Adverse Childhood Experiences and Socioemotional Outcomes of Children Born Very Preterm

Objective

To examine whether adverse childhood experiences (ACEs) confer risk for socioemotional problems in children born very preterm (VPT).

Study design

As part of a longitudinal study, 96 infants born VPT at 23-30 weeks of gestation were recruited from a level III neonatal intensive care unit and underwent follow-up at ages 2 and 5 years. Eighty-three full-term (FT) (37-41 weeks gestation) children were recruited from an adjoining obstetric service and the local community. ACEs were assessed with the Child Life Events Scale at age 2 and Preschool Age Psychiatric Assessment at age 5. At age 5, internalizing, externalizing, and attention deficit hyperactivity disorder (ADHD) symptoms were assessed with the Child Behavior Checklist and Conner's Rating Scale-Revised, respectively. Covariates including socioeconomic disadvantage, maternal distress, and parent ADHD symptoms were assessed at the 2- and/or 5-year follow-up. Mediation and moderation analysis, accounting for family clustering, examined associations between birth group, ACEs, and socioemotional outcomes.

Results

After covariate adjustment, children born VPT experienced more ACEs (P < .001), particularly medical ACEs (P < .01), and had worse ADHD and internalizing outcomes (P < .05) than full-term children. ACEs mediated the association between birth group and ADHD outcomes (95% CI, 0.11-4.08). There was no evidence of mediation for internalizing outcomes. Higher parent ADHD symptoms (P < .001) and maternal distress (P < .05) were associated with poorer internalizing outcomes.

Conclusions

Screening for childhood ACEs should be embedded in the follow-up care of children born VPT and their families. Strategies to screen for and address parent psychosocial functioning may be important to support children's socioemotional development.