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Behavioral Outcomes of Extremely Low Birth Weight Children at Age 8 Years

Hack, Maureen MB, ChB*; Taylor, Hudson G. PhD*; Schluchter, Mark PhD; Andreias, Laura MD, MS*; Drotar, Dennis PhD; Klein, Nancy PhD*

Journal of Developmental & Behavioral Pediatrics: April 2009 - Volume 30 - Issue 2 - p 122-130
doi: 10.1097/DBP.0b013e31819e6a16
Original Article

Objective: To describe the prevalence of behavioral problems and symptomatology suggestive of Autism and Asperger's disorders at age 8 years among extremely low birth weight (ELBW, <1 kg) children, born 1992 through 1995.

Method: Parent reports of the behavior of 219 ELBW (mean birth weight, 810 g; gestational age 26 weeks) were compared with 176 normal birth weight children of similar maternal sociodemographic status, sex, and age. Behavior was assessed via the Child Symptom Inventory that includes both Symptom Severity Scores and scores meeting DSM-IV criteria for disorders.

Results: ELBW compared with normal birth weight children had significantly higher mean Symptom Severity Scores for the inattentive, hyperactive, and combined types of attention-deficit hyperactivity disorder (all p < .001) as well as higher scores for Generalized Anxiety (p < .01) and Autistic (p < .001) and Asperger's (p < .01) disorders. When DSM-IV criteria were considered, ELBW children also had significantly higher rates of attention-deficit hyperactivity disorder of the inattentive (10% vs 3%, p < .01) and combined (5% vs 0.6%, p < .05) types.

Conclusions: Attention-deficit hyperactivity disorder, mainly the inattentive type is prevalent among ELBW children. Our findings of an increase in symptoms pertaining to Autistic and Asperger's disorders at school age agree with recent reports of others during early childhood. Early identification and intervention for these problems might improve child functioning and ameliorate parent and child distress.

From the *Departments of Pediatrics and †Epidemiology and Biostatistics, Case Western Reserve University, Cleveland, OH; and ‡Cincinnati Children's Hospital Medical Center, Cincinnati, OH.

Received October 2008; accepted January 2009.

The study was supported by Grants RO1 HD39756 and M01 RR00080 from the General Clinical Research of the National Institutes of Health (NIH).

Address for reprints: Maureen Hack, MD, Division of Neonatology, Rainbow Babies and Children's Hospital, University Hospitals of Cleveland Case Medical Center, 11,100 Euclid Avenue, Cleveland, OH 44106-6010; e-mail:

© 2009 Lippincott Williams & Wilkins, Inc.