Socioeconomic Status of Preterm Children With Cognitive Delays

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Introduction

Premature birth is still a considerable health risk for children. Although the survival rates of preterm infants have significantly improved in recent years, neurodevelopmental outcomes pose a concern (Mangin, Horwood, & Woodward, 2016). The most adverse neurodevelopmental results of preterm birth include cerebral palsy, full or partial blindness, and deafness that can occur in up to 15% of infants (Mangin et al., 2016). The majority of preterm children are diagnosed with developmental delays that can affect them even in their adult years. Up to 60% of preterm children display emotional, behavioral, and language difficulties, and can have lower intelligence than term-born children (Mangin et al., 2016). Cognitive delays in preterm children are a severe problem that receives much attention from researchers and medical professionals. However, only a small proportion of studies conducted on the topic concentrate on the effect that the socioeconomic background of the family has on children with cognitive disabilities. The proposed research will attempt to establish whether their families’ socioeconomic background impacts the developmental trajectories of preterm-born children with cognitive delays.

Literature Review

There are many research articles dedicated to the topic of cognitive delays in children born prematurely. A significant part of those articles focuses on the intelligence and academic performance of preterm infants. The meta-analysis compiled by Brydges et al. (2018) suggests that premature birth is negatively correlated with intelligence, the speed with which children process information, and behavior. Many studies report impaired language processing abilities in prematurely born children (Brydges et al., 2018). The meta-analysis by Allotey et al. (2017) examines the studies of cognitive, behavioral, and academic performances of preterm children compared to their term-born counterparts. According to Allotey et al. (2017), premature birth leads to various developmental issues that can persist at older ages. These issues include behavioral problems, difficulties in processing language, and impaired motor skill development (Allotey et al., 2017). The academic performance of preterm children is negatively impacted by the described delays in their cognitive development. Overall, the results of the two meta-analyses show that premature birth leads to numerous complications.

Many studies on the topic of early birth and its effects on infants discuss the same points. Mangin et al. (2016) focus on the examination of cognitive development patterns of children carried to term and those born before term. The study’s findings indicate that preterm children are more likely to perform below their full-term counterparts on intelligence tests (Mangin et al., 2016). Cognitive functions of children born before the 37th week of pregnancy remain at a similar level between the ages of 4 and 12 (Mangin et al., 2016). Thus, cognitive delays experienced by prematurely born children do not diminish with age. Mangin et al. (2016) note that parents’ low socioeconomic status is another predictor of cognitive risk for children born before term. Allotey et al. (2017) state that the family’s socioeconomic background can affect children diagnosed with developmental delays. Meanwhile, Brydges et al. (2018) indicate that the analysis of how this background can affect preterm children is not consistent. The literature review shows that there are gaps in research on the effect of birth at an early gestational age on children’s cognitive development.

Research Question

The review of previous articles on the subject indicates a lack of research on the correlation between the family’s socioeconomic status and the cognitive development of preterm children. This lack of analysis helped cultivate the research question for the proposed study. The research question for the future research study can be formulated as follows: Does the family’s socioeconomic status impact the developmental trajectories of prematurely born children with cognitive delays in a meaningful way?

Aims and Objectives

The main aim of the proposed research stems from the formulated research question. The study’s primary purpose is to establish whether the family’s socioeconomic status can affect the developmental trajectories of children diagnosed with cognitive disabilities due to preterm birth. The desired result of the study is to acquire evidence of the correlation between socioeconomic status and the cognitive progress of children born before term. Several steps will be taken in order to achieve the indicated aim. The first objective is to observe the development of the selected participants. This step will entail collecting relevant data from preborn children and analyzing its significance. Second, information on the socio-economic background of families taking part in the research will be obtained and analyzed. Third, the relationship between the two sets of data will be analyzed to establish whether there is a correlation between the two.

Theoretical Framework

Cognitive development is a complex process during which children start to explore the world around them and analyze what they encounter. They develop new knowledge and skills, including learning how to speak, and later read and write and learn socially acceptable behavior norms. The expansion of cognitive skills is affected by every new experience and the social context. The family environment has the most meaningful influence on the development of a child, with parents being the most substantial external influence in the children’s lives (Morawska & Mitchell, 2018). Children born at an early gestational age are not an exception, and their parents manifest a principal impact on their development. However, as premature birth leads to cognitive delays, those children need more attention than those carried to terms and exhibit no developmental problems. It can be argued that parents’ education and income can impact their children’s overall well-being and development.

The proposed research will rely on the theoretical framework provided by context-based theories. In particular, Bronfenbrenner’s social-ecological model will be employed to support the study. According to the theories mentioned above, all children have a bilateral relationship with their social environment (Morawska & Mitchell, 2018). Their development is affected by the social context around them, and they affect this context and others in it. Bronfenbrenner’s model shows that parents and siblings have the most substantial effect on the child’s development (Morawska & Mitchell, 2018). Parents’ level of education and approach to raising a child with cognitive issues will inevitably affect their development. The model also shows that parents’ workplaces can influence their children (Morawska & Mitchell, 2018). The family’s income can define the support system that a child with a cognitive disability can access, their education, and overall progress. Bronfenbrenner’s social-ecological model supports the idea that the family’s socioeconomic status can affect the developmental trajectories of children born prematurely and diagnosed with cognitive delays.

Research Design and Method

The research in question aims to establish how socioeconomic background affects children born with cognitive delays. In order to achieve this aim, the longitudinal cohort design was selected. The chosen design will allow the researchers to collect the required data sets over a long period. All the participants will have one common characteristic of having a child diagnosed with cognitive issues due to premature birth. The information on the development of those children will be collected for five years. This period was selected in order to gather quantifiable data that will help analyze the participants’ progress during that time. The information on the socioeconomic backgrounds of the participants’ families will also be collected and analyzed. Significant changes in levels of education and income will be recorded to better socioeconomic status can affect the cognitive development of children born preterm.

