Visual attention and processing function in relation to executive functioning in very preterm–born children aged 3 years: a prospective cohort study

The ability to orient attention to one's environment is a prerequisite for developing executive functions (EF) from preschool age. Very preterm children are vulnerable for delays in visual orienting function (VOF) and EF deficits. This study aimed to investigate associations between objective VOF and subjective parent-reported EF in very preterm-born children at 3 years corrected age (CA). In a prospective cohort study (BOND) involving 90 children born < 30 weeks, VOF and EF were assessed using an eye tracking-based method and BRIEF-P questionnaire. Associations between abnormal VOF (viewing reaction times) and EF scores (BRIEF-P scores) were studied using multivariable regression. Using a modified Delphi method, a subset of eight items related to VOF and EF was explored. Abnormal VOF was observed in 31% of the children and abnormal global EF composite scores in 41%. Abnormal VOF was not associated with global or domain-level EF scores. However, children with abnormal VOF more frequently had EF problems related to attentional behavior: "easily sidetracked" (OR 4.18 (CI: 1.21-14.41), p = 0.02) and "short attention span" (OR 4.52 (CI: 1.34-15.22), p = 0.02). Conclusion: Although abnormal VOF was not associated with global, parent-reported, EF at 3 years CA, secondary analyses did show a relation to specific attention and concentration span items. Further research is needed to study the role of VOF in objectifying preschool EF assessments in very preterm born children. What is known: • Very preterm children are vulnerable for executive function (EF) deficits and for delays in visual orienting function, as compared to term-born children • The ability to orient attention to one's visual environment is an important prerequisite for EF early in life and is easy to measure objectively with visual orienting function (VOF) assessment What is new: • VOF measurement at 3 years of age relates to parent-reported attention and concentration span items, important aspects of executive functions • Future work should explore the clinical additional value of early VOF measurement in children at risk for EF deficits.