School difficulties at adolescence in a regional cohort of children who were extremely low birth weight

Objectives. To compare measures of psychometric assessment and school diffi culties in a cohort of extremely low birth weight (ELBW) teenagers and term controls, and to determine whether there is stability in psychometric meas ures between age 8 and the teen years. Study Design. Longitudinal follow-up; geographically defined region. Partic ipants: 150 of 169 (89%) ELBW survivors born between 1977 and 1982 and 124 of 145 (86%) sociodemographically matched term controls between 12 and 16 y ears of age. Psychometric measures: Wechsler Intelligence Scale for Childre n-Revised, Wide Range Achievement Test-Revised, and a validated parent ques tionnaire. Results. Neurosensory impairments were present in 28% of ELBW and 1% of con trols. The mean Wechsler Intelligence Scale for Children-Revised scores wer e ELBW: 89 +/- 19 and controls: 102 +/- 13. ELBW children did less well on Wide Range Achievement Test-Revised Reading, Spelling, and Arithmetic measu res with mean scores in the range from 75 to 85. ELBW children <750 g were more disadvantaged, compared with those greater than or equal to 750 g. A s ignificantly higher proportion of ELBW children were receiving special educ ational assistance and/or had repeated a grade (ELBW: 58%; controls: 13%; o dds ratio: 9.0). Paired analysis of within-cohort data at age 8 and teen ye ars showed that for both cohorts Arithmetic scores declined, but there were small improvements in other measures, predominantly in the term children. Conclusions. Differences of 13 to 18 points in psychometric measures in ELB W teens compared with controls are both statistically significant and clini cally relevant. Decreasing birth weight was associated with increased risk on all measures. The high utilization of special educational resources has economic implications, and the incremental cost attributable to being extre mely premature needs to be determined.