1. Cross-disciplinary research project with a clear pathway to impact to inform intervention strategies for improving social skills in children born preterm. The project will provide foundational data to inform a subsequent funding application to develop and evaluate an intervention programme as part of a post-doctoral fellowship.
2. The student will gain experience in administering standardised psychometric tests in a clinical population, developing computerised cognitive tests, using eye-tracking methods, and in understanding and implementing open science practices.
3. The project will capitalise on Dr Spiller’s, Professor Johnson’s and Professor Draper’s experience of conducting cohort studies of children born preterm with substantial clinical impact (e.g. the EPICure Studies, the PRISM Studies and the EPICE study).
Compared with children born at term (≥37 weeks’ gestation), children born very preterm (VP; <32 weeks’ gestation) are more likely to have poor social skills and to be bullied, both of which increase the risk for mental health sequelae. Consequently, research is needed to identify the aetiology of VP children’s social difficulties to develop effective intervention strategies.
Two theories are proposed:
1) A general cognitive deficit in executive functions (EF) may underlie poor social competence in VP children. EF deficits are well documented in children born VP and there is evidence that EF skills mediate the relationship between VP birth and social problems in adolescence. General, rather than specific, cognitive deficits have also been shown to underlie VP children’s poorer academic attainment.
2) VP children may have a specific cognitive deficit in Theory of Mind (ToM) which underlies their poor social competence. The association between ToM and social skills is well established in typically developing children. However, the few studies on ToM in preterm-born children show mixed findings and have methodological limitations. In particular, no studies have assessed more complex ToM skills such as hidden emotion and understanding sarcasm in VP children. This is important as impairments in emotion recognition, perception of non-verbal cues for identifying others’ emotional states and social reasoning have been reported in children born VP and may be associated with poorer social skills.
There is a paucity of research on ToM in VP children in general, and no studies have investigated advanced ToM skills. To test both theories, the student will develop and pilot a battery of tests to assess EF, ToM and social skills in 80 VP and 80 term-born children to determine the aetiology of VP children’s poor social competence. The results will inform the development of intervention strategies to improve social skills and mental health in this population. The student will disseminate their results through presentations at academic conferences spanning multiple disciplines (paediatrics, psychology, psychiatry), via peer-reviewed publications and stakeholder events for professionals and people with lived experience of preterm birth.
With support from our clinical collaborators at University Hospitals of Leicester NHS Trust and Nottingham University Hospitals NHS Trust, the student will recruit and organise assessments in school for 80 VP children (aged 6-8 years at time of assessment). A term-born classmate of the same sex and age as each VP child will also be recruited to form a control group (n=80). 60 children per group will give sufficient power to detect a between-group difference of 0.54 SD in the primary outcome (Social Reciprocity Scale scores) (α 0.05, 90% power). The student will carry out a comprehensive literature review to identify which components of EF should be assessed. They will then identify or develop computerised tests to assess these component skills. They will also test advanced ToM skills and verbal comprehension alongside eye-tracking to assess orientation towards social stimuli. Parents and teachers will complete questionnaires to assess children’s social competence.
1. Korzeniewski, S.J., et al., Social responsiveness scale assessment of the preterm behavioral phenotype in ten-year-olds born extremely preterm. Journal of developmental and behavioral pediatrics: JDBP, 2017. 38(9): p. 697-705.
2. Healy, E., et al., Preterm birth and adolescent social functioning–alterations in emotion-processing brain areas. The Journal of pediatrics, 2013. 163(6): p. 1596-1604.
3. Wolke, D., et al., Bullying of preterm children and emotional problems at school age: cross-culturally invariant effects. The Journal of pediatrics, 2015. 166(6): p. 1417-1422.
4. Taylor, H.G. and C.A. Clark. Executive function in children born preterm: risk factors and implications for outcome. in Seminars in perinatology. 2016. 40(8): p.520-529.
5. Twilhaar, E.S., et al., Social adjustment in adolescents born very preterm: evidence for a cognitive basis of social problems. The Journal of pediatrics, 2019. 213: p. 66-73. e1.
6. Simms, V., et al., Nature and origins of mathematics difficulties in very preterm children: a different etiology than developmental dyscalculia. Pediatric Research, 2015. 77(2): p. 389-395.
7. Caputi, M., et al., Longitudinal effects of theory of mind on later peer relations: the role of prosocial behavior. Developmental psychology, 2012. 48(1): p. 257-270.
8. Imuta, K., et al., Theory of mind and prosocial behavior in childhood: A meta-analytic review. Developmental psychology, 2016. 52(8): p. 1192-1205.
9. Jones, K.M., P.R. Champion, and L.J. Woodward, Social competence of preschool children born very preterm. Early human development, 2013. 89(10): p. 795-802.
10. Mossad, S.I., et al., Neural correlates of “Theory of Mind” in very preterm born children. Human brain mapping, 2017. 38(11): p. 5577-5589.
11. Marleau, I., et al., Social cognition, adaptive functioning, and behavior problems in preschoolers born extremely preterm. Child Neuropsychology, 2021. 27(1): p. 96-108.
12. Roldán-Tapia, M.D., S. Moreno-Ríos, and R. Cánovas-López, Thinking about social and nonsocial alternative possibilities in premature preschoolers. Journal of clinical and experimental neuropsychology, 2017. 39(8): p. 725-737.
13. Witt, S., et al., Delayed theory of mind development in children born preterm: A longitudinal study. Early human development, 2018. 127: p. 85-89.
14. Peterson, C.C., H.M. Wellman, and V. Slaughter, The mind behind the message: Advancing theory‐of‐mind scales for typically developing children, and those with deafness, autism, or Asperger syndrome. Child development, 2012. 83(2): p. 469-485.
15. Lejeune, F., et al., Social reasoning abilities in preterm and full-term children aged 5–7 years. Early human development, 2016. 103: p. 49-54.
16. Williamson, K.E. and L.S. Jakobson, Social perception in children born at very low birthweight and its relationship with social/behavioral outcomes. Journal of Child Psychology and Psychiatry, 2014. 55(9): p. 990-998.
17. Wocadlo, C. and I. Rieger, Social skills and nonverbal decoding of emotions in very preterm children at early school age. European Journal of Developmental Psychology, 2006. 3(1): p. 48-70.