UCSF

Factors Influencing Early Trajectories of Adaptive Behavior among Children Born Prematurely

Anne DeBattista

Statement of the Problem: Children born prematurely score lower on adaptive behavior measures compared to term born peers. Because adaptive behavior encompasses a broad spectrum of motor, communication, socialization, and daily living skills, deficiencies can have a significant impact on development throughout life. Achievement of adaptive behavior scores in the normative range has been expected by age 2 or 3. However, information is lacking regarding the likelihood of preterm children catching up to their peers or their trajectories of adaptive behavior over the first few years of life. Additionally, factors that may influence these trajectories are not well understood, including the impact of intervention services experienced by children in their communities. The overarching aims of this study were to describe the trajectories of adaptive behavior for preterm children from 4 to 36 months of life, to examine the influence of specific infant and family factors on these trajectories, and to determine whether amount and timing of early intervention services are associated with improvement in children's adaptive behavior over time.

Methods/Procedures: A cohort of 218 premature infants was assessed at 4 times from infancy through preschool age using the Vineland Adaptive Behaviors Scales. Hours of intervention service received by each child between assessments were recorded by participating community agencies. Additional data was collected on neonatal illness severity, infant gender and gestational age, family income, and maternal education. Multilevel modeling was used to examine the aims.

Summary of Findings: Although individual trajectories varied, mean adaptive behavior scores of children declined over time. 43 percent of the children did not achieve scores in the normative range by age 2 or 3. Younger gestational age, male sex and lower income were significant predictors of worse adaptive behavior. While the amount of intervention received by children was not associated with improved adaptive behavior on average, increasing intervention was associated with some improvement in adaptive behavior as children aged. Results suggest that additional intervention might slow decline in adaptive behavior. Interventions to prevent this decline must be studied, with attention to the needs of boys born at younger gestational ages who are living in disadvantaged environments.