Adaptive Behavior Trajectories in Children Born Prematurely: The Influence of Biologic and Social Risk Factors over the First Few Years of Life - Abstract
Introduction: Preterm infants are expected to achieve skills consistent with term
born peers by age 3. The purpose of this study was to describe trajectories of adaptive behavior for preterm children, examining the influence of gestational age (GA), illness severity, sex, family income, and maternal education.
Method: 218 children (birth weight < 2500 grams, GA < 37 weeks) were evaluated four times over 36 months with the Vineland Adaptive Behavior Scales. Multilevel modeling was used to assess individual growth trajectories and betweengroup differences on the adaptive behavior composite score of the Vineland Scales.
Results: Individual trajectories of children varied. On average, adaptive
behavior composite scores declined to the low end of the average range until about 28 months of age when trajectories showed slight improvement (t=6.29, p<.001). Older gestational age was associated with better scores (t=4.68, p<.001). Male sex (t=2.77, p=.005) and poverty (t=-2.73, p=.007) were significant predictors of poorer adaptive behavior as children aged.
Discussion: Results suggest that a lower threshold for referral to early intervention may be prudent, especially for premature male infants who live in poverty. Research is needed to understand and address the causes of decline in adaptive behavior over time, especially among the large proportion of children born preterm who do not achieve adaptive behavior scores consistent with term peers by age 3 years.