Relationship between two-year behaviour and neurodevelopmental outcome at five years of very low-birthweight survivors.

A prospective five-year follow-up of survivors of very low birthweight (less than or equal to 1500 g) born in 1979 was carried out at the Queen Victoria Medical Centre, Melbourne, between 1980 and 1985. Of the 57 children reported here, 23 had been identified during psychological testing at two years as having an attention deficit disorder (ADD). Although the number with ADD at five years had decreased to 18, the two-year diagnosis was retained to test its predictive value for outcome at school-age. Children with ADD at two years differed significantly from their peers at five years in verbal, performance and full-scale IQ and had significantly more minor physical disabilities. They also had poorer visual acuity, more tremor, poorer balance, and more deviations with arms extended in pronation. The ADD children had more minor, though chronic, physical illnesses such as tonsillitis and serous otitis media. Their mothers expressed greater concern than the other mothers about hearing and behaviour. The ADD children were rated as significantly more aggressive, difficult to manage and less able to cope with frustration. As a predictor of five-year IQ, behaviour at two years was more powerful than social class. ADD discriminated a subgroup of very low-birthweight children whose lower IQ and multiple physical, neurological and behavioural difficulties place them at very high risk of learning disabilities.