Changes in emotional problems, hyperactivity and conduct problems in moderate to late preterm children – Dr. Ayten Bilgin

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In this podcast we talk to Dr. Ayten Bilgin about her JCPP Advances paper ‘Changes in emotional problems, hyperactivity and conduct problems in moderate to late preterm children and adolescents born between 1958 and 2002 in the United Kingdom’, ( Dr. Ayten Bilgin is a lecturer in psychology at the University of Kent, and developmental psychologist

Ayten set the scene by explaining about the PremLife Project, together with the key findings of this collaborative project, before moving on to discuss her paper.

Given improvements in neonatal care we could assume that the difference in emotional problems, hyperactivity and conduct problems would have declined in recent years, but Atyen’s study shows some fascinating results.

Dr. Ayten Bilgin
Dr. Ayten Bilgin
Dr. Ayten Bilgin completed her BSc in Psychology at Middle East Technical University (Ankara, Turkey) in 2010 followed by her MA in Developmental Psychology at Koç University (Istanbul, Turkey) and her MSc in Clinical Psychology and Mental Health at University of Sussex in 2013. Afterwards, she completed her PhD in Psychology at the University of Warwick in 2017. She joined the School of Psychology at University of Kent as a Lecturer in Developmental Psychology in 2020.

Ayten’s main research is in the area of developmental psychopathology with a particular focus on infant regulatory problems (excessive crying, sleeping and feeding problems), preterm birth (i.e., birth before 37 weeks of pregnancy), mother-infant attachment, and parenting.

Ayten uses large-scale longitudinal data to investigate whether and how infant regulatory problems have an impact on the development of mental health problems. In addition, she is interested in understanding the long-term outcomes of being born preterm, specifically regarding social relationship skills, well-being, emotional problems and inattention/hyperactivity. Moreover, she investigates parenting and mother-infant attachment in the context of infant crying, sleeping and feeding problems and preterm birth. Bio via University of Kent


Interviewer: Welcome to a different type of in conversation podcast from the Association for Child and Adolescent Mental Health Team, ACAMH, where we will look at the paper ‘Changes in emotional problems, hyperactivity and conduct problems in moderate to late preterm children and adolescents born between 1958 and 2002 in the United Kingdom’, recently published in JCPP Advances. This paper has been published within the PremLife Project and we’ll talk more about this in today’s podcast.

I’m Jo Carlowe, a freelance journalist with a specialism in psychology and I have Dr. Ayten Bilgin with me. Ayten is a lecturer in psychology at the University of Kent and the first author of the paper will be discussing today. If you’re a fan of our In Conversation series, please subscribe on iTunes or your preferred streaming platform. Let us know how we do it with a rating or review and do share with friends and colleagues. Hi Ayten, thanks so much for joining me. Can you start with a brief introduction about yourself?

Dr. Ayten Bilgin – Hi Jo. Thanks so much.  So first of all, thanks a lot for inviting me today. I’m quite happy to speak with you about our recent paper. So as you already mentioned, I’m a lecturer in psychology at the University of Kent. I’m a developmental psychologist and I use longitudinal approach in my research where I investigate the development of mental health problems, as well as other factors such as well-being and self-esteem. I’m mainly interested in understanding the role of early risk factors in the development of mental health problems. So far I have focused on two main risk factors in my research. So, the first one is preterm birth, which is also the topic of today’s interview. Second one is early regulatory problems. These are problems such as excessive crying, sleeping problems, and feeding problems during infancy. In addition to these factors, I also investigate parenting behaviours and decisions, and also insecure or disorganised infant-mother attachments, within the context of both preterm birth and early regulatory problems.

Interviewer – Thank you. Ayten, before we turn to the article in JCPP Advances, can you tell us a bit about the PremLife Project? What is the aim of PremLife?

Dr. Ayten Bilgin – PremLife is an international collaboration project which is based at the University of Warwick, and this project is led by Sakari Lemola, together with collaborators in Finland and Germany, and the main aim of the PremLife Project is to investigate the protective and also the resiliency factors that help preterm born children to achieve better life outcomes across their lifespan, and to identify these factors. For example, we have conducted research using life scale longitudinal data sets from the UK, Germany and Finland, and we have first conducted research on how preterm children are influenced in their social and emotional development, and then as a next step we are now focusing on the protective and resiliency factors.

