Developmental pathways leading to externalizing behaviors in 5 year olds born before 29 weeks of gestation.

Longitudinal data for 62 infants born before 29 weeks of gestation were used to assess the influence of four factors (i.e., neonatal health, family environment, language skill, and nonverbal ability) on the parental report of hyperactive and oppositional behaviors of children at 5 years 9 months. The proposed path analysis model tested the following: (1) whether neonatal health and family environment have a direct influence on language skill and nonverbal ability both measured at 18 months corrected age, (2) the predictive value of language skill and nonverbal ability on oppositional and hyperactive behaviors, and (3) whether the effects of neonatal health and/or family environment on oppositional and hyperactive behaviors can be conceived as mediated by language skill and/or nonverbal ability. The results revealed three main pathways. First, family environment predicted language skill, which, in turn, was negatively associated with children's hyperactivity. Second, neonatal health predicted nonverbal ability, which was positively linked to oppositional behaviors. Third, a direct negative relation between neonatal health and hyperactive outcome was observed. The implications of these substantially different pathways for hyperactive and oppositional behaviors are discussed.