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Rough beginnings: Executive function in adolescents and young adults after preterm birth and repeat antenatal corticosteroid treatment
Stockholm University, Faculty of Social Sciences, Department of Psychology.ORCID iD: 0000-0002-7824-0536
2014 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

This thesis investigates long-term cognitive outcome in two cohorts of adolescents and young adults exposed to stressors during the perinatal period: one group born preterm (<37 weeks of gestation and birth weight <1,500 g); one group exposed to two or more courses of antenatal corticosteroids (ACS), to stimulate lung maturation in the face of threatening preterm birth. In fetal life the brain undergoes dramatic growth, and a disruption to the early establishment of functional neural networks may interrupt development in ways that are difficult to predict. Executive function refers to a set of cognitive processes that are important for purposeful regulation of thought, emotion, and behavior, and even a subtle depreciation may influence overall functioning. Study I investigated the stability of executive function development after preterm birth. Executive functions were differentiated into working memory and cognitive flexibility. Both components were highly stable from preschool age to late adolescence. In Study II, we identified subgroups within the group of children born preterm with respect to cognitive profiles at 5½ and 18 years, and identified longitudinal streams. Outcome after preterm birth was diverse, and insufficiently predicted by perinatal and family factors. Individuals performing at low levels at 5½ years were unlikely to improve over time, while a group of individuals performing at or above norm at 5½ years had improved their performance relative to term-born peers by age 18. Studies I and II pointed to the need for developmental monitoring of those at risk, prior to formal schooling. Study III investigated long-term cognitive outcome after repeat ACS treatment. The study did not provide support for the concern that repeat ACS exposure will have an adverse impact on cognitive function later in life. In sum, exposure to perinatal stressors resulted in great variation in outcome. However, for many, their rough beginnings had not left a lasting mark.

Place, publisher, year, edition, pages
Stockholm: Department of Psychology, Stockholm University , 2014. , 100 p.
Keyword [en]
cognitive flexibility, cluster analysis, development, latent variable analysis, longitudinal studies, parental education, perinatal medical complications, person-oriented approach, structural equation modeling, working memory
National Category
Psychology
Research subject
Psychology
Identifiers
URN: urn:nbn:se:su:diva-106798ISBN: 978-91-7447-945-4 (print)OAI: oai:DiVA.org:su-106798DiVA: diva2:740022
Public defence
2014-10-15, David Magnussonsalen (U31), Frescati Hagväg 8, Stockholm, 10:00 (English)
Opponent
Supervisors
Note

At the time of the doctoral defense, the following paper was unpublished and had a status as follows: Paper 1: Submitted.

Available from: 2014-09-23 Created: 2014-08-20 Last updated: 2014-10-03Bibliographically approved
List of papers
1. Executive function development in adolescents born very and extremely preterm
Open this publication in new window or tab >>Executive function development in adolescents born very and extremely preterm
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(English)In: Article in journal (Refereed) Submitted
Abstract [en]

Executive function deficits are often reported as being a specific weakness in preterm born children. Yet, stability in function and development over time is largely unknown. In a prospective longitudinal study, 115 participants born very or extremely preterm, ≤ 31 weeks of gestation, participated in neuropsychological assessments at ages 5½ years and 18 years. Executive functions were separated into working memory and cognitive flexibility. Gestational age at birth, intrauterine growth, sex, perinatal medical complications, and parental education were tested as predictors, and developmental stability was investigated using Structural Equation Modeling. Working memory and cognitive flexibility were highly stable from preschool age to late adolescence. Higher parental education, higher gestational age, and female sex were related to better outcome at 5½ years which in turn fully mediated outcome at age 18 years. Perinatal medical complications and restricted intrauterine growth negatively influenced cognitive flexibility in late adolescence. The study poses an argument for identification of executive deficits before school entry among children born preterm, as such deficits are unlikely to diminish as a consequence of maturation.

