PGR-1: The Neuropsychological Profile of an Extremely Premature 9-Year-Old Female: Executive Functioning Deficits on D-KEFS Advanced
Abstract
Objective: This case study characterizes the neurocognitive phenotype associated with extremely preterm birth and differentiates from standalone attention-deficit/hyperactivity disorder (ADHD) or generalized anxiety disorder (GAD). Method/Data Selection: 9-year-old right-handed female, born at 27 weeks gestation with prolonged NICU stay, respiratory distress, seizures, early developmental delays, and diagnoses of ADHD (Predominantly Inattentive Presentation) and GAD was referred due to persistent mathematic difficulties despite ongoing special education supports and an Individualized Education Program. Inattention, low frustration tolerance, social immaturity, and adaptive skill delays were also reported. Results/Data Synthesis: Neuropsychological assessment demonstrated superior verbal comprehension and low-average fluid reasoning, yielding an overall average intelligence quotient (IQ). Delis-Kaplan Executive Function System (D-KEFS) Advanced revealed prominent deficits in cognitive sequencing, set-shifting, and inhibitory control. Trail Making showed frequent set-loss errors, Color-Word Interference was impaired under inhibition/switching demands, while the Tower Test indicated significant weaknesses in foresight, rule adherence, and problem-solving. Social Sorting further supported difficulties in concept formation and abstract reasoning, with elevated non-perseverative errors. Conclusions: These findings distinguish her profile from primary ADHD or GAD, as deficits are rooted in executive sequencing, cognitive flexibility, and multitasking rather than social-communication or pervasive worry. The pattern is consistent with disruption of fronto-subcortical and frontal white matter pathways (e.g., prefrontal cortical networks and anterior thalamic radiations), common in extreme prematurity due to perinatal white matter injury, hypoxia-ischemia, and aberrant neurodevelopment. The resulting deficits in attention and executive control compound her comorbid diagnoses. Overall, her profile reflects important implications for differential diagnosis and targeted intervention.