Nombre d’enfants nés prématurément ont des difficultés attentionnelles et des comportements d’hyperactivité qui sembleraient liés aux déficits des fonctions exécutives.

Examiner si le suivi proposé au niveau national en Suisse aux enfants nés prématurément permet la détection des problèmes exécutifs.

Quarante-neuf enfants nés avant 29 semaines de gestation et examinés entre 5 et 6ans dans le cadre du suivi neurodéveloppemental standard comprenant l’évaluation cognitive avec les trois échelles du K-ABC (Kaufman Assessment Battery for Children), les processus mentaux composites (PMC), séquentiels et simultanés, et l’évaluation du comportement (SDQ pour Strenghts and Difficulties Questionnaire). Les fonctions exécutives ont été évaluées par des épreuves neuropsychologiques supplémentaires testant l’attention, l’inhibition, la mémoire de travail et par un questionnaire parental (BRIEF pour Behaviour Rating Inventory of Executive Function). La valeur discriminative des épreuves standard (K-ABC et SDQ) pour les troubles exécutifs a été examinée.

Si l’échelle PMC discriminait peu les résultats obtenus aux tests neuropsychologiques, un score inférieur à 85 aux processus séquentiels était associé à une diminution significative des capacités attentionnelles. Le questionnaire SDQ permettait également une bonne discrimination des enfants présentant des difficultés explorées par le BRIEF.

Une analyse fine des résultats obtenus lors du suivi standard permet de cerner les difficultés des enfants nés prématurément : un résultat faible au niveau des processus séquentiels semble prédicteur de performances attentionnelles déficitaires. Les difficultés comportementales en lien avec les troubles exécutifs semblent bien dépistées par le SDQ. Il est important de détecter ces enfants, de les suivre avec des épreuves spécifiques si nécessaire et de favoriser des mesures de soutien.

A significant proportion of prematurely born children encounter behavioral difficulties, such as attention deficit or hyperactivity, which could be due to executive function disorders.

To examine whether the standard neurodevelopmental assessment offered to premature children in Switzerland recognizes executive function disorders.

The study population consisted of 49 children born before 29 weeks of gestation who were examined between 5 and 6 years of age with a standard assessment, with additional items to assess executive functioning. Children with severe neurodevelopmental impairment were excluded (mental retardation, cerebral palsy, autism). Standard assessment consisted in the Kaufman Assessment Battery for Children (K-ABC), which comprises three subscales: sequential processes (analysis of sequential information), simultaneous processes (global analysis of visual information), and composite mental processes (CMP) (result of the other two scales), as well as a behavioral evaluation using the standardized Strengths and Difficulties Questionnaire (SDQ). Executive functioning was assessed with tasks evaluating visual attention, divided attention, and digit memory as well as with a specialized questionnaire, the Behavior Rating Index of Executive Functions (BRIEF), which evaluates several aspects of executive function (regulation, attention, flexibility, working memory, etc).

Children were divided according to their results on the three K-ABC scales (< or>85), and the different neuropsychological tasks assessing executive function were compared between the groups. The CMP did not differentiate children with executive difficulties, whereas a score<85 on the sequential processes was significantly associated with worse visual and divided attention. There was a strong correlation between the SDQ and the BRIEF questionnaires. For both questionnaires, children receiving psychotherapy had significantly higher results. Children who presented behavioral problems assessed with the SDQ presented significantly higher scores on the BRIEF.

A detailed analysis of the standard neurodevelopmental assessment allows the identification of executive function disorders in premature children. Children who performed below 85 on the sequential processes of the K-ABC had significantly more attentional difficulties on the neuropsychological tasks and therefore have to be recognized and carefully followed. Emotional regulation had a strong correlation with behavioral difficulties, which were suitably assessed with the SDQ, recognized by the families, and treated.