Subtypes of behavioral functioning in 8–12 year old very preterm children

Background: Very preterm children often have difficulties in behavioral functioning, but there is large heterogeneity in the severity of these difficulties and in the combination of the difficulties observed. Few studies so far addressed this heterogeneity by examining whether more homogeneous subtypes of behavioral functioning can be identified. Aims: To identify behavioral subtypes in a group of very preterm children, examine whether such subtypes are related to neonatal medical complications and/or parental education level (to better understand origins) and to examine whether such subtypes are associated with IQ and neurocognitive deficits in attention and executive function (to study underlying mechanisms of dysfunction). Study design: Cross-sectional cohort study. Subjects: 135 very preterm (gestational age < 30 weeks and/or birthweight < 1000 g) children aged 8–12 years. Measures: Parent and teacher questionnaires covering a broad range of behavioral domains, parental education level, neonatal medical complications, short-form Wechsler Intelligence Scale for Children-III and performance-based attention and executive function measures. Results: Cluster analysis indicated two behavioral subtypes: a subtype characterized by low behavioral problems (76% of children) and a subtype characterized by high behavioral problems across behavioral domains (24% of children). Lower parental education level, lower IQ and poorer verbal working memory, visuospatial working memory and inhibition were associated with the high problems subtype, but neonatal medical complications were not. Conclusions: The majority of very preterm children was assigned to the low behavioral problems subtype. However, if problems do occur, they are wide-spread across behavioral domains and accompanied by problems in neurocognitive domains.