Interviewer – And what key findings have emerged from PremLife that you can share with us today?

Dr. Ayten Bilgin – There are several important findings. For example, we found that adolescents, for example, who were born preterm and full term hold similar levels of self esteem and well-being in many areas of their life, such as, for example, in their relationship with their parents and also well-being in their school environment or well-being about their physical appearance, so they report similar ratings. However very preterm adolescents, in particular, report that they are less happy about their relationship with their peers in comparison to full term births. And apart from that, looking at resiliency factors, so far, we showed that having good maths skills in the pre-school period, for example, is associated with higher GCSE grades, but this association is particularly high in preterm children than full terms. And in addition to that reading good skills in pre-school age is associated again with higher GCSE grades, for example. But this time the finding was similar in both preterm and full term groups, so this suggests that good reading ability is a protective factor for both groups of children, while on the other hand having good maths skills was a particular resiliency factor for the preterms, and also regarding mental health problems and well-being in adolescence, for example, we found that having good levels of physical activity are protective factors for both the preterms and full term groups.

Interviewer – Let’s turn to your paper. So you’ve co-authored the paper ‘Changes in emotional problems, hyperactivity and conduct problems in moderate to late preterm children and adolescents born between 1958 and 2002 in the United Kingdom’ and this was published in JCPP Advances. Can you start with a summary of the paper? What did you look at?

Dr. Ayten Bilgin – In this paper we were particularly interested in the moderate to late preterm group. This group includes babies born between 32 and 36 weeks of gestation during pregnancy, and majority of preterm babies are born just a few weeks early, so the majority of the preterms are in this group. And in the study we looked at if the differences between moderate to late preterms and full term children and adolescents has changed over the years in the UK in terms of their emotional problems, hyperactivity and conduct problems in particular. So this expectation is due to the substantial improvements in the neonatal care across the cases.

Interviewer – And can you say anything about the methodology that you used?

Dr. Ayten Bilgin – For this study we used actually the existing data sets for a population based cohort in the UK. So these are National Child Development Study, for example. This study started at 1958. Another study we used is British Cohort Study, which started at 1970. And we also used data from Avon Longitudinal Study, which started in the beginning of 1990s, and also the Millennium Cohorts, which started in the beginning of 2000s. So as you can see, these cohorts really span from the late 1950s to early 2000s, and all of these four cohorts used similar measurements of emotional problems, hyperactivity and conduct problems. So we were really able to harmonise all the mental health outcomes across cohorts. This is also thanks to the guidelines, which is already provided by the Centre for Longitudinal Studies at UCL. So all in all, this is a really good methodology and it provides a very good way to really document the changes in mental health problems starting from the late 1950s and up to early 2000s.

Interviewer – I think given improvements in neonatal care across the decades, it makes sense to assume that the difference is in emotional problems, hyperactivity and conduct problems between preterm and full term children would have declined in recent years. Did your study show that to be the case?

Dr. Ayten Bilgin – No. So I agree with you on this part, contrary to our expectations our findings actually showed an increase in emotional problems and hyperactivity in the recent years in the moderate to late preterm group.

Interviewer – Wow. Ok, so how do you account for the lack of improvement in neurodevelopmental outcomes, emotional issues, given improvements in neonatal care and higher survival rates?

Dr. Ayten Bilgin – I think that’s a really good question. So, for example, for emotional problems, this increase in the recent years was actually only found in the reports of mothers, but we did not find the increase in self-reports. For example, one explanation could be due to the increased aware of mothers about influence of preterm birth on development of emotional and behavioural problems. Another reason could be due to the overall increase of emotional problems and hyperactivity on a population level in the UK in the recent years. So this was actually shown by other researchers in the UK and they must explain it by the societal changes, and also increased pressure to perform academically, for example, and those who were born at moderate to late preterm may be particularly vulnerable to these pressures, in particular pressure to perform at school. So this could be an explanation, but there could also be clinical reasons for this increase in emotional problems and hyperactivity because a moderate to late preterm children really represent a clinically distinct population, since many of them are actually delivered with maternal medical complications through pregnancy and these complications might be linked with increased rates of behavioural and emotional problems in children.

