The silent struggle of very preterm children as they enter the formal schooling system has long posed a challenge for educators, parents, and clinicians alike. While the developmental hurdles faced by these children have been well-documented in broad terms, the intricate pathways through which these difficulties emerge, particularly during the formative preschool years, remain enigmatic. A groundbreaking study by Morales, Susperreguy, and Simms, soon to be published in Pediatric Research, offers new insights that illuminate how very preterm birth reverberates through early childhood development, ultimately influencing children’s readiness for school at ages 8 to 12.
Their research zeroes in on three critical domains of child development that often go awry in very preterm children: mathematical skills, behavioural regulation, and emotional well-being. These domains are pillars of academic and social success but are frequently compromised in children born significantly before term. The study is unique in its longitudinal design, tracking a cohort from ages 3 to 6 to uncover the developmental mechanisms mediating long-term outcomes, rather than offering a static snapshot at school entry. This approach reveals a dynamic interplay between early neurodevelopmental function and later school performance.
At the heart of their investigation is the role played by executive functions—those higher-order cognitive processes that include working memory, inhibitory control, and cognitive flexibility. Executive functions orchestrate a child’s ability to plan, focus attention, and regulate behavior and emotions. Meanwhile, receptive vocabulary, a cornerstone of language development, provides a window into the child’s ability to comprehend and process information. Morales and colleagues hypothesize that difficulties in these domains foster a cascade effect, compromising math skills and socioemotional health by the time children reach school age.
Very preterm birth, defined as birth prior to 32 weeks of gestation, dramatically alters the trajectory of brain development. The rapid neural maturation that occurs in the cerebral cortex during the third trimester is interrupted, placing these children at heightened risk for atypical neurodevelopment. This biological vulnerability manifests in a spectrum of cognitive and behavioural challenges. Prior research has identified impairments in executive function and language skills in preterm populations, but the present study advances the field by pinpointing how these deficits serve as mediators—meaning they partially explain the pathway from preterm birth to later school difficulties.
Quantifying the influence of these mediators on academic and emotional outcomes, the researchers utilized rigorous statistical modeling, disentangling direct and indirect effects. Their analyses underscored that deficits in executive functioning and receptive vocabulary measured during preschool years were robustly associated with reduced math achievement and increased behavioural and emotional difficulties at ages 8 to 12. Remarkably, these cognitive mediators accounted for a significant portion of the variance, highlighting their central role as early indicators and potential intervention targets.
The study’s findings carry profound implications for early intervention strategies. They suggest that bolstering executive functioning and language skills well before the child enters formal education could ameliorate or perhaps even prevent the downstream academic and socioemotional challenges that have long been observed. In essence, these preschool years present a critical window of opportunity where targeted support could alter developmental trajectories towards more favorable outcomes.
Moreover, the nuanced understanding offered by this research challenges educators and clinicians to rethink how they assess school readiness. Often measured by surface-level skills or single time-point assessments, readiness encompasses a complex constellation of underlying cognitive and emotional processes. The inclusion of executive function and language development in readiness assessments could create a richer, more predictive profile, identifying children at risk for future difficulties earlier and with greater precision.
Importantly, the study also sheds light on the emotional and behavioural struggles encountered by very preterm children. Emotional regulation is tightly linked with executive functioning, and difficulties in control and flexibility can manifest as anxiety, mood disturbances, or behavioural dysregulation. These challenges not only interfere with academic learning but can also compromise peer relationships and overall well-being. By unravelling how early cognitive deficits translate into these socioemotional outcomes, the authors provide a roadmap for integrated therapeutic approaches.
Beyond immediate clinical and educational applications, these findings contribute to a broader theoretical understanding of developmental neuropsychology. The longitudinal nature of the research reveals how early neural disruptions set off cascading effects that intersect multiple domains of functioning. This dynamic interplay aligns with developmental cascade models, which emphasize how early deficits compound over time rather than operate in isolation.
Despite the clarity and importance of these findings, Morales and colleagues also acknowledge the complexities that remain. While executive function and language skills are key mediators, they likely represent just part of a multifaceted developmental protocol influenced by genetic, environmental, and contextual factors. Future work is needed to tease apart these influences and to explore how interventions might be tailored to individual constellations of risk and resilience.
The trajectory from very preterm birth to school readiness complications is neither linear nor predestined. The study’s identification of executive functioning and receptive vocabulary as pivotal mediators paves the way for proactive, data-driven interventions capable of reshaping futures. It underscores the imperative for early screening in neonatal follow-ups and for interdisciplinary collaboration spanning pediatrics, psychology, education, and speech-language therapy.
In an era increasingly attuned to personalized medicine and education, this research exemplifies the power of longitudinal, nuanced studies to guide practical applications. Targeting cognitive and language development in the preschool years offers a tangible, empirically supported strategy to bridge the gap that very preterm children face as they transition to the demanding environment of formal schooling.
The road ahead involves implementing these insights in real-world settings, refining intervention protocols, and ensuring equitable access for the diverse populations affected by preterm birth globally. It also beckons parallel scientific endeavors into the underlying neurobiological substrates—possibly through neuroimaging or genetic studies—that drive these observable developmental cascades.
As science converges with clinical practice, the hope is that children born very preterm will encounter not only survival but also thriving in academic and emotional domains. This transformative research injects fresh optimism and a conceptual framework for early remediation, emphasizing that the story of school readiness is written well before the first day of kindergarten.
Through their meticulous and innovative approach, Morales, Susperreguy, and Simms provide more than just data; they offer a vision—one where early detection and intervention transform the developmental trajectories of vulnerable children, paving a future in which very preterm birth does not doom a child’s potential to struggle but instead serves as a call to action for timely support.
Subject of Research: The study investigates the long-term cognitive and socioemotional effects of very preterm birth on children’s school readiness, focusing on the mediating role of executive functions and receptive vocabulary during preschool years.
Article Title: The long-term effect of very preterm birth on school readiness: exploring preschool mediating pathways
Article References:
Morales, M.F., Susperreguy, M.I. & Simms, V. The long-term effect of very preterm birth on school readiness: exploring preschool mediating pathways. Pediatr Res (2025). https://doi.org/10.1038/s41390-025-04352-y
Image Credits: AI Generated
