In-sync and on-track: self-regulation in preschoolers born very /extremely prematurely
Penner, Karen A.H.
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INTRODUCTION: Self-regulation (SR) is a major childhood developmental achievement that predicts important preschool academic, adaptive, and psychosocial outcomes. Very or extremely premature (VP/EP) birth impacts cognitive development, however SR and related adaptive outcomes for this group of at-risk children are under-studied despite their importance to optimal outcomes. Consequently, the research goal was to examine the impact of premature birth on preschool SR and related areas and further to identify potential early predictors of risk. METHODS: This data-driven clinically derived study explored preschool SR outcomes in a convenience sample of 104 Manitoban children born VP/EP at 2 and 4 years of age. A novel SR framework incorporating ‘hot’ and ‘cool’ executive function (EF), behavioural, and adaptive components was examined using parent-report measures (Behavior Rating Inventory of Executive Function- preschool, Behavior Assessment System for Children- Parent Report System, Adaptive Behavior Assessment System- second edition) and individually administered cognitive and language measures. Cognitive and language scores were compared at two and four years of age. Scores for participants completing all measures (sample A, n = 60) were compared to participants who did not complete all measures (sample B, n = 44). FINDINGS: Sample A demonstrated poorer preschool adaptive, ‘cool’ EF, and atypical behaviour scores relative to test norms, of moderate to strong effect size. Principal Axis Factoring of parent report measures revealed 7 latent factors with Factors 1(Adaptive), 5(Internalizing), 6(Social Communication), and 7(Developmental) predicted by birth weight, brain injury, bronchopulmonary dysplasia, days of hospitalization, and/or chronological age. Cognitive and language scores for 4-year-olds were significantly correlated with preschool adaptive, behavioural and ‘cool’ EF scores. Sample B demonstrated more complex neonatal histories, greater adaptive (cognitive, practical, social) and externalizing concerns, and reduced likelihood of ‘catch-up’ between 2 and 4 years of age. IMPLICATIONS: The study’s In-Sync/On-track framework provides a useful lens to inform research and clinical monitoring of children born VP/EP. Findings revealed limitations to daily function and childhood SR prior to school entry, pointing to practice, policy and research implications, particularly for children with more complex medical histories who demonstrated higher levels of SR impairment but failed to complete testing.