Interviewer – Why would the clinical reasons be more pronounced now then, than say, decades earlier?

Dr. Ayten Bilgin – The reason for this is that the delivery due to medical complications has also now increased in the recent years. For example, delivery due to preeclampsia or Caesarean section or induction of labour I think that might also explain that.

Interviewer – What are the key findings can you highlight from the paper?

Dr. Ayten Bilgin – So apart from the increase in emotional problems and hyperactivity, the other key finding from the study was that pattern of findings regarding conduct problems were a bit less consistent than emotional problems and hyperactivity, for example. So, conduct problems include behaviours such as being physically violent and also having a disregard for other people. And our findings showed lower scores of conduct problems for those born moderate to late preterm during adolescence, particularly in the Alspac cohort, which started in early 1990s, but surprisingly our finding also showed higher scores of conduct problems in late childhood, so not in adolescence but in late childhood, and particularly in the oldest and the most recent cohort. So the pattern of finding regarding conduct problems is not consistent, but this is actually in line with previous findings because a similar mixed findings, depending on the age of the children, were actually found also in previous studies, including preterm babies with younger gestational ages. So, for example, studies focusing on extremely preterm born children also showed higher rates of conduct problems in childhood, but this was not found in adolescence. I find this interesting and one explanation for this could be due to the comorbidity between hyperactivity and conduct problems, and which might be more pronounced in adolescence, so in adolescence hyperactivity might be more apparent than conduct problems. So maybe that’s why findings work for conduct problems is a bit more less consistent.

Interviewer – What are the implications of your findings, Ayten, for professionals working with young people and their families?

Dr. Ayten Bilgin – Despite the fact that moderate to late preterm children actually experience fewer neonatal complications and they have a more mature brain size at birth than, for example, those born at earlier gestational ages, such as very preterm children, but the moderate to late preterms are still born immature in comparison to the full term born children, so considering also the increasing number of moderate to late preterm birth survivors, I think the implication for our finding is that the teachers particularly should be really made aware of this risk. They should be aware of the particular increase in emotional problems and hyperactivity in late childhood and adolescence, following moderate to late preterm birth in the recent years because behavioural and emotional problems associated with moderate to late preterm birth is particularly important for later employment and educational achievement during adulthood, thus identification of problems during the school years would be helpful in improving the long term outcomes on behavioural and emotional development as well, and also employment and educational achievement.

Interviewer – Are you planning some follow up research that you can reveal to us?

Dr. Ayten Bilgin – So now we are conducting follow up studies to identify the potential resiliency factors regarding emotional problems, for example. And these factors include self-control abilities and also warm parenting. So for example, good self control abilities and also having good parenting relationships may protect preterm children in particular from developing emotional problems later on.


Interviewer – Ayten, what else is in the pipeline for you that you’d like to mention?

Dr. Ayten Bilgin  – Yes, so as I already mentioned in the beginning of our interviews, apart from the influence of being born preterm, I’m interested in other factors, such as infant regulatory problems, which are crying problems and sleeping difficulties and feeding difficulties during infancy. I’m currently involved in a study looking into the adulthood mental health outcomes of these difficulties.

Interviewer – Finally, what’s your takeaway message for those listening to our conversation?

Dr. Ayten Bilgin – So my takeaway message is that it’s important to really raise awareness of teachers in particular about association between moderate to late preterm birth and emotional problems and hyperactivity in childhood to, as I also mentioned before, to prevent long-term negative outcomes associated with preterm birth.

Interviewer – Ayten, thank you so much. For more details on Dr Ayten Bilgin, please visit the ACAMH website, and Twitter at ACAMH.  ACAMH is spelled ACAMH. And don’t forget to follow us on iTunes or your preferred streaming platform. Let us know if you enjoyed the podcast with a rating or review, and do share with friends and colleagues.


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