Origins and Predictors of Friendships in 6- to 8-Year-Old Children Born at Neonatal Risk

Children’s peer relationships are crucial for their emotional, cognitive, and social development. Having close, dyadic friendships and being well-accepted by the peer group facilitates life span mental health, behavioral, and academic outcomes, and protects against peer victimization.

Children born very preterm (VP; <32 weeks gestational age [GA]) are at increased risk of poor social adjustment.8 Compared with term-born peers, VP children more often experience peer relationship problems and social isolation, and differences persist into adulthood. Although social difficulties are well documented for VP/very low birth weight (<1500 g) individuals, few studies have investigated the social adjustment of moderately to late preterm children (32-36 weeks GA). Some have reported more internalizing problems, including social withdrawal, whereas others did not. There is considerable uncertainty whether VP children’s peer relationship problems extend across the whole gestation spectrum, as has been found for cognitive difficulties. Additionally, past studies mainly investigated the broader domain of peer relationships in VP children using subscales of screening questionnaires, and these were often limited to parent and teacher reports in childhood. Little attention has been paid to children’s own perceptions of friendships and their quality.

Some studies reported that VP children’s social difficulties are related to their cognitive and neuromotor deficits, but others found differences after accounting for cognitive or neurosensory impairments. Some authors suggest that multiple risk factors such as biological conditions (eg, brain alterations, poor somatic growth), early life stress (eg, neonatal pain), social experiences (eg, parent–infant attachment), and individual child characteristics (eg, minor motor and visual difficulties, impaired cognitive functions, poor social skills, and early behavioral problems) may contribute to preterm children’s vulnerability in social contexts. Furthermore, it is uncertain whether entering school provides an opportunity for preterm children to make more friends or whether it may increase the risk of adverse peer relationships.28 Overall, the origins and underlying mechanisms of preterm children’s social relationship problems are still poorly understood.

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