Executive function is associated with social competence in preschool-aged children born preterm or full term

https://doi.org/10.1016/j.earlhumdev.2014.02.011Get rights and content

Abstract

Background

Executive function (EF), defined as higher-order cognitive processes used in planning and organizing actions and emotions, is often impaired in children born preterm. Few studies have assessed social competence, the processes and resources required to meet social demands and achieve social goals, in children born preterm. The relations between EF and social competence in preterm and full term preschoolers have not been well characterized.

Aims

To characterize social competence and assess the relationship between EF and social competence in preschool-aged children born preterm or full term.

Study design

Cross-sectional study.

Subjects

Study subjects had a history of preterm birth (≤ 34 weeks of gestation) and birth weight < 2500 g (n = 70). Controls were born full term (≥ 37 weeks) (n = 79).

Outcome measures

Children completed a battery of EF tasks; a mean age-adjusted z-score for the battery was generated for each child. Parents rated child EF on one scale and child social competence on two standardized scales.

Results

Compared to full term children, preterm children showed a lower mean EF battery z-score, poorer parent-rated EF, and poorer scores on the two social competence scales. In hierarchical multiple regression models, EF battery z-score and parent-rated EF made independent contributions to both measures of social competence. Preterm birth explained additional variance for one measure of social competence.

Conclusions

Standard assessment of EF skills and social competence in young preschool children, including children born preterm, may identify at-risk children for long-term social difficulties and may also provide targets for intervention.

Introduction

Executive function (EF) has been defined as “higher-order cognitive processes involved in the self-regulation of thought, action, and emotion” ([1] page 1). EF is necessary for purposeful, goal-directed activity [2]. The EF skills that are developing in the preschool-aged child include inhibitory control, set shifting, planning and working memory [3], [4], [5], [6]. Deficits in EF are seen in young child clinical populations, such as children with histories of prematurity [4], [5], [7], [8], attention-deficit/hyperactivity disorder (ADHD) [4], [9], aggression [2] or brain injury [10]. Poor EF skills are related to difficulties in important areas of function, including cognitive and academic domains [2], [11]. It also has been proposed that poor EF has a role in social problems, from early childhood onward. However, published studies have focused on general social skills [1], [12], and are challenging to interpret as they measure a wide variety of psychosocial constructs spanning cooperative behavior and social functioning.

Social competence is one important facet of children's social–emotional development [1]. Social competence can be defined as “active and skillful coordination of multiple processes and resources of the child to meet social demands and achieve social goals in a particular type of social interaction (e.g., parent–child, peer relations) and within a specific context (e.g., home, school)” ([13], page 13). Social competence emerges gradually through childhood and adolescence and reflects a dynamic interplay between the individual and his/her environment [14]. Social competence can be assessed using child interviews, direct observations, or parent and teacher questionnaires [15], [16], [17], [18], [19], [20]. Social competence has important implications for public health from infancy to adulthood because it is associated with mental health, academic performance, and work place functioning [19], [21].

Studies of children born preterm have shown increased likelihood of adverse developmental, cognitive, and behavioral outcomes [4], [5], [7], [8], [22], [23], [24]. Further, researchers have shown that, compared to peers born at term, youth born preterm have greater difficulty with social relationships [22], [25], [26]. However, very few studies have specifically assessed the social competence of children born preterm [27], [28], particularly at young ages. Studies have shown that EF contributes to social outcomes in older preterm children [29], [30]. Studies of typically developing young children suggest that emerging EF skills may facilitate children's social competence [1], [3], [11]. An understanding of the associations of EF and social competence in young preschool children born preterm might inform intervention strategies to improve their EF and social competence early in life. The overall goal of this study was to determine if EF skills play a role in the social competence of preschool-aged children born preterm.

Sociodemographic factors, such as socioeconomic status and age, may also affect the development of both social competence and EF. Socioeconomic status (SES) has been associated with a wide array of socioemotional, cognitive, and health outcomes in childhood [31], including preterm birth [32]. Poor EF skills have been associated with economic disadvantage in children [33], [34]. A longitudinal study of preterm and full term children followed from birth to thirty-six months showed that higher SES was predictive of better cognitive and social development for all children [35]. Age is another important factor in the development of social competence and EF as both typically improve from childhood through adolescence [36].

The objective of our study was to characterize the relationship between EF and social competence in preschool-aged children who were born preterm or full term. We previously have demonstrated EF differences between full term and preterm children [37]. In this study, we focused on children born preterm as a model of biomedical risk for both impairments in EF and problems in social competence. We had three main hypotheses. Hypothesis 1 addresses social competence differences between full term and preterm children: Compared to full term children, preterm children show poorer parent-rated social competence. Hypothesis 2 addresses links between EF and social competence in both preterm and full term children: EF, whether assessed using performance-based measures or parent rating, is associated with social competence. These associations persist after controlling for maternal education and child age. Hypothesis 3 addresses contributions of preterm birth to social competence: Given the increased risk of adverse outcomes in children born preterm, gestational group contributes additional variance, beyond the effect of EF, to social competence.

Section snippets

Participants

Participants were 3- to 5-year-old children recruited from Palo Alto, CA, and surrounding counties. Gestational age (GA), birth weight (BW), and medical complications were gathered from parent report and medical records. Study subjects had a history of preterm birth (≤ 34 weeks of gestation) and BW < 2500 g (n = 70). Controls were born full term (≥ 37 weeks) and had no major medical complications (n = 79). Exclusion criteria for all participants included sensory impairments (i.e., blind or deaf),

Demographics and health

One hundred forty-nine participants were enrolled: 70 born preterm and 79 born full-term (see Table 1). Across gestational groups, child age, gender, race, and ethnicity distributions were similar. Overall, the mean participant age was 4.5 years (SD = .79), 50% male, 60% White, and 9% Latino. The two groups differed, by study design, with regard to birth weight and gestational age. Medical complications at birth in the preterm group included: 11 had abnormal findings on head ultrasound or MRI (at

Discussion

This study of three- to five-year old preterm and full term preschool children found that compared to full term children, preterm children showed poorer social competence on two parent rating measures that assess different components of social competence. As previously reported, preterm children compared to full term children had poorer EF skills on both performance-based and parent-rated EF measures [37]. Our investigation of the association between EF and social competence showed that both

Financial disclosure

The authors have no financial relationships relevant to this article to disclose.

Conflict of interest

The authors have no conflict of interest relevant to this article to disclose.

Acknowledgments

This work was supported by the Lucile Packard Foundation for Children's Health under a Pilot Early Career Grant, the Society for Developmental–Behavioral Pediatrics under the Young Investigator Award, the Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, under the Mentored Patient-oriented Research Career Development Award Grant K23HD071971 to Irene M. Loe, and the National Center for Research Resources, National Institutes of Health

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