Inattention in very preterm children : implications for screening and detection

Objective: Children born very preterm (VP; <32 weeks) are at risk for attention deficit/hyperactivity disorders (ADHD). ADHD in VP children have a different clinical presentation to ADHD in the general population, and therefore VP children with difficulties may not come to the teacher's attention in school. We have assessed ADHD symptoms to determine whether VP children's difficulties may go undetected in the classroom. Design: Parents and teachers of 117 VP and 77 term-born children completed the Strengths and Difficulties Questionnaire to assess hyperactivity/inattention, emotional, conduct and peer problems, and the Du Paul ADHD Rating Scale-IV to assess inattention and hyperactivity/impulsivity symptoms. Special Educational Needs (SEN) were assessed using teacher report. Group differences in outcomes were adjusted for socio-economic deprivation. Results: Parents and teachers rated VP children with significantly higher mean Strengths and Difficulties Questionnaire hyperactivity/inattention scores, and parents rated them with more clinically significant hyperactivity/inattention difficulties than term-born controls (Relative Risk (RR) 4.0; 95% CI 1.4 to 11.4). Examining ADHD dimensions, parents and teachers rated VP children with significantly more inattention symptoms than controls, and parents rated them with more clinically significant inattention (RR 4.8; 95% CI 1.4 to 16.0); in contrast, there was no excess of hyperactivity/impulsivity. After excluding children with SEN, VP children still had significantly higher inattention scores than controls but there was no excess of hyperactivity/impulsivity. Conclusions: VP children are at greater risk for symptoms of inattention than hyperactivity/impulsivity. Inattention was significantly increased among VP children without identified SEN suggesting that these problems may be difficult to detect in school. Raising teachers’ awareness of inattention problems may be advantageous in enabling them to identify VP children who may benefit from intervention.