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Premature birth: why are premature babies at increased risk of developing ADHD?

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What did the project achieve?

“We have identified specific brain changes in teenagers who were born prematurely, which may help explain the attention difficulties experienced by some,” says Professor Jonna Kuntsi of King’s College London. “We hope that ultimately, this will lead to ways to help identify children with these problems earlier so that families can get help sooner.”

Around one in every 13 babies in the UK will be born prematurely, before 37 weeks of pregnancy.1-8 These children have an increased risk of developing Attention Deficit Hyperactivity Disorder (ADHD), a condition characterised by a poor attention span, difficulties concentrating, restlessness and impulsive behaviour.

But the reasons why being born early puts babies at increased risk of ADHD are not well understood. Professor Kuntsi is searching for clues from within their brains by assessing more than 300 teenagers – including 186 who were born prematurely, along with many of their siblings.

“We found that young adults who were born early have differences in several types of brain activity,” says Professor Kuntsi. “And, while some of their brain changes are similar to those seen in young people with ADHD, they also have additional issues, suggesting that being born early is also a risk factor for more wide-ranging difficulties.”

The team identified that although many of the changes are likely to be due to the impact of a premature birth on brain development, some may be related to other risk factors within families.

“By distinguishing between the root causes for different issues, our results provide stepping stones towards better-targeted interventions to reduce the impact of specific risk factors,” says Professor Kuntsi.


  1. Office for National Statistics: https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/livebirths/bulletins/birthsummarytablesenglandandwales/2016 [website accessed 12 December 2017]
  2. National Records of Scotland: 2016 Births, Deaths and Other Vital Events - Preliminary Annual Figures: https://www.nrscotland.gov.uk/statistics-and-data/statistics/statistics-by-theme/vital-events/general-publications/births-deaths-and-other-vital-events-preliminary-annual-figures/2016 [website accessed 12 December 2017]
  3. Northern Ireland Statistics and Research Agency. Births. Live births 1887-2016. https://www.nisra.gov.uk/publications/monthly-births [website accessed 12 December 2017]
  4. National Institute for Clinical Excellence: Preterm labour and birth final scope April 2013 https://www.nice.org.uk/guidance/ng25/documents/preterm-labour-and-birth-final-scope2
  5. Office for National Statistics. Childhood mortality in England and Wales 2014. Table 6. http://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/datasets/childmortalitystatisticschildhoodinfantandperinatalchildhoodinfantandperinatalmortalityinenglandandwales  [website accessed 12 December 2017]
  6. National Records for Scotland. Section 4: Stillbirths and Infant deaths: http://www.nrscotland.gov.uk/statistics-and-data/statistics/statistics-by-theme/vital-events/general-publications/vital-events-reference-tables/2014/section-4-stillbirths-and-infant-deaths  [website accessed 12 December 2017]
  7. Northern Ireland Statistics and Research Agency. Registrar General Annual Report 2015 – Stillbirths and Infant Deaths: https://www.nisra.gov.uk/publications/registrar-general-annual-report-2015-tables-and-full-report [website accessed 12 December 2017]
  8. Bliss charity: https://www.bliss.org.uk/prematurity-statistics-in-the-uk [accessed 06 December 2017]

This research was completed on

Over 60,000 babies are born prematurely in the UK every year.1-4 These babies are at increased risk of developing attention deficit hyperactivity disorder (ADHD) and other psychiatric problems, including anxiety, social difficulties and autism. Professor Jonna Kuntsi and her team, of King’s College London, are investigating why. Their work could make it possible to identify earlier in children’s lives whether they are likely to have problems, so they can get help sooner. It could also pave the way to better therapies.

What is the problem and who does it affect?

“No-one knows exactly why, but a premature birth puts babies at increased risk of developing certain psychiatric problems, including ADHD, anxiety, social difficulties and autism,” says Professor Kuntsi. “Unfortunately, it’s not possible to tell the parents of a newborn whether their baby will be affected, but those who are can experience serious difficulties during childhood and beyond.”

Children with ADHD, for example, tend to be overactive and impulsive, with a short attention span. They may seem restless, are easily distracted and often fidget constantly.

“Children with ADHD can have trouble with schoolwork, meaning they underachieve academically,” explains Professor Kuntsi. “They can find it hard to avoid common hazards. They can also have problems forming positive relationships with both their friends and family. The children’s self-esteem can be low and some of them suffer also from depression or anxiety.”

Estimates suggest around two thirds of children with ADHD find their problems persist into adult life, when they can experience additional, sometimes severe, difficulties.5

“There is no cure for ADHD,” adds Professor Kuntsi. “Medical and psychological treatments can help control symptoms, although the benefits of medicines cease if children stop taking them.” The demand for new treatments that offer long-term benefits is high.

What is the project trying to achieve?

“We hope to boost understanding of how premature birth puts babies at increased risk of developing ADHD, by looking for changes within the brain in 150 adolescents who were born early,” explains Professor Kuntsi. “We are investigating whether the changes we find have anything in common with changes that we’ve already detected in adolescents with ADHD.”

The adolescents and their siblings are taking part in a variety of tests, including EEG (electroencephalopathy), which involves wearing a comfortable cap, containing electrodes that measure brain activity.

“We aim to estimate the extent to which environmental factors and genetic susceptibility each contribute to the changes we find in the children’s brains, and find out whether there is a link between how early the children are born and the severity of their problems,” explains Professor Kuntsi. “We are also investigating the link between an early birth and anxiety, social difficulties and symptoms of autism.”

Professor Kuntsi hopes her work will eventually allow earlier identification of children’s difficulties, so they can get help sooner. It may also lead to better therapies.

What are the researchers’ credentials?

The research team has an excellent track record. Team members have complimentary expertise that is perfect for this study – in using EEG to study brain function in ADHD, in clinical and genetic aspects of the disorder, and in the complex statistical analyses needed to interpret the data that they are generating.



  1. Office of National Statistics. (24 Jan 2013) Live births in England and Wales by characteristics of the mother 1, 2011 [Online]. Available from http://www.ons.gov.uk/ons/search/index.html?newquery=Birth+Summary+Table... [Accessed 25 January 2013] No. of live births = 723,913
  2. Northern Ireland Statistics and Research Agency Registrar General Annual Report 2011 (Section 3 Births, Table 3) [Online] Available from http://www.nisra.gov.uk/demography/default.asp98.htm [Accessed 25 January 2013]. No. of live births = 25,273
  3. General Register Office for Scotland Vital Events Reference Tables 20011 (Section 3 Births; Table 3.1b) [Online]. Available from http://www.gro-scotland.gov.uk/statistics/theme/vital-events/general/ref... [Accessed 25 January 2013]. No. of live births = 58,590
  4. Office of National Statistics News Release 24 July 2007. Pre term birth data (2005) - 7.7% live births in England and Wales are born preterm (before 37 weeks gestation). [Online] Available from http://www.ons.gov.uk/ons/publications/re-reference-tables.html?edition=... [Accessed 25 January 2013]
  5. Faraone SV, Biederman J, Mick E. The age-dependent decline of attention deficit hyperactivity disorder: a meta-analysis of follow-up studies. Psychol Med 2006;36(2):159-65.


Project Leader Professor Jonna Kuntsi BSc MSc PhD CPsychol
Project Team Professor Philip Asherson PhD MRCPsychDr F Rijsdijk MSc PhD
Project Location MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, King's College London
Project duration 3 years
Date awarded 15 November 2012
Project start date 4 March 2013
Project end date 3 March 2016
Grant amount £169,944
Grant code GN2080


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