Keyword
cognitive flexibility, parental education, perinatal medical complications, structural equation modeling, working memory
National Category
Psychology
Research subject
Psychology
Identifiers
urn:nbn:se:su:diva-106801 (URN)
Available from: 2014-08-20 Created: 2014-08-20 Last updated: 2017-07-28Bibliographically approved
2. Individual cognitive patterns and developmental trajectories after preterm birth
Open this publication in new window or tab >>Individual cognitive patterns and developmental trajectories after preterm birth
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2015 (English)In: Child Neuropsychology, ISSN 0929-7049, E-ISSN 1744-4136, Vol. 21, no 5, 648-667 p.Article in journal (Refereed) Published
Abstract [en]

Cognitive outcome after preterm birth is heterogeneous, and group level analyses may disguise individual variability in development. Using a person-oriented approach, this study investigated individual cognitive patterns and developmental trajectories from preschool age to late adolescence. As part of a prospective longitudinal study, 118 adolescents born preterm, with a birth weight <1,500 g, participated in neuropsychological assessments at age 5½ years and at 18 years. At each age, four cognitive indices, two tapping general ability and two tapping executive functions, were formed to reflect each individual’s cognitive profile. Cluster analyses were performed at each age separately, and individual movements between clusters across time were investigated. At both 5½ and 18 years, six distinct, and similar, cognitive patterns were identified. Executive functions were a weakness for some but not all subgroups, and verbal ability was a strength primarily among those whose overall performance fell within the normal range. Overall, cognitive ability at 5½ years was highly predictive of ability at age 18. Those who performed at low levels at 5½ did not catch-up, but rather deteriorated in relative performance. Over half of the individuals who performed above norm at 5½ years improved their relative performance by age 18. Among those performing around norm at 5½ years, half improved their relative performance over time, whereas the other half faced increased problems, indicating a need for further developmental monitoring. Perinatal factors were not conclusively related to outcome, stressing the need for cognitive follow-up assessment of the preterm born child before school entry.

Keyword
cluster analysis, executive function, longitudinal, parental education, perinatal factors
National Category
Psychology
Research subject
Psychology
Identifiers
urn:nbn:se:su:diva-106802 (URN)10.1080/09297049.2014.958071 (DOI)000360617900006 ()
Available from: 2014-08-21 Created: 2014-08-20 Last updated: 2017-12-05Bibliographically approved
3. Cognitive outcome in adolescents and young adults after repeat courses of antenatal corticosteroids
Open this publication in new window or tab >>Cognitive outcome in adolescents and young adults after repeat courses of antenatal corticosteroids
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2013 (English)In: Journal of Pediatrics, ISSN 0022-3476, E-ISSN 1097-6833, Vol. 163, no 2, 441-446 p.Article in journal (Refereed) Published
Abstract [en]

Objective To investigate whether repeat courses of antenatal corticosteroids have long-term effects on cognitive and psychological functioning. Study design In a prospective cohort study, 58 adolescents and young adults (36 males) who had been exposed to 2-9 weekly courses of betamethasone in utero were assessed with neuropsychological tests and behavior self-reports. Unexposed subjects (n = 44, 25 males) matched for age, sex, and gestational age at birth served as a comparison group. In addition, individuals exposed in utero to a single course (n = 25, 14 males) were included for dose-response analysis. Group differences were investigated using multilevel linear modeling. Results Mean scores obtained in 2 measures of attention and speed were significantly lower in subjects exposed to 2 or more antenatal corticosteroids courses (Symbol Search, P = .009; Digit Span Forward, P = .02), but these were not dose-dependent. Exposure to repeat courses of antenatal corticosteroids was not associated with general deficits in higher cognitive functions, self-reported attention, adaptability, or overall psychological function. Conclusions Although this study indicates that repeat exposure to antenatal corticosteroids may have an impact on aspects of executive functioning, it does not provide support for the prevailing concern that such fetal exposure will have a major adverse impact on cognitive functions and psychological health later in life.

Keyword
WAIS, Wechsler Adult Intelligence Scale, WISC, Wechsler Intelligence Scale for Children
National Category
Psychology
Research subject
Psychology
Identifiers
urn:nbn:se:su:diva-94190 (URN)10.1016/j.jpeds.2013.01.030 (DOI)000322959500029 ()
Note

AuthorCount:6;

Available from: 2013-09-30 Created: 2013-09-30 Last updated: 2017-12-06Bibliographically approved

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