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Updated: Oct 11, 2025

Psychophysiological Assessment of the Effectiveness of Emotion Regulation Strategies in Childhood
Published on: February 11, 2017
Patterns and Correlates of Changes in Emotional and Behavioral Problems Among Children with Congenital Heart Disease
Lu-Chi Hsiao1, Shuenn-Nan Chiu2, Ling-Yin Chang1
1Institute of Health Behaviors and Community Sciences, College of Public Health, National Taiwan University, Taipei, Taiwan.
Insights
Parenting stress significantly impacts emotional and behavioral problems in children with congenital heart disease (CHD). Interventions reducing this stress may improve outcomes for these children.
Area of Science:
- Pediatric Psychology
- Child Development
- Cardiology
Background:
- Congenital heart disease (CHD) affects children's development and well-being.
- Emotional and behavioral problems are common in children with CHD.
- Understanding changes in these problems and associated factors is crucial.
Purpose of the Study:
- To identify patterns of change in emotional and behavioral problems in children with CHD.
- To investigate factors associated with these changes.
- To inform targeted interventions for children with CHD.
Main Methods:
- Longitudinal study of 327 children with CHD (aged 1.5-12 years) and their parents in Taiwan (2017-2019).
- Utilized the Child Behavior Checklist for two survey waves.
- Employed multinomial logistic regression to analyze patterns and associated factors.
Main Results:
- Identified five change patterns: persistent normal, initial problematic, worsening, persistent problematic, and subclinical.
- Parenting stress was consistently linked to problematic change patterns.
- Other factors included child's sex, number of surgeries, and parental perceived health.
Conclusions:
- Parenting stress plays a key role in the emotional and behavioral trajectories of children with CHD.
- Interventions focused on reducing parenting stress could mitigate problem development and worsening.
- Further research can explore specific intervention strategies.
Objective:
The objective of this study was to examine patterns of changes in emotional and behavioral problems among children with congenital heart disease (CHD) and investigate associated factors in different domains.
Method:
The study sample comprised 327 pairs of children with CHD (aged 1.5-12 yrs) and their parents who participated in 2 waves of a survey in Taiwan from 2017 to 2019. The Child Behavior Checklist was used to evaluate the children's emotional and behavioral problems during both waves. The scores were later used to determine the patterns of changes in emotional and behavioral problems. Multinomial logistic regression was then applied to examine factors associated with varied patterns of changes in emotional and behavioral problems.
Results:
Five patterns of changes in emotional and behavioral problems were identified: "persistent normal," "initial problematic," "worsening," "persistent problematic," and "subclinical." Among the factors examined, parenting stress was consistently associated with different patterns of change in emotional and behavioral problems. Specifically, children with parents who had higher levels of parenting stress were more likely to belong to the "initial problematic," "persistent problematic," or "subclinical" groups than to the "persistent normal" group. Other significant factors included sex, number of surgeries, and perceived health of parents.
Conclusion:
This study highlights the potential role of parenting stress in changes in emotional and behavioral problems. Accordingly, intervention programs aimed at relieving parenting stress may help reduce the development and worsening of emotional and behavioral problems among children with CHD.
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