National Forum for Neuroscience in Special Education
STATEMENT ON THE EDUCATIONAL NEEDS OF CHILDREN BORN PRETERM
This statement is a joint parent- and professional-instigated outcome from the National Forum for
Neuroscience in Special Education’s Second Annual Conference: ‘The learning and
neurodevelopmental needs of children born pre-term – a conference to bridge thinking and
understanding between education and neuroscience across the school years’ (Institute of
Education, London, 31 January 2013). This Conference was given in partnership with Bliss, the
special care baby charity, and generously funded by The Waterloo Foundation.
Background
With improving medical skill and knowledge, more children born premature1 or with low birth
weight2 are surviving than ever before (Reijneveld et al., 2006), and greater numbers are arriving in
our schools. Yet, the teachers in our schools do not have the information or tools to support their
learning needs (Carpenter, 2013; Wolke, 2013). A survey by the University of Warwick (Henderson et
al. 2012) found that although 89% of 120 teachers said they were likely to teach a child born
prematurely, only 6% felt they had received sufficient training.
Approximately 1 in 8 (80,000 per annum) children are born preterm in the UK every year (Medical
Research Council, 2008). There are likely to be four children born preterm in every classroom, and
two in every 100 children are born extremely preterm (Hornby and Woodward, 2009).
In addition to neurodevelopmental impairments (e.g. visual, hearing and motor disabilities),
premature birth can result in (Poehlmann et al., 2011; Wolke, 2010):
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Reduced cognitive capacity
Social and behavioural difficulties
Learning disabilities
Poor academic outcomes, especially in the areas of mathematics and literacy.
Pritchard et al. (2009) note:
By middle childhood, children born very preterm (VPT) are 3 to 5 times more likely to show
difficulties across a range of school based skills and educational domains… As a consequence,
it is estimated that 60–70% of VPT children will require support from special education
services by middle school age. (Pritchard et al., 2009)
Even children born premature who are unaffected by neurodevelopmental impairments and who
have IQ within the normal range are at risk of poorer school performance than children born at term
with a normal birth weight (Lee et al., 2011; Marlow, 2005).
1
Full-term - Over 37 weeks; Preterm - Less than 37 weeks; Very preterm - Less than 32 weeks; Extremely
preterm – Less than 28 weeks
2
Normal birth weight (NBW) - Greater than 2,500g; Low birth weight (LBW) - Less than 2,500g; Very low birth
weight (VLBW) - Less than 1,500g; Extremely low birth weight (ELBW) - Less than 1,000g
1
CHIEF EXECUTIVE, Sue Williamson
5th Floor, 142 Central Street, London, EC1V 8AR
T: 020 7802 2300 F: 020 7802 2345
E: info@ssatuk.co.uk
SSAT (The Schools Network) Ltd, A PRIVATE COMPANY LIMITED BY SHARES
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Sensitive and responsive parenting and teaching can ameliorate disadvantages. However, children’s
difficulties are often ‘invisible’ to educators who lack the information and training to recognise them.
Lack of support in childhood has been linked with detrimental life outcomes for young people born
preterm – school underachievement, unemployment, poor social and psychological well being
(Woythaler et al., 2011).
Although incidence of neurodevelopmental disabilities, such as sensory impairment and cerebral
palsy is falling, the levels of cognitive, social and behavioural impacts remain largely unchanged
(Wolke, 2013). These learning problems persist throughout childhood and adolescence, therefore
cannot be explained solely by developmental delay (Anderson et al., 2004; Kierkegaard et al., 2006).
With Department for Education support and guidance, schools need to:
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Raise educator knowledge and understanding of the potential difficulties of children and young
people born preterm, and of the need for proactive educational responses
Promote best outcomes for children born preterm and their families.
Preterm birth – Educational risk
Premature birth may result in smaller brain volume, which impacts on verbal and performance IQ
scores at school age and is associated with poorer neurodevelopmental outcomes in adolescence.
(Skiold, 2011). The longitudinal Epicure study (Marlow et al., 2005), following all children born
premature in 1995, found that of those surviving at age 6 years, 32% of had mild disabilities, 24%
had moderate disabilities and 22 % had severe disabilities (Johnson et al., 2009).
