Context Research on psychiatric disturbances in low-birth-weight (LBW) children (
2500 g), which has focused primarily on the extreme low end of the LBW distribution, has suggested an increased risk of attention, externalizing, and internalizing problems.
Objective To examine the long-term effects of LBW on psychiatric problems in socially disadvantaged children and in middle-class children.
Design A stratified random sample assessed at ages 6, 11, and 17 years.
Setting Random samples of LBW and normal-birth-weight children from newborn discharge lists (1983 through 1985) of 2 major hospitals in southeast Michigan, one serving an inner city and the other serving middle-class suburbs.
Participants Cohort members with 1 or more assessments (n = 823).
Main Outcome Measures Attention, internalizing, and externalizing problems rated by mothers and teachers (Child Behavior Checklist and Teacher's Report Form, respectively) at ages 6, 11, and 17 years, using standard cutoffs that identify children with disturbances above the normal range.
Results Low-birth-weight children had modest excesses of externalizing and internalizing disturbances (adjusted odds ratios = 1.53 and 1.28, respectively) (P = .001 and .02, respectively). An increased risk of attention problems was associated with LBW only in the urban community (adjusted odds ratio = 2.78) (P = .001) and was greater among very LBW children (1500 g) than heavier LBW children (1501-2500 g). In the suburban community, there was no increased risk for attention problems associated with LBW. Psychiatric outcomes of LBW did not vary across ages of assessments.
Conclusions Effects of LBW on psychiatric disturbance appear to be stable through the period of school attendance. The differential effect of LBW on attention problems between the 2 communities suggests the possibility of interplay between prenatal adversity and social environment.