The proposed study will employ a quantitative, descriptive research method. The relationship between the two main variables will only be observed and analyzed. None of the variables will be manipulated, and there will be no control groups. The chosen method is the most appropriate for the study aiming to establish whether the correlation between the socioeconomic status of the family and the development of children with cognitive problems exists.

Data Collection

The proposed research will use a survey data collection method to gather the necessary information on the development of children born before term and diagnosed with cognitive problems. Standard measures of intelligence, processing speed, and executive functions will be employed to collect the data. Preschool and Primary Scale of Intelligence developed by Wechsler will be used to measure intelligence and processing speed in children ages 2 to 7, whereas Wechsler Intelligence Scale for Children will be given to older participants (Mangin et al., 2016). All the tests will be delivered to the participants in person or via video call if necessary.

Furthermore, information on the socioeconomic backgrounds of the participants will be collected. This data will be provided by the parents or legal guardians of the child participants. A questionnaire will be designed specifically for the proposed research. The adults will be asked to disclose information about their levels of education, work experience, current job, and mean income. They will also be asked to estimate the amount of money annually on their children. This data will be collected once a year in order to determine whether any changes took place.

Sample

The research participants will be recruited among families with children born between 32 and 37 weeks of pregnancy. The recruitment process will be conducted online and offline through various hospitals and support groups for parents with prematurely born children. During the recruitment, prospective participants will be given general information about the research. A minimum of 300 participants will be drafted to ensure the generalizability of the research findings. Furthermore, families with diverse socioeconomic backgrounds will be selected for the research to establish whether there is a connection between socioeconomic status and the development of preterm children with cognitive delays.

After an initial sample is obtained, it will be evaluated to verify its suitability for the study. The criteria for the selection of the participants are broad. Children taking part in the study must be born early or late preterm and diagnosed with cognitive development problems. There are no geographical limitations as the data collection can take place online via video calls. However, the participants will be given preference if they are more conveniently located for the researchers to visit in person to collect data. Prospective families will be excluded if they are taking part in other research studies on cognitive development in prematurely born children. However, participation in descriptive or observational studies will be permitted. Researchers will also, exclude participants if the quota for a specific socioeconomic status is filled.

Ethical Considerations

There are ethical considerations relating to the protection of human subjects in medical research. First, informed consent will be secured from the parents of the participants. Underage children cannot legally consent, and their parents or guardians will be accountable for providing it. All the information about the study, including the research question, aims, objectives, and data collection and analysis methods will be provided to the participating families. A separate consent form will be offered to the parents and guardians as they also will take part in the research by contributing information about their education, work experience, job, and income.

The participants will be informed about the voluntary basis of the research. They will have an opportunity to quit the research at any stage. However, they will be notified that the information collected from them before the withdrawal will be used in the study. The research will acknowledge whether anyone withdrew from it and the reasons for withdrawal. Furthermore, all the participants will be offered a short survey to state their opinion of the research upon withdrawal or completion. Personal information will not be included in order to protect the confidentiality of human subjects. The information about the socio-economic backgrounds of the participants will be used in summary form. They will also receive the results of the study with explanations of possible implications.

Implications

The proposed study will contribute considerably to the existing body of research on cognitive delays in premature children. The research will help establish whether the family’s socioeconomic status has a meaningful impact on children’s developmental trajectories. If it is confirmed that socioeconomic status influences the cognitive development of children with cognitive disabilities, further research will be required. As the proposed study is descriptive, future research can focus on comparing the development of preterm and term-born children from similar socioeconomic backgrounds. Additionally, a new support system for families with cognitively impaired children can be discussed. This discussion can entail financial support for such families to ensure that their children have access to high-quality medical support. Similarly, this can include education for families on cognitive delays and how to advance the development of children diagnosed with them.

Conclusion

In conclusion, premature birth can significantly affect children’s cognitive development. Although there are many research studies dedicated to the discussion of developmental delays in preterm children, few focus on the family’s socioeconomic status and how it can affect their development. The proposed research will help establish whether the family’s socioeconomic background has an impact on the development of children with cognitive disabilities. The study will focus on observation and the analysis of the progress made by children with developmental issues. It will also collect data on the participating families’ socioeconomic backgrounds and try to determine whether there is a correlation between them and children’s cognitive development. Further research will be required if the proposed study achieves its aim and determines that the family’s socioeconomic background has a meaningful effect on the developmental trajectories of premature children with cognitive delays.

References

Allotey, J., Zamora, J., Cheong-See, F., Kalidindi, M., Arroyo-Manzano, D., Asztalos, E., … Thangaratinam, S. (2017). Cognitive, motor, behavioural and academic performances of children born preterm: A meta-analysis and systematic review involving 64 061 children. BJOG: An International Journal of Obstetrics & Gynaecology, 125(1), 16-25.

Brydges, C. R., Landes, J. K., Reid, C. L., Campbell, C., French, N., & Anderson, M. (2018). Cognitive outcomes in children and adolescents born very preterm: A meta-analysis. Developmental Medicine & Child Neurology, 60(5), 452-468.

Mangin, K. S., Horwood, L. J., & Woodward, L. J. (2016). Cognitive development trajectories of very preterm and typically developing children. Child Development, 88(1), 282-298.

Morawska, A., & Mitchell, A. (2018). Children’s health, physical activity, and nutrition. In M. Sanders & A. Morawska (Eds.), Handbook of parenting and child development across the lifespan (pp. 289-312). Springer.

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