The Epicure study has identified a clear phenotype for very and extremely preterm children (Wolke,
2010) which carries increased risk of:
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Pervasive cognitive processing difficulties
Learning problems: reading and maths
Educational problems and high special education resource needs
High service costs.
At 11 years, extremely preterm children continue to have much poorer school performance and a
high level of special educational needs, including (Johnson et al., 2009):
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Need for additional support (in mainstream schools - £53%; in special schools – 13%)
Serious impairment in maths (44%)
Serious impairment in reading (25%).
Nosarti et al. (2012) have also identified significant executive function difficulties in young
adulthood. These difficulties can intensify with age associated with increasing educational support
needs (Reijneveld et al., 2006; Wolke, 2010).
Preterm birth – Social and emotional risk
Children born very or extremely preterm are 50% more likely than their full-term peers to have
behaviour difficulties in the clinical range, both at preschool and school ages (Reijneveld et al.,
2
CHIEF EXECUTIVE, Sue Williamson
5th Floor, 142 Central Street, London, EC1V 8AR
T: 020 7802 2300 F: 020 7802 2345
E: info@ssatuk.co.uk
SSAT (The Schools Network) Ltd, A PRIVATE COMPANY LIMITED BY SHARES
REGISTERED IN ENGLAND AND WALES, COMPANY NO. 8073410
2006). They are also at increased risk of developing social and emotional problems (Elgen et al.,
2012; Reijneveld et al., 2006; Skiöld, 2011; Wolke, 2010) including significantly more symptoms of:
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ADHD (inattention type)
Autistic spectrum symptoms
Social phobia/peer interaction
Depression/anxiety
Emotional/conduct disorders or problems.
Young people born at 32 to 36 weeks’ gestation are also at greater risk than full-term peers for
development of mental health issues (Nosarti et al., 2012):
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Psychosis: 1.6 times more likely (below 32 weeks, 2.5 times more likely)
Depressive disorder: 1.3 times more likely (below 32 weeks, 2.9 times more likely)
Bipolar: 2.7 times more likely (below 32 weeks, 7.4 times more likely).
It is likely that, as children get older, behavioural and emotional problems may affect academic
functioning (Reijneveld et al., 2006; Wolke, 2010).
Call to action
Professionals agree that, In order to divert bleak outcomes for children born preterm, ‘it is
imperative that their health and educational needs are identified and resources are committed to
address their needs’ (Mandy, 2011).
They suggest the following provisions to support the child’s education (Anderson et al., 2004;
Carpenter, 2013; Hack et al., 2005; Munck, 2012; Nosarti et al., 2012; Reijneveld et al., 2006; Tutt et
al., 2012):
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School-held developmental record of the child
Appropriate personalised decisions on school entry (e.g. consideration of deferred/delayed
school entry)
Regular cognitive/social/emotional assessment of children born preterm to allow early
identification and intervention of educational need, and long-term follow up
Targeted, personalised educational assistance to overcome learning barriers (e.g. attention,
executive function issues, etc.) to enable the young person to achieve their potential
Development of interdisciplinary, evidence-based education pathways
Support, guidance and involvement of families
Continuing professional development to enable staff to recognise and respond proactively to the
learning difficulties and disabilities associated with premature birth
Support for educational research to improve life chances for these children.
3
CHIEF EXECUTIVE, Sue Williamson
5th Floor, 142 Central Street, London, EC1V 8AR
T: 020 7802 2300 F: 020 7802 2345
E: info@ssatuk.co.uk
SSAT (The Schools Network) Ltd, A PRIVATE COMPANY LIMITED BY SHARES
REGISTERED IN ENGLAND AND WALES, COMPANY NO. 8073410
Conclusion
Educator knowledge and awareness are key to the diagnosis, assessment and successful intervention
of young people born preterm. This needs targeted support and guidance around educational
provision for this very vulnerable group of children to ensure their positive life outcomes.
