Background and aims Preterm birth and delay gratification abilities both predict long-term achievement. The aim was to test if adverse effects of preterm birth on attention regulation and academic achievement are mediated by children’s early delay gratification abilities.

Methods 558 children ranging from 26 to 41 weeks gestational age (GA) at birth were studied as part of a prospective geographically defined longitudinal investigation in South Germany. At corrected age 20 months, children’s delay gratification abilities were observed with an adapted version of the ‘marshmallow test’. At age 8 years, children’s attention regulation was assessed by paediatricians, psychologists, and mothers while academic achievement was measured with standardised mathematics, reading, and writing/spelling tests.

Results Structural equation modelling showed that preterm birth was directly associated with low attention regulation and academic achievement at 8 years. In addition, very preterm children (<32 weeks GA) were less able to delay instant gratification at age 20 months (ß = -.23, 95% CI[-.33,-.14]) compared with full term controls (39–41 weeks GA). Ability to delay gratification predicted attention regulation (ß = 0.21, 95% CI[.06,.32]) and academic achievement (ß = 0.15, 95% CI[.07,.24])). Analyses were controlled for child sex and family socio-economic status (CMIN/DF = 1.83; p = 0.005; CFI = 0.981; RMSEA = 0.039).

Conclusions Adverse effects of preterm birth on later attention regulation and academic achievement are partially mediated by children’s early abilities to delay instant gratification. These findings provide new information about the mechanisms linking preterm birth with long-term attention difficulties and academic underachievement. Practical implications include the use of this easy tool in routine follow-up assessments after preterm birth and possible new pathways to intervention.