Medical challenges at birth less important than stressful home life in predicting future psychiatric health — ScienceDaily

As they grow and develop, children who were born at least 10 weeks before their due dates are at risk for attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder and anxiety disorders. They are also more likely to develop neurodevelopmental problems than full-term children, such as cognitive difficulties, motor delays, and language difficulties.

Washington University School of Medicine in St. Louis has discovered that children with mental problems may not be at greater risk due to their medical conditions after birth. Instead, they may be at higher risk due to the environment they enter after they leave the newborn intensive-care unit (NICU).

A new study has shown that children who had more stable homes and mother who were more nurturing were more likely than those who were born too early to overcome the challenges.

The findings were published in The 26th of August. Journal of Child Psychology and Psychiatry.

Rachel E. Lean PhD, first author, is a postdoctoral researcher associate in child psychosiatry. She stated that the home environment was what made these children stand out. “Preterm children who performed well had mothers who reported lower levels in depression and parenting stress. These children had more cognitive stimulation at home thanks to parents who read to them and engaged in learning activities with them. Their families also had more stability. This suggests that there may be positive outcomes for very preterm infants if certain factors are changed in the home.

The researchers evaluated 125 5-years-old children. 85 of them were born at least 10 week before their due dates. The remaining 40 children were full-term at 40 weeks gestation.

Children took standardized tests to evaluate their cognitive, motor and language skills. Teachers and parents were also asked to complete checklists in order to determine if a child may have ADHD or autism spectrum disorder.

It turned out that the children who were born at 30 or earlier weeks of gestation tended to be in one of four groups. One group, which represented 27% of very preterm children was particularly resilient.

Lean stated, “They had cognitive and language skills and motor skills in a normal range, which is what we would expect for children their ages.” He also said that they were not likely to have psychiatric issues. “About 45%” of the very preterm babies were in the low end of the normal range. They were healthy but not as resilient as the other children in the first group.

The two other groups had no psychiatric issues, such as ADHD, autism spectrum disorder, or anxiety. A small number of very preterm babies had moderate-to severe psychiatric issues. Teachers identified 15% of the remaining children as having problems with inattention, hyperactive, and impulsive behavior.

Although the cognitive, motor, and language skills of the children in these last two groups were not significantly different than those of other children in this study, they did have higher rates of ADHD, autistic spectrum disorder, and other issues.

Senior investigator Cynthia E. Rogers, MD, a professor of child psychoiatry, said that children with psychiatric disorders also came from homes where their mothers experienced more ADHD symptoms, higher levels in psychosocial stress, and more parenting stress. “The factors that contributed to the children with significant impairment were likely to include the mothers’ issues and the environment in which they lived. Our clinical programs screen mothers for depression and mental health issues while their babies are still in the NICU.

Rogers and Lean believe that the findings could be good news as maternal psychiatric and family environment can be modified to improve the long-term outcomes of prematurely born children.

Rogers stated that “our results show that it wasn’t necessarily the clinical features infants experienced in the NICU that put their at risk for problems later on.” It was what happened after a baby left the NICU. Many people believe that babies born very prematurely will be the most severely affected. However, we didn’t see this in our data. If we want to promote optimal developmental outcomes, we need to not only focus on the babies’ health in NICU but also on maternal and family functioning.

The children are being followed by the researchers.

This work was supported in part by the Eunice Kennedy Shriver National Institute of Child Health and Human Development and the National Institute of Neurological Disorders and Stroke and National Institute of Mental Health of National Institutes of Health (NIH). R01 HD057098; R01MH113570; K02 NS089852; UL1TR000448, K23 MH105179, and U54–HD087011. Additional funding was provided through the Cerebral Palsy International Research Foundation (Cerebral Palsy International Research Foundation), the Dana Foundation and the Child Neurology Foundation.

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