Executive functions deserve special attention in children born preterm

Executive functions (EFs) are higher-order cognitive skills that support goal-directed behavior and help children adapt to their environment, particularly when routine responses are insufficient. EFs include key components, such as inhibition, working memory, and cognitive flexibility, which underlie higher-order processes such as planning. We conducted an integrative assessment of EFs in preterm children by combining standardized performance-based tests, questionnaires on daily life, and an analysis of academic performance (reading, spelling, and mathematics).

The preterm children in this study are from the LACTACOL cohort. Our study includes 56 children, aged 7 to 9 years, who were born preterm (between 28 and 34 weeks of gestation), have no neurological disorders, and are growing up in favorable educational and socioeconomic environments. These children underwent a multidimensional assessment of EFs, combining performance-based measures (the Child Executive Functions Battery, or “CEF-B”) and daily life measures (the Behavior Rating Inventory of Executive Functions, or “BRIEF,” parent and teacher versions). EF disorder was defined as congruent impairments in both the CEF-B Deficity Index and the BRIEF Overall Composite Index of Executive Functions (parent or teacher version), relative to French norms (scores ≥ 90th percentile).

EF impairments were identified in 30.4% of preterm infants, despite an above-average mean IQ (107 ± 12.5). The CEF-B revealed a high prevalence of EF difficulties (ranging from 19.6% to 51.8% depending on the component: inhibition, working memory, flexibility, or planning). In daily life, difficulties were generally reported by parents (23.2%) and teachers (16.4%). Scores on the CEF-B and the BRIEF showed weak to moderate correlations and poor-to-fair congruence. A higher level of education among fathers (OR: 6.73, p = 0.049) and a higher level of education among both parents (OR: 8.22, p = 0.033) were protective factors against EF disorders. Perinatal variables (sex, gestational age, birth weight) and family income did not show a significant impact. These results confirm the high risk of EF-related difficulties among preterm children.

We also examined the impact of EFs on academic achievement. Children with EF deficits were at higher risk for academic difficulties (OR 7.87; 95% CI: 2.2–35.2), with planning emerging as the most significant predictive factor.

The results confirm the high risk of executive function disorders among preterm children. Further research should help identify high-risk children to ensure they receive follow-up and support, while also raising awareness of these disorders. A structured, multidimensional assessment of academic performance and EFs should be systematically incorporated into the follow-up care for these children.

1. Cadeau O, Muller JB, Guerra A, Boscher C, Frondas A, Rozé JC, Flamant C, Boquien CY, Simon L, Roy A (2026) Executive Functions Predict Academic Difficulties in Preterm with Protective Factors and Normal IQ. Developmental neuropsychology:1-17. doi:10.1080/87565641.2026.2671827

2. Cadeau O, Muller JB, Guerra A, Boscher C, Frondas A, Rozé JC, Flamant C, Boquien CY, Simon L, Roy A (2026) Beyond protective factors and normal IQ in preterm children: More executive disorders than expected. Journal of neuropsychology. doi:10.1111/jnp.70065

Contact: clair-yves.boquien@univ-nantes.fr