Social competence of preschool children born very preterm

Background: Relatively little is known about the early social development of children born very preterm despite clear suggestions of later interpersonal difficulties.

Aims: To compare the social competence of very preterm (VPT) and full term (FT) born children at age 4 and identify infant, social and family factors associated with later risk.

Study design: Prospective longitudinal study.

Subjects: A regionally representative cohort of 103 VPT (≤ 32 weeks gestation) children and a comparison group of 105 FT children (36-41 weeks gestation) born between 1998 and 2000.

Outcome measures: At corrected age 4 years, a range of parent report, observational and laboratory measures assessed children's emotional and behavioral adjustment, emotional regulation, social interactive behavior and theory of mind understanding. Extensive perinatal, social background and family functioning data were also available from birth to age 4.

Results: Compared to their FT peers, VPT born children had poorer emotional and behavioral adjustment, were less effective in regulating their emotions, had lower levels of positive peer play and had less synchronous interactions with their parents. Within the VPT group, predictors of poor social competence included family socioeconomic disadvantage, extreme prematurity, severity of cerebral white matter abnormalities and early childhood exposure to high levels of maternal anxiety and negative parenting.

Conclusions: VPT pre-schoolers are characterized by a range of subtle social difficulties likely to adversely affect their ability to establish and maintain positive relationships with others. These difficulties need to be monitored alongside other potential neurodevelopmental concerns and parents supported to actively nurture child social competence.