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Psychiatric Symptoms

Prevalence, Co-occurrence, and Functioning Among Extremely Low Gestational Age Newborns at Age 10 Years

Dvir, Yael MD*; Frazier, Jean A. MD*; Joseph, Robert M. PhD; Mokrova, Irina PhD; Moore, Phoebe S. PhD*; O'Shea, T. Michael MD, MPH; Hooper, Stephen R. MD; Santos, Hudson P. Jr PhD, RN; Kuban, Karl MD, SM Epi for the ELGAN Study Investigators

Journal of Developmental & Behavioral Pediatrics: December 2019 - Volume 40 - Issue 9 - p 725–734
doi: 10.1097/DBP.0000000000000744

Objective: To evaluate the percentage of children born extremely preterm (EP) who screen positive for ≥1 DSM-IV psychiatric disorders, the co-occurrence of and sex-related differences in these classifications, and the functional correlates of psychiatric symptoms.

Methods: The Extremely Low Gestational Age Newborn (ELGAN) Study is a prospective cohort follow-up of children born <28 weeks' gestation. For 871 10-year-old children, parents completed the Child Symptom Inventory-4 (CSI-4), a child educational/medical history questionnaire, and the Pediatric Quality of Life Inventory (PedsQL).

Results: At age 10 years, ELGANs were more likely to screen positive for a number of psychiatric disorders when compared with normative expectations on the CSI-4, with a few sex-related differences. Fifteen percent of participants screened positive for 1 disorder, 7% for 2, 3% for 3, and 4% for ≥4 psychiatric disorders. Compared with children who did not screen positive for psychiatric disorders, children who screened positive for ≥3 psychiatric disorders were approximately twice as likely to have repeated a grade, have an individualized educational program, have an individual school aide, and to require special remediation classes. Children who screened positive for any psychiatric disorder were 4 times more likely to use 1 or more psychotropic medication, and those who screened positive for ≥2 psychiatric disorders had lower PedsQL scores.

Conclusion: Among 10-year-old children born EP, rates of psychiatric symptoms exceeded normative expectation, and children who screened positive for more than 1 psychiatric disorder were at increased risk of having multiple functional impairments.

This article has supplementary material on the web site:

*University of Massachusetts Medical School, Worcester, MA;

Boston University School of Medicine, Boston, MA;

University of North Carolina at Chapel Hill, Chapel Hill, NC.

Address for reprints: Jean A. Frazier, MD, University of Massachusetts Medical School, 55 Lake Avenue, North, Worcester, MA 01655; e-mail:

This study was supported by The National Institute of Neurological Disorders and Stroke (5U01NS040069-05; 2R01NS040069-06A2), and the National Institute of Child Health and Human Development (5R01HD092374-02 and 5P30HD018655-34), and the Office of the National Institutes of Health Director (1UG3OD023348-01).

Disclosure: J. A. Frazier has the following disclosures: receiving research support from Takeda Pharmaceuticals, Fulcrum Therapeutics, Janssen Research and Development, and Roche. No funds from these entities supported this project, and none of these entities reviewed/commented on this study. The remaining authors declare no conflict of interest.

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Received April , 2019

Accepted August , 2019

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