PASTA – from grams to symptoms: visuo-motor deficits as transdiagnostic mediators between preterm birth and adolescent mental health

Preterm birth and low birth weight (PTB) are global health challenges associated with substantially elevated symptoms of psychiatric disorders. Particularly, increased symptoms related to ADHD, anxiety, and autism-spectrum-disorder have been proposed as a distinct “preterm behavioural phenotype”. In addition, PTB children often exhibit impaired development of visual perception and motor skills, and face frequent challenges with visuo-motor integration (VMI). However, the extent of these challenges remains elusive in adolescence after PTB. The PASTA project (Preterm-to-Adolescent Specifically Tailored Assessment) aims to investigate the value of these skills as easily obtainable (bio)markers for the future development of low-threshold, non-stigmatising assessments, which are tailored to the unique challenges of PTB populations. More specifically, we (1) compare disorder-specific to transdiagnostic screening approaches of mental health in PTB adolescents and (2) examine the mechanisms driving the reported elevated risks of developing mental disorders in adolescence.

To address these aims, we evaluated motor-reduced visual perception (MRVP) and visuo-motor integration (VMI) within a sample of 355 adolescents aged 10-14 years who have been followed from birth as part of the longitudinal German Neonatal Network cohort (GNN; N = 265; mean gestational age [GA] 28.0 weeks and 996 g birth weight [BW]; full-term control: N = 90). These adolescents underwent standardised testing of their MRVP and VMI skills as well as screening of their self-reported mental health status as part of the GNN’s second follow-up assessment. We used the Frostig Developmental Test of Visual Perception–Adolescents and Adults (FEW-JE) and diagnostic system for mental disorders for children and adolescents – III (DISYPS – III) in conducting these assessments. Separate causal mediation analyses investigated links between birth circumstances (GA and BW) and DISYPS total symptom scores with MRVP and VMI as mediators while controlling for age and sex.

These data showed corroborating evidence of increased self-reported symptoms of mental disorders in PTB adolescents, already at age 10. The reported symptoms aligned more closely with broader transdiagnostic concepts than disorder-specific categorisations and differ selectively between genders. That is, girls reported more frequent experience of internalising symptoms, while boys reported more frequent experience of externalising symptoms. Importantly, while we observed general deficits in visual perception (MRVP) and visuo-motor integration (VMI) amongst PTB adolescents, we also found that deficits in MRVP and VMI are not merely comorbidities. In fact, they are significant primary mediators of self-reported transdiagnostic psychiatric symptoms in young adolescents aged 10-14 after PTB, as they mediate the impact of both GA and BW.

Together, the uncovered relations have important implications for tailoring early-detection of mental disorders in early adolescence to this specific risk group. They reveal an important modifiable mediator between biological birth parameters and adolescent mental health, which can be addressed in paediatric departments, starting shortly after birth. Strengthening visual and VMI skills in childhood may equip PTB infants with protective factors for their future mental health.

References

No references