The Protective Role of Positive Parent-Child Interaction in Mitigating Neurodevelopmental Risks Associated With Preterm Birth

Preterm birth is a well-established biological risk factor for adverse cognitive, behavioral, and emotional outcomes throughout development. However, considerable variability in these outcomes suggests that environmental factors may significantly influence developmental trajectories. The quality of parent–child interactions represents a particularly salient and modifiable context that can either exacerbate or mitigate early biological vulnerability. This study investigated whether parent–child dysfunctional interaction (PCDI) moderates the relationship between preterm birth and cognitive, behavioral, and emotional outcomes in middle childhood. Data were obtained from the Healthy Brain Network Biobank, comprising 2,550 children aged 6–12 years. Children were classified into four groups based on gestational age (preterm or full-term) and PCDI level (high or low), as measured by the Parenting Stress Index. Outcomes were assessed using standardized measures of intellectual functioning (WISC–V), executive functioning and attention (NIH Toolbox), behavioral and emotional functioning (Child Behavior Checklist), and ADHD symptoms (SWAN). Multivariate analyses of covariance were conducted to examine main and interaction effects, controlling for child age and sex, followed by logistic regression analyses to assess clinically meaningful risk for cognitive and behavioral difficulties. The results indicated significant main effects of preterm birth and PCDI across multiple cognitive and behavioral domains, as well as significant interaction effects. Children born preterm and exposed to high levels of parent–child dysfunctional interaction exhibited significantly lower intellectual functioning across most cognitive indices compared to all other groups and markedly elevated emotional and behavioral problems compared to full-term and preterm children with low PCID. In contrast, preterm children with low PCDI levels demonstrated relatively preserved emotional functioning and often did not differ significantly from full-term peers with low PCDI, emphasizing the protective role of adaptive parent–child interactions on emotional functioning. Secondary analyses showed that children in the high-PCDI and preterm group were at substantially increased risk for clinically significant cognitive deficits and behavioral problems, whereas preterm status alone was associated with a more modest risk for cognitive deficits. High PCDI alone was linked to significantly elevated risk for behavioral and emotional problems. These findings highlight the importance of considering parent–child interaction quality in evaluating developmental outcomes following preterm birth and suggest that family-level interventions targeting parent–child relationships may be critical for reducing long-term neurodevelopmental risk in this vulnerable population.