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The role of executive and general cognitive functioning in the attention problems of very and extremely preterm adults

journal contribution
posted on 26.03.2020, 17:31 by Robert Eves, Adrian von Mühlenen, Marina Mendonca, Samantha Johnson, Helen O'Reilly, Peter Bartmann, Neil Marlow, Dieter Wolke

Objective—To determine whether the attention problems in adults born very preterm/very low birthweight (VP/VLBW; <32 weeks’ gestation/ <1500g) or extremely preterm (EP; <26 weeks’ gestation) are associated with specific executive or general cognitive deficits.

Method— Cohorts of VP/VLBW (the Bavarian longitudinal study (BLS)) and EP (the EPICure Study) participants were followed from birth to early adulthood, each also following a respective control group. Adult ADHD symptoms were assessed via self-report in both cohorts and additionally by parent-report in the BLS. Participants in both cohorts also had their attention span rated by trained observers. Performed separately in each cohort, hierarchical regression analyses were used to assess whether the association between preterm birth status and attention problems remained after accounting for executive functioning (inhibitory control and working memory) in adulthood, childhood IQ or sex.

Results— In the discovery cohort of the BLS, significant differences were found between VP/VLBW adults and controls for parent-rated inattention (p<0.001). However, for self-reported measures of ADHD, no significant differences were found in the BLS or in the EPICure replication cohort. In both cohorts, observer-rated attention spans were lower for VP/VLBW and EP participants in comparison to their respective control groups (p <0.001). In final models for the BLS, inhibitory control and childhood IQ were significantly associated with parent-rated inattention symptoms (p<0.006). Whereas working memory and childhood IQ were significantly associated with observer-rated attention span (p<0.001). The effect of childhood IQ on observer-rated attention span was replicated in EPICure.

Conclusions—VP/VLBW and EP adults are at increased risk of observer-rated attention problems. These problems were predominantly associated with poorer general cognitive ability in early childhood and somewhat with adult executive functioning.


The BLS study was supported by grants PKE24, JUG14, 01EP9504, and 01ER0801 from the German Federal Ministry of Education and Science. Authors Robert Eves, Marina Mendonça, Samantha Johnson, Peter Bartmann and Dieter Wolke are supported by an EU horizon 2020 grant, agreement number 733280. The authors thank all current and former Bavarian Longitu-dinal Study group members, pediatricians, psychologists, and research nurses. They also thank those who contributed to study organization, recruitment, data collection, and management at the 26 year assessment: Barbara Busch, Stephan Czeschka, Claudia Gruenzinger, Christian Koch, Diana Kurze, Sonja Perk, Andrea Schreier, Antje Strasser, Julia Trummer, and Eva van Rossum. Special thanks are due to the study participants and their families. The EPICure study was funded by the Medical Research Council, UK. We are indebted to the EPICure 1 Study Group, which includes pediatricians in 276 maternity units in the UK whose contribution was invaluable. We are also indebted to the many children and parents for their continued participation in the EPICure Study.



Journal of Developmental and Behavioral Pediatrics (2020) In Press


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Journal of Developmental and Behavioral Pediatrics


Lippincott, Williams & Wilkins



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