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Study finds preschool children with congenital heart disease have higher odds of ADHD and peer relationship problems

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Study Links Congenital Heart Disease to Behavioral Difficulties in Preschoolers

A new study published in Frontiers in Pediatrics has found that preschool children with congenital heart disease (CHD) face higher odds of attention difficulties and poor peer relationships compared to their healthy peers.

The research was conducted by a team in the UK, led by corresponding author Chiara Nosarti, Professor of Neurodevelopment and Mental Health at King's College London.

Study Design and Participants

The study involved two groups of children aged four to six:

  • 56 children with CHD, enrolled in the Congenital Heart Imaging Project between 2014 and 2020. These children had either critical CHD (e.g., transposition of the great arteries) or serious CHD requiring catheterization or surgery before age one.
  • 215 healthy control children, enrolled in the UK's Developing Human Connectome Project.

Parents completed five questionnaires to measure behavioral profiles, including the Children's Behavior Questionnaire, Social Communication Questionnaire, and Empathy Questionnaire. Higher scores indicated more severe difficulties.

After correcting for sex, gestational age at birth, and neighborhood deprivation, children with CHD had higher odds of ADHD and peer relationship problems than healthy peers.

The research team also accounted for socio-economic status, estimated using the Index of Multiple Deprivation based on postal code, and measured cognitive stimulation at home using the 28-item Cognitively Stimulating Parenting Scale.

Key Findings and Protective Factors

The analysis revealed a significant protective factor within the home environment.

The results indicated that a highly stimulating home environment may protect against developing these behavioral difficulties.

The authors noted, however, that it remains unclear whether stimulating environments influence child behaviors or whether child behavior affects the cognitive stimulation caregivers provide.

Context, Limitations, and Recommendations

The study did not examine the specific mechanisms causing the observed differences. The authors suggested that peer relationship problems may be linked to a lower capacity of children with CHD to recognize facial emotion expressions and identify false beliefs, as shown in previous research with school-age children.

According to Professor Nosarti, the findings suggest behavior in preschool children with CHD should be assessed regularly to identify problems early.

Nosarti concluded that alongside cardiac care, environmental factors like fostering a stimulating home learning environment should be considered when designing support plans for children with CHD.