Temperament and Behavior of Preterm Infants: A Six-Year Follow-up

To test the commonly held premise that prematurity is a risk factor for problems of behavior and social interaction, as well as cognitive and physical development, temperament and behavior of children born preterm and full-term control subjects were compared at five separate time periods from infancy through early school age. All the preterm infants (n = 126) of a representative group of infants enrolled in a longitudinal study (n = 2443) were surveyed at 4 to 8 months corrected age. Subsamples of the group were studied further in successive years as young toddlers (n = 65), older toddlers (n = 60), preschoolers (n = 84), and at early school age (n = 81). At each period there were no differences between those studied and those not studied on socioeconomic status, gestational age, sex, or birth order. Parental ratings of temperament and behavior were used at appropriate ages: the Revised Infant Temperament Questionnaire, the Toddler Temperament Scale, the Childhood Temperament Questionnaire, Behaviour Checklist, Preschool Behaviour Questionnaire, and Rutter's Childhood Behaviour Questionnaire (CBQ), as well as mother's overall rating of temperament. In infancy there were no significant differences on temperament dimensions, clinical temperament categories, or parental ratings of individual or composite behaviors between the preterm and full-term groups. For toddlers, temperament scores were similar for the two groups but preterm subjects were significantly more likely (P < .01) to have an easy temperament and less likely to have a difficult temperament. There were no differences on any of the other temperament or behavior ratings. There were no differences between the two groups in the preschool period on the Childhood Temperament Questionnaire, Preschool Behaviour Questionnaire, or on parental ratings of behavior. At early school age no differences were found on the Childhood Temperament Questionnaire or Childhood Behaviour Questionnaire. All of these results were independent of sex, birth order, gestational age, and socioeconomic status. There were no significant correlations within the preterm sample at any of the time periods between gestational age and any measures of temperament and behavior. It is concluded that as a group preterm children do not differ greatly in temperament and behavior from full-term control subjects. Where problems do arise they are likely to be the result of intrinsic or environmental factors in the transaction that are independent of prematurity per se, such as severe perinatal stress or difficulties in the caretaking milieu.