Researchers identify ADHD and social symptoms in preschoolers with heart defects

Congenital heart disease (CHD)—which is a problem with how the heart forms before birth—occurs in about 1% of newborns.

It has previously been shown that school-age children, adolescents, and young adults with CHD are more likely to exhibit symptoms of autism. Now, a team of researchers in the UK has shown that preschool children with CHD are also at risk for developing behavioral problems. they published their results Frontiers in Pediatrics.

“Here we show that, although children with congenital heart disease show higher levels of attention difficulties and poor peer relationships than healthy children during the preschool years, greater cognitive stimulation in the home environment may reduce the risk of developing such difficulties,” said corresponding author Chiara Nosarti, professor of neurodevelopment and mental health at King’s College London.

Nosarti and colleagues focused on 56 children aged four to six with CHD and enrolled in the Congenital Heart Imaging Project led by Professor Serena Council of King’s College London between 2014 and 2020. These children either had severe CHD, for example transposition of the great arteries; or severe CHD, which includes any non-serious heart lesion that requires catheterization or surgery before the age of one year.

The researchers compared these children with a group of 215 healthy control children enrolled in the UK’s Developing Human Connectome Project, an unrelated program.

measuring problematic behavior

The authors invited all parents to fill out five tried and tested questionnaires to measure the comprehensive behavioral profile of their child, namely the Child Behavior Questionnaire, the Social Communication Questionnaire and the Empathy Questionnaire. Higher scores on these questionnaires indicate more severe behavioral difficulties.

The researchers used the Multiple Deprivation Index, based on postal code, as a proxy for parents’ socio-economic status. And to measure how much children’s environments stimulated their cognitive development, parents were asked to complete a 28-item Cognitively Stimulating Parenting Scale. It evaluates the degree of verbal interaction and educational activities at home as well as the availability of materials such as child-sized tables and chairs, story books, coloring books, and musical instruments.

Analyzes showed that after correcting for the effects of sex, gestational age at birth, and neighborhood deprivation, children with CHD were more likely to have ADHD and peer relationship problems than their healthy peers.

close to home

Importantly, the results also showed that a highly stimulating home may protect against developing these problematic behavioral outcomes.

“It is not clear whether the cognitively stimulating environment influences the child’s behavior, or whether the child’s behavior influences the degree of cognitive stimulation provided by caregivers,” the authors wrote.

The study did not look at mechanisms that might account for the observed differences. However, they noted in their study that peer relationship problems may be driven by children with CHD’s reduced ability to recognize facial emotional expressions and identify false beliefs, which has been shown in earlier school-age children.

Clinically, these findings suggest that the behavior of preschool children with CHD should be regularly assessed so that any problems can be identified and children can be helped as early as possible.”

Chiara Nosarti, Professor, Neurodevelopment and Mental Health, King’s College London

“Along with cardiovascular care, environmental factors such as fostering a stimulating learning environment at home should also be taken into account when designing support plans for children with CHD,” Nosarti concluded.