The facts in this statement are corroborated by research carried out in countries around the world,
including in UK and Ireland, Canada, France, New Zealand, Sweden and the USA among many others.
Further information
In the first instance, please contact:
Natalie Eccles, Research and Development Assistant (Natalie.Eccles@ssatuk.co.uk).
References
Anderson, P.J., Doyle, L.W. and the Victorian Infant Collaborative Study Group (2004) ‘Executive
functioning in school-aged children who were born very preterm or with extremely low birth
weight in the 1990s’, NeoReviews, 114 (1), 50-57.
Carpenter, B. (2013) ‘The emerging new SENs of students born prematurely’, SecEd Magazine,
10.1.13 [Online at: http://www.sec-ed.co.uk/best-practice/the-emerging-new-sens-of-studentsborn-prematurely/; accessed: 13.5.13]
Elgen, S.K., Leversen, K.T., Grundt, J.H., Hurum, J., Sundby, A.B., Elgen, I.B. and Markestad, T. (2012)
‘Mental health at 5 years among children born extremely preterm: a national population-based
study’, European Child and Adolescent Psychiatry, 21 (10), 583-589.
Hack. M., Taylor, H.G., Drotar, D., Schluchter, M., Cartar, L., Andreias, L., Wilson-Costello, D. and
Klein, N. (2005) ‘Chronic conditions, functional limitations, and special health care needs of
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CHIEF EXECUTIVE, Sue Williamson
5th Floor, 142 Central Street, London, EC1V 8AR
T: 020 7802 2300 F: 020 7802 2345
E: info@ssatuk.co.uk
SSAT (The Schools Network) Ltd, A PRIVATE COMPANY LIMITED BY SHARES
REGISTERED IN ENGLAND AND WALES, COMPANY NO. 8073410
Johnson, S., Fawke, J., Hennessy, E., Rowell, V., Thomas, S., Wolke, D., et al. (2009)
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gestation’, Pediatrics, 124 (2), e249-e257.
Kirkegaard, I., Obel, C., Hedegaard, M. and Henriksen, T.B. (2006) ‘Gestational age and birth weight
in relation to school performance of 10-year-old children: a follow-up study of children born
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Marlow, N., Wolke, D., Bracewell, M.A. and Samara, M. (2005) ‘Neurologic and developmental
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Munck, P. (2012) Cognitive Development of Very Low Birth Weight Children from Infancy to PreSchool Age. Turku, Finland: University of Turku.
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and Hultman, C.M. (2012) ‘Preterm birth and psychiatric disorders in young adult life’, Archives
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Verloove-Vanhorick, S.P. (2006) ‘Behavioural and emotional problems in very preterm and very
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Tutt, R., Kirby, A., Grant, A. and Truman, J. (2012) ‘Insights from Neuroscience (Module 4.3):
Premature birth – Implications for education’. In: Teaching Agency (Ed.) Training Materials for
Teachers of Learners with Severe, Profound and Complex Learning Difficulties. London:
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GA: Emory University.
Wolke, D. (2010) ‘Small beginnings – large impact: development of preterms and implications for
early childhood intervention’. Presentation to the Complex Learning Difficulties and Disabilities
Research Project, Wolverhampton.
Wolke, D. (2013) ‘Pre-term birth: the implications for learning’. Presentation to the National Forum
for Neuroscience in Special Education’s Second Annual Conference: ‘The learning and
neurodevelopmental needs of children born pre-term – a conference to bridge thinking and
understanding between education and neuroscience across the school years’, Institute of
Education, London (31 January).
Woythaler, M.A., McCormick, M.C. and Smith, V.C. (2011) ‘Late preterm infants have worse 24month neurodevelopmental outcomes than term infants’, NeoReviews, 127 (3), e622-e630.
5
CHIEF EXECUTIVE, Sue Williamson
5th Floor, 142 Central Street, London, EC1V 8AR
T: 020 7802 2300 F: 020 7802 2345
E: info@ssatuk.co.uk
SSAT (The Schools Network) Ltd, A PRIVATE COMPANY LIMITED BY SHARES
REGISTERED IN ENGLAND AND WALES, COMPANY NO. 8073410