ERP markers of language processing difficulties in extremely preterm children at 6–9 years of age

Advances in neonatal care have substantially reduced mortality among extremely preterm children (≤1,500 g at birth), although survivors remain at increased risk for neurodevelopmental vulnerabilities. This study examined event-related potentials (ERPs) associated with print processing and language-related functions in extremely preterm children at school age. Twenty-six extremely preterm children completed a same/different distractor task involving graphical symbols, illegal letter strings, legal pseudowords, and real words. ERP components indexing print sensitivity (N1), lexico-semantic access (N400), and sensitivity to orthographic regularities (late positive component, LPC) were analyzed across two age groups reflecting early reading initiation and reading acquisition stages. Print sensitivity (N1) exhibited typical developmental patterns in both age groups. However, lexico-semantic access (N400) and orthographic regularity sensitivity (LPC) diverged from patterns reported in studies with typically developing peers, suggesting atypical neural responses to linguistic stimuli despite a presumed adequate behavioral performance. Extremely preterm children may display subtle but meaningful differences in neural mechanisms supporting reading and language processing. These findings highlight the importance of early monitoring and targeted educational interventions to support reading foundations and prevent emerging academic difficulties.