Which one is stronger, nature or nurture? That was the question posed by researchers who led a study to find out whether the problems faced by premature babies later in their lives were related to the time they were born or rather, how they were raised.

Compared to full-term babies, babies born at least ten weeks premature have a heightened risk of developing several disorders like autism spectrum disorder (ASD), anxiety, and attention-deficit/hyperactive disorder (ADHD). But, this study – conducted by researchers from Washington University School of Medicine in St Louis, Missouri, USA – suggests that the environment preemies go home to might play a more significant role in whether or not they develop these disorders. The findings were published in The Journal of Child Psychology and Psychiatry.

The study

Researchers gathered 125 five-year-olds, 85 of whom were born at least ten weeks before their due dates. The remaining 40 children were born full-term at 40 weeks.

The children were given standardised tests to complete that the researchers used to assess their cognitive, motor and language skills. The researchers also gave parents and teachers checklists to fill. Those checklists helped the researchers tell whether the children had issues that could indicate ASD, ADHD, or any other social, behavioural and emotional problems.


Researchers found that children born at least ten weeks before term fell into one of four groups. One group, about 27 per cent of the preemies, were found to develop at a normal rate, with cognitive, motor and language skills in the range expected for their age. Those children were also unlikely to have psychiatric issues.

Another group of kids – about 45 per cent of the preemies – were also found to be healthy and developing within the normal range but on its lower end. In the last two groups, the children visibly dealt with psychiatric issues like ADHD, ASD or anxiety. In one of those groups – about 13 per cent of the preemies –, the children had moderate to severe challenges. The remaining group (15 per cent) were identified through the teachers’ surveys as dealing with a mixture of challenges, like impulsive behaviour, inattention and hyperactivity.

But, the kids from the last two categories weren’t that different from the others in the study when it came to cognitive, motor and language skills. However, their rates of ADHD, ASD and other problems were still higher.

Possible reasons for these differences

Cynthia E. Rogers, MD, a senior investigator in the study and an associate professor of child psychiatry, said that the children who had psychiatric problems also came from homes where the mothers had similar problems.  According to Dr Rogers, those mothers had more ADHD symptoms and also faced high parenting and psychosocial stress. She also said that the families those children came from had more dysfunction in general. Dr Rogers believes that these factors likely contributed to the challenges faced by the groups of children she said dealt with “significant impairment”.

And the opposite is true, according to the study’s first author, Rachel E. Lean, PhD, a postdoctoral research associate in child psychiatry. Lean said that the mums of the children who did the best in the study reported lower levels of depression and parenting-related stress. She also said that those children had more stable homes and parents who engaged with them in mentally stimulating activities like reading and other educational activities.

Why this matters

Rogers and Lean believe that the results could be considered “good news” because the things that seemed to affect the premature children the most can be modified, like maternal mental health and familial environment. They say that these factors could be improved with specific interventions and that such improvements could better the long-term prospects of preterm kids.

This study’s results, according to Rogers, went against the common notion that very premature children – like those in the study – will be significantly affected development-wise because of the challenges they had to overcome as NICU babies. She said that what appeared to matter the most “was what happened after a baby went home from the NICU”.

The researchers are continuing to follow up with the kids from the study.

Written By : Tesneem Ayoub


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