Caregiving Influences on Attention and Executive Function in Children Born Very Preterm

PROJECT SUMMARY / ABSTRACT Children born very preterm are at increased risk for deficits in attention and executive function, two domains that are strongly implicated in long-term health and developmental outcomes. We have not yet identified modifiable environmental factors that could prevent or mitigate cognitive deficits in very preterm children at school age,

though research with younger children suggests that caregiving quality is a potent protective factor. Understanding relationships between dimensions of caregiving quality and child attention and executive function at school-age is critically important as the transition to formal schooling poses new challenges for children and

families. Yet, existing interventions targeting caregiving quality in preterm dyads have exclusively focused on early infancy and not surprisingly, the positive effects of these interventions are completely washed out by school age. A wider focus on caregiving as a protective factor for preterm children during the sensitive period

represented by the transition to formal schooling is critical. With funds from our prior awards (R01HD072267; R01HD084515), we established a cohort of very preterm infants recruited at birth (NOVI Study) and have demonstrated prospective associations among early caregiving factors (e.g., psychological distress) and child

neurodevelopmental outcomes at age 2. The NOVI cohort was selected for inclusion in the NIH Environmental Influences on Child Health Outcomes (ECHO) program (UG3OD23347; UH3OD23347) which provided funding for extensive phenotypic characterization of NOVI children through age 7, including assessments of child

attention and executive function. We additionally collected an observational measure of caregiving quality at the age 7 visit which was not part of the ECHO protocol and requires additional resources for coding and analysis. The current proposal aims to code multiple dimensions of caregiving quality (e.g., caregiver sensitivity and

structuring) from the observational caregiver-child interaction task. These new data will provide vital information that could explain the tremendous variability in child attention and executive function we observe in the NOVI cohort. Using both new and existing data, this proposal aims to determine (a) child-, caregiver-, and family-

related predictors of caregiving quality and (b) associations between caregiving quality and child attention and executive function during the school-age period in children born very preterm. Findings from this study will advance theory regarding the contributions of caregiving quality to the development of very preterm children and

could be used to create interventions to mitigate cognitive deficits in very preterm children during the transition to school. By pinpointing predictors of caregiving quality, these results could also be used to identify preterm children and their caregivers who could benefit most from a novel caregiving intervention.