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We evaluated social functioning and physiological regulation in 70 preterm children aged 5.5\u2009years compared to 32 matched full\u2010term controls (total sample: 59 boys, 43 girls; 98% White). Heart rate and heart rate variability (HRV) were recorded during rest and structured social interactions with the mother and a stranger, including eye contact, conversations, and triadic play. Preterm children demonstrated significantly greater social difficulties and internalizing problems than full\u2010term peers. Across conditions, the preterm children exhibited consistently elevated heart rate, whereas HRV patterns were comparable with the full\u2010term group. Across both groups, RMSSD\u2010HRV varied by interaction partner (stable with mother, fluctuating with stranger), while HF\u2010HRV reflected general condition effects independent of partner familiarity. In both groups, conversation tasks elicited the strongest autonomic activation, with the lowest parasympathetic indices during negative interactions. In conclusion, preterm children show persistent cardiac hyperarousal and social\u2010behavioral difficulties yet maintain context\u2010dependent autonomic regulation similar to full\u2010term peers. The distinct sensitivity of HRV indices suggests preserved regulatory mechanisms, indicating that prematurity's physiological signature may reflect heightened baseline arousal rather than impaired regulation.<\/jats:p>","DOI":"10.1111\/psyp.70393","type":"journal-article","created":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T04:26:11Z","timestamp":1788495971000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Regulation of Stress Physiology Across Social Contexts in Preterm\u2010Born Preschoolers"],"prefix":"10.1111","volume":"63","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2054-8765","authenticated-orcid":false,"given":"Lisa","family":"Gistelinck","sequence":"first","affiliation":[{"name":"Centre for Developmental Psychiatry, Department of Neurosciences KU Leuven  Leuven 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