A recent study has identified three distinct profiles among children born preterm, showcasing significant variations in cognitive and behavioral test results.
Every year, approximately thirteen million infants are born prematurely, which is associated with an elevated risk for conditions like attention-deficit/hyperactivity disorder (ADHD), social development challenges, and lower academic performance.
Historically, analyses of preterm birth often failed to account for the diversity observed among preterm children, including some who perform better than the average for those born full-term. Preterm birth is defined as occurring before 37 weeks of gestation, while full-term is considered to be around 40 weeks.
Researchers have noted that combining all preterm infants into one category limits the ability to provide individualized care. The new study, published online on August 13 in the journal Child Development, identifies three distinct profiles among preterm-born children, each displaying significantly different outcomes on cognitive (thinking, reasoning, memory) and behavioral (attention capabilities) assessments.
Conducted by researchers at NYU Grossman School of Medicine, the study revealed a first profile, composed of 19.7% of participants, who scored above average compared to full-term children’s performance on standardized cognitive tests. The second profile, consisting of 41% of the children, exhibited scores higher than the average on four assessments (including memory, vocabulary, and reading) but lower on three others (like pattern recognition and working memory).
The third profile, representing 39.3% of the group, scored below average on all tests, showing cognitive impairments that aligned with attention issues and decreased academic performance. Notably, children in profile 1 outperformed those in profile 3 by an average of 21% on cognitive assessments. In terms of behavioral outcomes, only 2.5% of children in profile 1 were identified with attention deficits, in contrast to 9.9% in profile 3.
Regarding academic success, 66.47% of profile 1 participants achieved a grade average of A- or above, while 60.69% in profile 2 and only 32.21% in profile 3 did the same.
“Our findings challenge the stereotype that all preterm children face cognitive and behavioral challenges,” explains lead author Iris Menu, PhD, a post-doctoral researcher in Moriah Thomason’s laboratory, PhD, vice chair for research in the Department of Child and Adolescent Psychiatry.
“Precision psychiatry focuses on the individual, not just a broad diagnosis, acknowledging that two patients with the same diagnosis, like preterm birth, can have vastly different experiences,” added Thomason, the study’s senior author. “Our research underscores the complexity of preterm birth and has the potential to enhance individual treatment strategies.”
This study evaluated cognitive and behavioral data from 1,891 boys and girls who were born prematurely, aged between 9 and 11 years, and participating in another extensive study: the Adolescent Brain Cognitive Development (ABCD) study. This ongoing study monitors children’s cognition using a standardized set of seven tests that examine attention, decision-making, memory, reading comprehension, and processing speed. Using advanced statistical methods, researchers categorized the children’s results into meaningful subgroups that reflect the actual developmental spectrum.
Brain Differences
Brain imaging showed that children aged 9 to 11 in profile 3 had an average of 3% smaller brain volumes and gray matter surface area compared to those in profile 1. Although children in profile 3 were born about 4.5 days earlier on average than those in the other profiles, the reduced brain size did not directly correlate with the extent of prematurity. The study authors noted that understanding whether these outcome differences relate to smaller brain volumes—and what causes them—deserves further exploration.
The research team also assessed functional connectivity, which gauges the activity in two interrelated brain networks by measuring blood flow via functional MRI. For an essential network pair—the dorsal attention network and the default mode network—the connectivity was found to be approximately 11.21% weaker in profile 3 compared to profile 1.
Since the dorsal attention network is critical for maintaining attention, these findings suggest that the profiling method used in the study could facilitate earlier diagnoses (potentially for conditions like ADHD) and enable more customized behavioral therapies and medications, according to the authors.
Crucially, the analyses indicated that preterm Black children were nearly four times more likely to fall into the lower-performing profile 3.
“Given these outcomes, we advocate for the implementation of social and structural interventions to ensure equitable care for all preterm-born children,” Menu urged. “Children receiving frequent speech, physical, and behavioral therapies—typically more available in affluent families—tend to achieve better scores in studies. Other determinants also matter; for example, children from communities with higher health insurance coverage were less likely to be categorized in Profile 3.”
Looking ahead, the research team intends to conduct further studies to identify common factors among poorly performing preterm children (such as those who may have experienced reduced oxygen supply during birth) and to uncover the elements that contributed to the success of the 20% of preterm children in profile 1 who outperformed many full-term peers.
Alongside Menu and Thomason, NYU Langone researchers involved in the study included Lanxin Ji, Tanya Bhatia, Mark Duffy, and Cassandra Hendrix from the Department of Child & Adolescent Psychiatry. This research was funded by various National Institutes of Health grants, including MH125870, MH126468, MH122447, DA055338, ES032294, and K99MH133978.
