598 - Early Detection of Executive Functioning Problems in Children Born Very Preterm at Longer-Term Risk

Publication Number: 598.4704

Lianne J. Woodward, University of Canterbury, Christchurch, Canterbury, New Zealand; Megan Gath, University of Canterbury, Christchurch, Canterbury, New Zealand; Sarah J. Timperley, University of Melbourne, Melbourne, Victoria, Australia; Carrie Clark, University of Nebraska-Lincoln, Lincoln, NE, United States

Background: Children born very preterm (VPT) are at high risk of executive functioning (EF) difficulties that impact their longer-term academic achievement, mental health and social functioning. Yet their early identification is resource intensive and challenging.

Objective: To examine the psychometric properties of a novel Observational Rating System of Executive Behavior (ORSEB) for the detection of EF difficulties at/or before school entry in children born VPT. Of particular interest, is its diagnostic utility in identifying children at longer-term executive function risk, as well as its potential prediction of longer-term educational and mental health problems.

Design/Methods: A regional cohort of 110 very preterm (23–32 weeks’ gestation) and 113 full-term children born during 1998–2000 were followed prospectively to corrected age 12 years, with high retention (95%). At age 6, five ORSEB executive function behaviors were rated qualitatively by two “blinded” independent observers during a research clinic visit: initiation; inhibitory control; sustained attention; self-monitoring; and cognitive flexibility. At ages 9 and 12, children's executive functioning (age appropriate test battery, parent-report BRIEF), educational achievement (Woodcock Johnson III Test of Achievement) and mental health (Strengths and Difficulties Questionnaire, Development and Wellbeing Assessment) were blindly assessed.

Results: The ORSEB was internally consistent (alpha=.87) and had good inter-rater agreement (ICC = .88, Cohen’s kappa =.79). ORSEB scores effectively discriminated between children with and without EF difficulties on psychometric testing at ages 6 and 9 years (87% & 70% classified correctly, p<.001). They were also significantly predictive of later executive functioning (r=.48-.54), educational (r=.37-.54), and mental health problems (-.49-.51) to age 12 years. Receiver Operating Curve (ROC) analyses showed an ORSEB score <=13 had good sensitivity (76%, PPV=61%) and specificity (89%, NPV=94%) in identifying children at risk of longer-term EF impairments (Figure 1). Predictive accuracy for later cross-domain educational (sensitivity=.70, specificity=.67) and mental health risks (sensitivity=.62, specificity=.84) were also reasonable. Similar results were found in each study group (very preterm, full term) and the total sample.

Conclusion(s): Findings support the prognostic importance of executive functioning difficulties at school entry and the psychometric utility of the ORSEB in identifying children at later neurodevelopmental risk.

Figure 1. Receiver Operating Characteristic Curve for the Identification of Young Children at Risk of Longer Term Clinically Significant Executive Functioning Impairments (Green dot shows recommended cut-point score of >=13).