The Spectrum of Behavioral Outcomes after Extreme Prematurity: Regulatory, Attention, Social, and Adaptive Dimensions
Section snippets
The ICF Model
In the 1970s, it was assumed that the majority of VLBW and ELBW survivors would have neurodevelopmental disability or challenges in emotional, behavioral, or adaptive competencies continuing throughout childhood. Too often size at birth and degree of prematurity were assumed to be predictive factors for all aspects of a child’s physical and emotional health later in life. However, increasing evidence demonstrates that the continuum of developmental and behavioral competencies does not depend on
Behavioral, Attention, Social, and Adaptive Outcomes of Premature and Low Birth Weight Children
Each year in the United States, there are approximately 60,000 children born after VP gestation and with VLBW status. In the past 25 years, the field of medicine has seen a growing body of research documenting the complex pathways underlying adverse outcomes in physical, developmental, emotional, and behavioral health. In the early stages of these outcome studies, much of the attention was focused on major neurodevelopmental disorders, such as cerebral palsy, blindness, deafness, and severe
Environmental Attributes
Environmental factors such as social risk (eg, distressed neighborhoods), family capital (eg, parental education, one- or two-parent family), and socioeconomic status (SES) are key factors that contribute to both management resources and outcomes for VLBW and ELBW survivors.6, 9, 18, 22, 24, 25, 28
In many instances, poverty and low SES contribute to a cascade of stressors, including limited parental education and employment, prenatal exposures to both legal (eg, alcohol and tobacco) and illegal
Assessing Early Childhood Social–Emotional Competencies
Several tools are available for health professionals to describe early social, emotional, behavioral, and adaptive competencies and are listed in Table 2.
The Infant Toddler Social Emotional Assessment (ITSEA) was developed to assess internalizing, externalizing, and regulatory behaviors between 1 and 3 years as well as social competencies.34 This tool has been used in community samples of children as risk for developmental, behavioral, and social problems. A screening version of this evaluation
Helping Children with Emotional, Regulatory, Attention, Social, and Adaptive Challenges
Although the effects of prematurity and low birth weight can increase the risks for suboptimal developmental, behavioral, or social outcomes, these effects can be reduced or minimized with educational, family, and social supports. Research points to the importance of environmental factors on behavioral and emotional health as well as adaptive skills and indicates that functioning and participation of premature birth and low birth weight survivors can be improved or worsened depending on
Conclusion
There is increased recognition that children who survive very and extreme prematurity have a spectrum of behavioral, adaptive, and social challenges. This vulnerability requires both ongoing surveillance so as to guide families in the management of feeding, sleep, play, communication, discipline, and learning. This cannot be solely done by health professionals alone, but by explicit community partnership supports that promote exploration, curiosity, interaction, and learning. If neonatal
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