Source:Hollo O, Rautava P, Korhonen T, et al. Academic achievement of small-for-gestational-age children at age 10 years.
Arch Pediatr Adolesc Med.
2002
;
156
:
179
–187.

This study investigates the academic achievement in school of small for gestational age (SGA) children when compared with a group of appropriate for gestational age (AGA) 10-year-old children. This Finnish study evaluated multiple associations (perinatal history, sociodemographics, neurological status, head growth, neurocognitive abilities, and behavior) with academic achievement in order to gather information on academic achievement of SGA children at age 10 years. The SGA group consisted of 106 children with birthweight below the 25th percentile. The degree of in utero growth retardation was standardized to an SGA index. The control group of 105 AGA children was matched for gestational age and type of delivery. Both groups were evaluated at age 10 years during routine outpatient visits.

Measure of intellectual ability was performed using the Finnish or Swedish version of the revised Wechsler Intelligence Scale (WISC) for children. Testing included visual motor perception, fine motor abilities, memory, and attention. Classroom teachers rated the child’s school behavior with the Conners’ abbreviated teacher rating scale, while behavior at home was assessed by the mother and/or father with the Conners’ parent rating scale.

Perinatal risk factor frequency was 18% in the SGA group and 12% in the AGA group. Socioeconomic status of the family and parental basic education were significantly higher in the AGA than the SGA group (P=.04). The mean head circumference of SGA children was significantly smaller than in the AGA children (P<.001), and the percentage of children with subnormal head growth at age 10 years was significantly greater in the SGA group than in the AGA group (P=.001). SGA children had significantly poorer short-term auditory memory (P=.004) and perceptual organization ability (P=.003) and a higher incidence of inattention than AGA children. Ten percent of the SGA children were restless during the clinic visit (versus 5% of AGA children) and 15% were overly timid in their interaction (compared to 5% of AGA children). Parent evaluation indicated SGA children had significantly more learning problems than AGA children. Concerning academic achievement, 25% of SGA children and 14% of AGA children were school failures (P=.05). Seven SGA children were in special education because of an intellectual disability compared to 1 AGA child. The adverse perinatal history of SGA children correlated with difficulties in school achievement, whereas in AGA children it did not.

This study, which indicated that SGA children performed worse at school than matched AGA controls, suggests the most powerful independent predictor of academic achievement was inattentive, passive behavior at school. Internalizing or withdrawn behavioral problems have been reported in association with intrauterine growth restriction (IUGR).1 The second most powerful predictor was verbal intelligence quotient (IQ) score where the overall intellectual performance of SGA children was lower than that of AGA children but within the reference range. The third most powerful...

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