Addressing mathematical computation difficulties in individuals born very preterm, through working memory, processing speed, and selective attention: A casual mediation analysis

BACKGROUND: Mathematical computation skills are a common vulnerability in those born very preterm (VP), but the underlying cognitive mechanisms have not been established. Using causal mediation methods, we aimed to investigate whether working memory, processing speed, and selective attention at 7 years of age could mediate the relationship between VP birth and mathematics computation performance at 13 and 20 years of age. METHODS: Participants completed standardized measures of working memory, processing speed, and selective attention at 7 years. At 13 and 20 years, participants completed a standardized measure of mathematical computation. Using an interventional effects approach, we estimated the extent to which differences in mathematic performance could be reduced by hypothetically intervening on working memory, processing speed, and selective attention in childhood. RESULTS: The VP group performed lower than the FT group on mathematic computation at 13 and 20 years. Improving working memory, processing speed, and selective attention separately in the VP group to the level of the FT group reduced the difference in mathematics performance at both 13 and 20 years. If all cognitive domains were to be simultaneously intervened on so that the VP group matched the FT group, there would be a reduction in difference in mathematic performance by 68.7% at 13 years and 44.1% reduction at 20 years. CONCLUSIONS: Findings from our causal mediation analyses suggest that interventions targeting working memory, processing speed, and selective attention in childhood for those born VP have potential for improving mathematical outcomes in adolescence born VP, especially if implemented concurrently.