Psychiatric sequelae of low birth weight at 11 years of age.

BACKGROUND We examined the relationship between low birth weight (LBW) and psychiatric problems at age 11 years. METHODS Random samples of 6-year-old LBW and normal birth weight (NBW) children from two socioeconomically disparate communities were identified, traced, and assessed. We targeted the 1983-1985 cohort of newborns who reached age 6 in 1990-1992, the scheduled period of fieldwork. Of the 1,095 in the target sample, 823 (75%) were assessed. Five years later, the sample was reassessed. Behavior problems were evaluated by standardized behavior problems scales rated by mothers and teachers. A multiple regression application that combines data from multiple informants was used. Prospective data were used to estimate the incidence of severe attention problems during the follow-up period. RESULTS Information from mothers and teachers revealed that LBW was associated with an excess of attention problems at age 11 in the urban but not in the suburban children. In the urban setting, LBW children had a higher incidence of clinically significant attention problems than NBW children. Although LBW children scored higher than NBW children on externalizing problems, the effect was accounted for in large part by maternal smoking in pregnancy. CONCLUSIONS The LBW-attention problems association observed in the urban community suggests an interaction between biologic vulnerability associated with premature birth and environmental risk associated with social disadvantage. Further research and replication are called for.