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Minor neurodevelopmental impairments are associated with increased occurrence of ADHD symptoms in children born extremely preterm

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Abstract

ADHD is more common in children born preterm than at term. The purpose of the study was to examine if, and to what extent, ADHD symptoms are associated with minor neurodevelopmental impairments (NDI) in extremely preterm children. In a national population-based cohort with gestational age 22–27 weeks or birth weight <1,000 g assessed at 5 years of age, scores on Yale Children’s Inventory (YCI) scales (seven scales) were related to normal functions vs. NDI defined as mild impairments in cognitive function (IQ 70–84), motor function (Movement Assessment Battery for children score > the 95th percentile or freely ambulatory cerebral palsy), vision (correctable), and hearing (no hearing aid). YCI was completed for 213 of 258 eligible children (83 %). Children with minor NDIs (n = 98) had significantly higher scores (more ADHD symptoms) than those without NDI (n = 115) on the YCI scales of Attention, Tractability, Adaptability and Total score. Increasing numbers of minor NDIs were associated with higher mean YCI scores. In multivariate analysis only decreased hearing, IQ, and male gender were significantly associated with scores on the Attention scale. Thirty-three children (16 %) had scores >3 on the Attention scale (probably ADHD), and the proportion was significantly higher for those with mild NDIs compared to those without (Odds ratio = 2.7, 95 % CI 1.3–6.0). Children born extremely preterm with minor NDIs were more likely to have ADHD symptoms than those with no NDI, and increasing number of minor NDIs were associated with more ADHD symptoms.

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Acknowledgments

The study was funded by the Norwegian Foundation for Health and Rehabilitation through The Unexpected Child Death Society of Norway, the Research Council of Norway, Helse Vest Hospital Trust, University of Bergen, and Uni Health Center for Child and Adolescent Mental Health. Other members of the Norwegian Extreme Prematurity Study are as follows: Pediatrics: Arild Rønnestad, Oslo University Hospital, Rikshospitalet, Oslo; Per Ivar Kaaresen, University Hospital of North Norway, Tromsø; Theresa Farstad, Akershus University Hospital, Lørenskog; Janne Skranes, Oslo University Hospital, Ullevål University Hospital, Oslo; Ragnhild Støen, St Olav‘s Hospital, Trondheim University Hospital, Trondheim; Siren Rettedal, Stavanger University Hospital, Stavanger, and Haukeland University Hospital, Bergen; Lorentz M Irgens, University of Bergen, Bergen; Sven Harald Andersen, Østfold Hospital, Fredrikstad; Jørgen Hurum, Innlandet Hospital, Lillehammer; Sveinung Slinde, Telemark Hospital, Skien; Jorunn Ulriksen and Kåre Danielsen, Sørlandet Hospital, Kristiansand; Jon Skranes, Sørlandet Hospital, Arendal; Sabine Brügman, Buskerud Hospital, Drammen; Lars Tveiten, Innlandet Hospital, Elverum; Fabian Bergqvist, Førde Hospital, Førde; Andreas Andreassen, Fonna Hospital, Haugesund, Lutz Nietsch, Ålesund Hospital, Ålesund; Ingebjørg Fagerli, Nordland Hospital, Bodø; Bjørn Myklebust, Levanger Hospital, Levanger. For technical assistance, we thank Inger Elise Engelund and Magnhild Viste, Medical Birth Registry of Norway, Locus of Registry-Based Epidemiology. The authors thank biostatistician Geir Egil Eide for advice on statistics.

Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Ethical standards

This study has been approved by the Regional Committee on Medical Research Ethics and the Norwegian Data Inspectorate, and has, therefore, been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. Prior to their inclusion in the study, parents gave written informed consent.

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Authors and Affiliations

  1. Department of Clinical Medicine, University of Bergen, 5021, Bergen, Norway

    Silje Katrine Elgen, Kristian Sommerfelt & Trond Markestad

  2. Department of Pediatrics, Haukeland University Hospital, Bergen, Norway

    Silje Katrine Elgen, Kristian Sommerfelt, Katrine Tyborg Leversen & Trond Markestad

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  1. Silje Katrine Elgen
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  2. Kristian Sommerfelt
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  3. Katrine Tyborg Leversen
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  4. Trond Markestad
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Correspondence to Silje Katrine Elgen.

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Elgen, S.K., Sommerfelt, K., Leversen, K.T. et al. Minor neurodevelopmental impairments are associated with increased occurrence of ADHD symptoms in children born extremely preterm. Eur Child Adolesc Psychiatry 24, 463–470 (2015). https://doi.org/10.1007/s00787-014-0597-9

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  • DOI: https://doi.org/10.1007/s00787-014-0597-9

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