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Inattention, hyperactivity, and school performance in a population of school-age children with complex congenital
Amanda J Shillingford1, Marianne M Glanzman, Richard F Ittenbach
1Division of Cardiology, Children's Hospital of Philadelphia, 34th Street and Civic Center Boulevard, Philadelphia, PA 19104, USA. shillingford@email.chop.edu
Insights
School-aged survivors of complex congenital heart disease often experience inattention and hyperactivity, with nearly half requiring remedial school services. No perioperative factors were linked to these neurodevelopmental outcomes, highlighting the need for ongoing screening.
Area of Science:
- Pediatric Cardiology
- Neurodevelopmental Outcomes
- Congenital Heart Disease
Background:
- Growing interest in neurodevelopmental outcomes for school-age survivors of cardiac surgery.
- Focus on children aged 5-10 who underwent newborn surgery for complex congenital heart disease.
- Assessment of risk factors for inattention, hyperactivity, and remedial school service use.
Purpose of the Study:
- To characterize neurodevelopmental outcomes in school-age children with complex congenital heart disease.
- To identify risk factors associated with inattention and hyperactivity.
- To determine the prevalence of remedial school service utilization.
Main Methods:
- Cross-sectional analysis of 109 children (5-10 years old) post-newborn cardiac surgery.
- Utilized parent and teacher questionnaires for academic performance and general health.
- Assessed inattention and hyperactivity using standardized scales (ADHD Rating Scale-IV, Behavior Assessment System for Children).
Main Results:
- 49% of children received remedial academic services; 15% were in special education.
- Clinically significant inattention and hyperactivity scores were 3-4 times higher than general population rates.
- 30% of parents reported high-risk inattention scores, 29% for hyperactivity.
Conclusions:
- A significant proportion of children with complex congenital heart disease are at risk for inattention and hyperactivity.
- Nearly half of the cohort utilized remedial school services.
- No perioperative factors were statistically associated with adverse neurodevelopmental outcomes or service use, underscoring the need for continued monitoring.
Introduction:
There is a growing interest in characterizing the neurodevelopmental outcomes of school-age survivors of cardiac surgery. The purpose of this study was to examine a population of 5- to 10-year-old children who underwent newborn cardiac surgery for complex congenital heart disease to characterize and assess risk factors for problems with inattention and hyperactivity, as well as the use of remedial school services.
Patients And Methods:
This study was a cross-sectional analysis of patients who underwent newborn cardiac surgery and were enrolled in a neuroprotection trial conducted at our institution between 1992 and 1997. Parents and teachers completed questionnaires for the school-age child to elicit information pertaining to the child's general health and academic performance. The severity of hyperactivity and inattention were assessed by using 2 standardized questionnaires (Attention-Deficit/Hyperactivity Disorder Rating Scale-IV and Behavior Assessment System for Children). In addition to calculating descriptive estimates of their occurrence, single-covariate logistic regression models were specified and tested by using 3 different outcomes (inattention, hyperactivity, and use of remedial school services) and 14 different covariates representing preoperative, intraoperative, and postoperative factors.
Results:
Data were obtained from parents and/or teachers for 109 children. Fifty-three (49%) were receiving some form of remedial academic services, and 15% were assigned to a special-education classroom. The number of children receiving clinically significant scores for inattention and hyperactivity on the Behavior Assessment System for Children was 3 to 4 times higher than observed in the general population. On the Attention-Deficit/Hyperactivity Disorder Rating Scale-IV, 30% of the parents reported high-risk scores for inattention and 29% reported high-risk scores for hyperactivity. No perioperative factors were statistically associated with adverse outcomes.
Conclusion:
In this cohort of children with complex congenital heart disease, a significant proportion of the children were at risk for inattention and hyperactivity, and nearly half were using remedial school services. We did not identify any perioperative risk factors, which correlated with high-risk scores or the use of remedial school services. Ongoing neurodevelopmental follow-up and screening are recommended in this vulnerable population.
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