Moderately preterm born children need attention!

Every year 11.000 children are born with a gestational age of 32-36.6 weeks
(moderately preterm) in the Netherlands. This is 6.3% of all births in the
Netherlands. A recent Dutch study (van Baar et al., 2009) showed that
moderately preterm children at school age (7-9 years) have more attention and
concentration problems than term born children. In order to have the
possibility to intervene before school age, studies are needed to investigate
whether these problems are already visable at earlier age. In what way
attention and concentration problems of young children can be assessed and
recognized deserves further study. Questionnaires, rated by parents are
important, but also more objective data collection, for instance by using an
eye tracker system that informs on eye movements, may reveal important aspects
of attention
Next to that, studies showed that not all moderately preterm children showed
attention and concentration problems. Therefore, it is important to study
factors that might be linked to the development of attention and concentration
problems. Next to neonatal characteristics, parenting might be an important
factor. There are no recent studies on the influence of parenting on moderately
preterm children. Van de Weijer (2009) showed in her study, with severe
premature children, that especially a directive interaction style from the
mother was beneficial for the cognitive development of these children. How
parenting and mother-child interaction are of influence on the development of
moderately preterm children needs further study.

The next questions will be addressed in the present study:
1. Do moderately preterm infants differ in development and attention and
concentration capacities from a term and very preterm infants during the first
years of life?
2. Do attention and concentration difficulties as reported by parents,
correspond with a more detailed and objective measure of attention and
concentration capacities, such as by using eye tracker apparatus, and is this
the same for the three groups of children?
3. Is maternal stimulation related to attention and concentration capacities of
children during semi-structured interaction tasks? Are maternal personality and
well-being of influence on quality of maternal stimulation?
4. Do parents of moderately preterm children report differences in daily care
taking and parenting since birth of their children in comparison to parents of
a term children and very preterm children?
5. Do moderately preterm children differ from a term and very preterm children
on development as assessed with the Bayley-III developmental scales at 2 years
of age, the WPPSI and the attention tasks of the TEA-Ch and the NEPSY at 6
years of age?
6. Are developmental capacities of the children related to their attention and
concentration capacities and is this the same for all groups of children?
7. Are the assessments of attention, cognition, temperament and behavioral
problems and parenting and mother-child interaction at toddler age, related to
such asessments at six years of age?

Three data collection waves (consisting of filling out questionnaires during
every wave, and at wave 2 and 3 also a visit to Utrecht University and the
local hospital) will be done to study the research questions. For this study,
200 parents of moderately preterm children and 200 parents of a term children
and 140 parents of extremely preterm children, from different hospitals in and
around Utrecht, will be asked to participate in this study. Taking into account
a response rate of 50%, all groups will consist of 70-100 children
participating in the three measurement waves. For the first wave, parents are
asked to answer frequently used and standardized questionnaires on development
and temperament of their children, as well as about their family and their
caretaking and stimulation habits. The questionnaires will be sent when the
children are 11-13 months old.
For the second wave, when the children are 16-19 months of age, the parents and
children will be invited to the laboratory at Utrecht University to study
attention and concentration processes and mother-infant interaction. This visit
will take about 30 minutes. Next to that, the parents will again be asked to
answer frequently used and standardized questionnaires on development and
behavior of their children, as well as on their own background. Some of these
questionnaires will be identical to questionnaires from the first wave, in
order to be able to follow the development of the children over time.
After 6 months, when the children are 22-25 months of age, the parents and
children will be invited by us in the local hospital, for the third wave:
assessment of the development of the child, using the Bayley III scales. This
visit will take about 1.5 hours. Again parents will be asked to fill in
frequently used and standardized questionnaires on the development of their
children. Some of these questionnaires will be identical to questionnaires from
earlier data waves.

After these three data waves, parents who gave consent to contact them for
further study, are contacted and asked if they are willing to participate in a
fourth wave when their children are 36 months of age. This wave consists of
filling out questionnaires about the development and behavior of their child.

The fifth wave will consist of two visits. For the first visit parents and
child are invited to the research facilities at Utrecht University. The second
visit will be arranged at school (if possible), where the parents do not need
to be present. Time investment for the child will be around 1 hour for the
first visiit and 1* hour for the assessment at school. Time investment for the
parents will be around 1* uur regarding the interaction task and answering
questionnaires. Time investment for the teacher will be around * hour for
answering a questionnaire.

Parents' participation is voluntary and they are free to withdraw from the
study at all times without consequences. The study does not burden the
children. Usually the children enjoy the games and play materials very much. If
the children do not want to cooperate, or if the parents like to stop, the
assessment will be finished. Time investment for the child will be about 30
minutes during the second data wave and 1* hours in the third data wave,
resulting in a total of 2 hours. For parents this investment will be about 6
hours in total. They have to fill in questionnaires at all three measurement
waves (about 1 hour each time) and have to join the child during the lab- and
hospital visit (2 hours in total and the traveling time).

Participation in the fourth data wave will take another 30 minutes from the
parents' time.
Participation in the fifth data wave will take around 135 minutes of the
children; 75 minutes of the parents; and 15 minutes of the teachers.