# Behavioral and Cognitive Assessment in a Cohort of Term Small-for-Gestational-Age Children

## TL;DR

Term-born small-for-gestational-age children have slightly lower IQs, with specific weaknesses in visuospatial skills and attention, but verbal and memory skills are mostly unaffected.

## Contribution

The study identifies specific cognitive weaknesses in term SGA children and highlights the role of birth head circumference as a predictor of cognitive outcomes.

## Key findings

- SGA children had significantly lower IQ scores compared to AGA peers, particularly in perceptual reasoning and processing speed.
- Birth head circumference was a strong predictor of perceptual reasoning and a modest predictor of processing speed.
- No significant associations were found between rhGH treatment and cognitive outcomes in SGA children.

## Abstract

What is the main findings?
•Term-born SGA children show a slightly reduced overall IQ with specific weaknesses in visuospatial abilities, attention, and processing speed, while verbal and memory skills remain relatively preserved.

Term-born SGA children show a slightly reduced overall IQ with specific weaknesses in visuospatial abilities, attention, and processing speed, while verbal and memory skills remain relatively preserved.

What is the implication of the main finding?
•Early identification of deficits in perceptual reasoning and processing speed may guide timely cognitive and educational interventions, potentially improving long-term academic and social outcomes.

Early identification of deficits in perceptual reasoning and processing speed may guide timely cognitive and educational interventions, potentially improving long-term academic and social outcomes.

Background/Objectives: Children born small for gestational age (SGA) are at increased risk for impaired growth, metabolic disturbances, and neurodevelopmental difficulties. Although previous research has examined cognitive and behavioral outcomes in this population, findings remain inconsistent. Moreover, limited evidence is available regarding the potential effects of recombinant human growth hormone (rhGH) therapy on cognitive development. We aimed to assess cognitive performance, emotional–behavioral functioning, and neonatal predictors of neurocognitive outcomes in term SGA children compared with age- and sex-matched peers born appropriate for gestational age (AGA). We also explored potential differences in cognitive outcomes between rhGH-treated and untreated SGA children. Methods: A total of 18 term SGA children and 23 AGA controls underwent anthropometric measurements, biochemical evaluation, cognitive testing using the Wechsler Intelligence Scale for Children—Fourth Edition (WISC-IV), and behavioral assessment through the Child Behavior Checklist (CBCL). Birth weight, length, and head circumference were analyzed as potential predictors of cognitive performance. Results: SGA children demonstrated significantly lower Intelligence Quotient (IQ) scores than AGA peers, with marked weaknesses in Perceptual Reasoning index (PRI) and Processing Speed index (PSI), while Verbal Comprehension and Working Memory were preserved. They also exhibited higher internalizing behavioral symptoms, whereas externalizing behaviors did not differ between groups. Birth head circumference emerged as a strong predictor of PRI and a modest predictor of PSI. No associations were found between rhGH treatment parameters and cognitive outcomes. Larger longitudinal studies are needed to clarify how early growth restriction affects brain development and cognition and whether GH therapy influences these processes.