A hidden phenotype: understanding subclinical deficits in attention, executive function, and social communication in children born very preterm

The National Institutes of Health Office of the Director awarded Women & Infants Hospital of Rhode Island $875,534 on July 6, 2026, under the Trans-NIH Research Support program (CFDA 93.310) to study subclinical deficits in attention, executive function, and social communication in children born very preterm.

The project will recruit and follow a cohort of 240 very preterm children (born before 32 weeks gestation) from the hospital's neonatal follow-up program, tracking them from ages 3 through 5. Researchers will abstract existing data from the neonatal intensive care unit and follow-up program regarding early medical course and neurodevelopment, then conduct new assessments to measure attention, executive function, social communication, and functional outcomes in academic and family functioning. The study addresses a "hidden phenotype" of subclinical deficits that pilot data suggests affects over 30 percent of very preterm children by school age but often goes undiagnosed or is diagnosed later in life, despite these children performing equally poorly on academic measures compared to those with more severe diagnosed deficits.

Work is performed in Providence, Rhode Island. The period of performance runs through March 31, 2031.

Abstract

Children born very preterm (VPT; < 32 weeks gestation) are at increased risk for poor neurodevelopmental outcomes including specific deficits in attention, executive function (EF), and social communication (SC). While VPT children with the most severe impairments in these areas are often detected and diagnosed with disorders such as attention deficit hyperactivity disorder (ADHD) or autism spectrum disorder (ASD), attention, EF, and SC skills exist on a spectrum and more subtle impairments may not be diagnosed or may be diagnosed later in life. We currently lack understanding about this "hidden phenotype" characterized by subclinical deficits in attention, EF, and/or SC though our pilot data shows that over 30% of VPT children have these subtle deficits by school age, and that children with subclinical deficits perform equally poorly on measures of academic functioning compared to children with more severe deficits. To further elucidate this "hidden phenotype", the proposed project will recruit a cohort of 240 VPT children from the neonatal follow-up program at women and infants hospital of rhode island and follow them from ages 3 through 5. We will abstract data routinely collected by the neonatal intensive care unit (NICU) and follow-up program regarding the child's early life medical course and neurodevelopment and conduct new data collection to obtain additional measures of attention, EF, and SC, as well as functional outcome data (academic and family functioning). Combining existing follow-up data with new assessment data allows US to address our specific aims using a wider developmental lens (birth to age 5) and a more cost-effective strategy than if we were to recruit a single, DE novo cohort at birth. The proposed MPI/CO-I team brings together experts in developmental psychology, clinical psychology, and neonatology who have a productive collaboration history including on a prior NIH-funded, longitudinal study of VPT children. The overarching goal of this proposal is to identify a subgroup of VPT children with subclinical deficits in attention, EF, and/or SC, and investigate the early life precursors (medical, environmental, and neurobehavioral factors) and functional impairments associated with this subclinical phenotype. IT is imperative to identify this phenotype in preschool-aged children because this period precedes the transition to formal schooling, is a period of rapid development in attention, EF, and SC skills, and is a time period during which some neonatal follow-up programs continue to offer developmental surveillance and thus have the potential to put supports in place for children with subclinical deficits. Results from this study could inform future resource allocation, assessment procedures, and discharge criteria for neonatal follow-up programs, and improve identification of all VPT children at risk for poor outcomes, especially those not meeting current diagnostic criteria. Our findings will also help identify modifiable risk factors in the early environment that could inform the development of new preventive interventions to promote positive outcomes for all VPT children.