Although recent advances in neonatal intensive care have led to dramatic increases in the survival of children with extremely low birth weight or extremely preterm birth (ELBW/EPTB, <1000 g or <28 weeks gestational age), this subset of the children is at the highest risk for risk for learning and behavioral problems. These disorders are of particular concern at school entry, as they forecast long-term educational failure. The primary aims of this study are to: (1) investigate the manifestations and development of learning and behavioral problems during the early school-age years, (2) determine their cognitive basis, with specific focus on deficits in executive functions (EF), and (3) examine the home and school environments as predictors of these outcomes and as moderators of the effects of ELBW/EPTB. To accomplish these aims, we will assess an established birth cohort of children with ELBW/EPTB (n = 150) in kindergarten and follow them across the next two years in school. Consequences of ELBW/EPTB will be determined by comparing the cohort with a matched control group of term-born children (n = 150). We hypothesize that the ELBW/EPTB group, relative to controls, will display more academic deficiencies, higher rates of psychiatric disorders, less engagement in learning and more inappropriate classroom behavior, and less positive learning and behavioral progress over time. We further hypothesize that specific deficits in EF will predict early learning failure, and that environments associated with better learning and behavioral outcomes will buffer the effects of ELBW/EPTB. Innovative features include classroom observations of student and teacher behavior, use of measures of EF designed for younger children, and comprehensive assessments of the home and school environments. The project employs an integrative approach encompassing health and developmental, neuroscience, and educational perspectives. The findings will inform efforts to identify and treat learning disorders in high-risk children at school entry.
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