Regional cerebral development at term relates to school-age social-emotional development in very preterm children

J Am Acad Child Adolesc Psychiatry. 2012 Feb;51(2):181-91. doi: 10.1016/j.jaac.2011.11.009.


Objective: Preterm children are at risk for social-emotional difficulties, including autism and attention-deficit/hyperactivity disorder. We assessed the relationship of regional brain development in preterm children, evaluated via magnetic resonance imaging (MRI) at term-equivalent postmenstrual age (TEA), to later social-emotional difficulties.

Method: MR images obtained at TEA from 184 very preterm infants (gestation <30 weeks or birth weight <1,250 g) were analyzed for white matter abnormalities, hippocampal volume, and brain metrics. A total of 111 infants underwent diffusion tensor imaging, which provided values for fractional anisotropy and apparent diffusion coefficient. Social-emotional development was assessed with the Infant Toddler Social and Emotional Assessment (ITSEA) at age 2 and the Strengths and Difficulties Questionnaire (SDQ) at age 5 years.

Results: Higher apparent diffusion coefficient in the right orbitofrontal cortex was associated with social-emotional problems at age 5 years (peer problems, p < .01). In females, smaller hippocampal volume was associated with increased hyperactivity (p < .01), peer problems (p < .05), and SDQ total score (p < .01). In males, a smaller frontal region was associated with poorer prosocial (p < .05) scores. Many of the hippocampal findings remained significant after adjusting for birthweight z score, intelligence, social risk, immaturity at birth, and parental mental health. These associations were present in children who had social-emotional problems in similar domains at age 2 and those who did not.

Conclusions: Early alterations in regional cerebral development in very preterm infants relate to specific deficits in social-emotional performance by school-age. These results vary by gender. Our results provide further evidence for a neuroanatomical basis for behavioral challenges found in very preterm children.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Anisotropy
  • Attention Deficit Disorder with Hyperactivity / diagnosis*
  • Attention Deficit Disorder with Hyperactivity / physiopathology
  • Autistic Disorder / diagnosis*
  • Autistic Disorder / physiopathology
  • Brain / pathology*
  • Brain / physiopathology
  • Child, Preschool
  • Diffusion Magnetic Resonance Imaging*
  • Dominance, Cerebral / physiology
  • Emotional Intelligence / physiology*
  • Female
  • Follow-Up Studies
  • Frontal Lobe / pathology
  • Frontal Lobe / physiopathology
  • Hippocampus / pathology
  • Hippocampus / physiopathology
  • Humans
  • Image Interpretation, Computer-Assisted
  • Infant
  • Infant, Newborn
  • Infant, Premature, Diseases / diagnosis*
  • Infant, Premature, Diseases / physiopathology
  • Infant, Very Low Birth Weight*
  • Male
  • Organ Size / physiology
  • Peer Group
  • Sex Factors
  • Social Behavior