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Prevalence and pattern of executive dysfunction in school age children with congenital heart disease
Jacqueline H Sanz1,2, Madison M Berl1,2, Anna C Armour1
1Division of Neuropsychology, Children's National Health System, Washington, District of Columbia, USA.
Insights
Children with congenital heart disease (CHD) show higher rates of executive dysfunction, particularly in working memory and flexibility. These children are often underserved by school systems, highlighting the need for better neurodevelopmental support.
Area of Science:
- Pediatric Neurology
- Developmental Psychology
- Cardiology
Background:
- Executive function is crucial for social and academic success.
- Children with congenital heart disease (CHD) often exhibit cognitive weaknesses.
- Executive dysfunction is a recognized challenge in school-aged children with CHD.
Purpose of the Study:
- To determine the prevalence and profile of executive dysfunction in school-aged children with CHD.
- To assess if children with executive dysfunction receive adequate school services.
- To identify risk factors for executive dysfunction in this population.
Main Methods:
- Utilized parent-reported questionnaires, including the Behavior Rating Inventory of Executive Function (BRIEF).
- Assessed 91 school-aged patients with CHD and compared them to a normative database.
- Collected medical history data to identify potential risk factors.
Main Results:
- Children with CHD demonstrated significantly higher rates of executive dysfunction (OR=4.37), especially in working memory (OR=8.22) and flexibility (OR=8.05).
- Executive dysfunction was not associated with increased likelihood of receiving school services (P>.05).
- Predictive factors for executive dysfunction included male gender, premature birth (≤37 weeks), and CHD with aortic obstruction.
Conclusions:
- School-aged children with CHD have a higher prevalence of executive dysfunction, impacting working memory and flexibility.
- These children are underserved by the school system, indicating a need for improved support.
- Prematurity, aortic obstruction, and male gender are associated with increased risk, suggesting developmental origins and potential susceptibility to brain injury.
Objective:
Executive function, a set of cognitive skills important to social and academic outcomes, is a specific area of cognitive weakness in children with congenital heart disease (CHD). We evaluated the prevalence and profile of executive dysfunction in a heterogeneous sample of school aged children with CHD, examined whether children with executive dysfunction are receiving school services and support, and identified risk factors for executive dysfunction at school age.
Design:
Ninety-one school aged patients completed questionnaires, including the Behavior Rating Inventory of Executive Function (BRIEF) and a medical history questionnaire. An age- and gender- matched control sample was drawn from a normative database.
Results:
Children with CHD had a higher rate of parent reported executive dysfunction (OR = 4.37, P < .0001), especially for working memory (OR = 8.22, P < .0001) and flexibility (OR = 8.05, P < .0001). Those with executive dysfunction were not more likely to be receiving school services (P > .05). Gender, premature birth (≤37 weeks), and CHD with aortic obstruction were predictive of executive dysfunction, especially for behavior regulation skills.
Conclusions:
School aged children with CHD have an increased prevalence of executive dysfunction, especially problems with working memory and flexibility, and are underserved by the school system. The increased risk for executive dysfunction in those with CHD and prematurity or CHD with aortic obstruction suggests an etiology of delayed brain development in the fetal and neonatal periods, while male gender may increase susceptibility to brain injury. This study highlights the need for regular neurodevelopmental follow up in children with CHD, and a need to better understand mechanisms that contribute to adverse neurodevelopmental outcomes.
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