Identifying very preterm children at educational risk using a school readiness framework

OBJECTIVES: Children born very preterm (VPT) are at high risk of educational delay, yet few guidelines exist for the early identification of those at greatest risk. Using a school readiness framework, this study examined relations between preschool neuro-developmental functioning and educational outcomes to age 9 years.METHODS: The sample consisted of a regional cohort of 110 VPT (≤32 weeks' gestation) and 113 full-term children born during 1998-2000. At corrected age 4 years, children completed a multidisciplinary assessment of their health/motor development, socioemotional adjustment, core learning skills, language, and general cognition. At ages 6 and 9, children's literacy and numeracy skills were assessed using the Woodcock-Johnson III Tests of Achievement.RESULTS: Across all readiness domains, VPT children were at high risk of delay/impairment (odds ratios 2.5-3.5). Multiple problems were also more common (47% vs 16%). At follow-up, almost two-thirds of VPT children were subject to significant educational delay in either literacy, numeracy or both compared with 29% to 31% of full-term children (odds ratios 3.4-4.4). The number of readiness domains affected at age 4 strongly predicted later educational risk, especially when multiple problems were present. Receiver operating characteristic analysis confirmed ≥2 readiness problems as the optimal threshold for identifying VPT children at educational risk.CONCLUSIONS: School readiness offers a promising framework for the early identification of VPT children at high educational risk. Findings support the utility of ≥2 affected readiness domains as an effective criterion for referral for educational surveillance and/or additional support during the transition to school.