodward, L. J., Edgin, J. O., Thompson, D. K. H., & Inder, T. E. (2005). Object working memory deficits predicted by early brain injury and development in the preterm infant. Brain, 128(Pt 11), 2578-2587.

     

     



AlbertEinstein_iconOne of the greatest minds in history, Albert Einstein was born preterm.

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Preemie, Premmie, or Prem?

Most babies spend between 38 and 42 weeks in their mother’s uterus. So, technically a preterm birth, preemie, premmie, or prem, is an infant who is born less than 37 completed gestational weeks. 


Read More: Defining Preterm birth


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