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Prevalence and patterns of executive function, adaptive function, and behavioral outcomes in preschool and school age
Enrico Danzer1, Jane E Schreiber1, Casey Hoffman1
1The Richard Wood Jr. Center for Fetal Diagnosis and Treatment, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
Insights
Congenital diaphragmatic hernia (CDH) survivors show age-appropriate adaptive skills but lower executive function and attention compared to norms. These neurobehavioral outcomes in CDH patients require further attention for improved long-term care.
Area of Science:
- Pediatric Surgery
- Developmental Pediatrics
- Neuroscience
Background:
- Congenital diaphragmatic hernia (CDH) survivors' executive function, adaptive function, and behavioral outcomes are understudied.
- Early identification of neurodevelopmental challenges is crucial for this population.
Purpose of the Study:
- To evaluate executive function and neurobehavioral dysfunction in preschool and early school-aged children with CDH.
- To compare outcomes of CDH survivors to standard population norms.
Main Methods:
- Retrospective cohort study of 100 CDH survivors aged 3-7 years.
- Utilized Behavior Rating Inventory of Executive Function (BRIEF), Adaptive Behavior Assessment System (ABAS-II), and Child Behavior Checklist (CBCL).
- Compared summary scores to normative data.
Main Results:
- Preschoolers showed normal executive function; school-aged children had worse global executive composite and emotional regulation.
- CDH survivors demonstrated favorable adaptive functioning.
- Significantly worse attention problems and attention deficit hyperactivity problems were noted in CDH survivors compared to norms.
- Disease severity, prematurity, race, and insurance status were associated with poorer neurobehavioral outcomes.
Conclusions:
- Most CDH survivors exhibit age-appropriate executive, adaptive, and behavioral functioning.
- However, CDH survivors, as a group, present with lower executive function and attention scores than the general population.
- These findings highlight the need for targeted neurodevelopmental support in CDH care.
Background:
Executive function, adaptive function, and behavioral outcomes in congenital diaphragmatic hernia (CDH) survivors have not been well studied.
Aim:
To evaluate executive and neurobehavioral dysfunction in preschool and early school-aged children with CDH.
Study Design:
Retrospective cohort study.
Subjects:
All eligible CDH survivors ages 3 to 7 years enrolled in our follow-up program between February 2020 and February 2021.
Outcome Measures:
The Behavior Rating Inventory of Executive Function (BRIEF), the Adaptive Behavior Assessment System, 2nd Edition (ABAS-II), and the Child Behavior Checklist (CBCL) were used to assess functional and behavioral outcomes. Summary scores were compared to standard population norms.
Results:
A total of 100 patients were enrolled during the study period. Of those, 73 parents completed at least one of the questionnaires, resulting in completion of the BRIEF, ABAS-II, and CBCL for 63, 68, and 63 patients, respectively. Preschool children had normal executive function (BRIEF-P) while global executive composite (P = 0.012) and the emotional regulation index (P = 0.010) for school age patients (BRIEF-2) were worse. CDH survivors had favorable adaptive functioning (ABAS-II). Mean CBCL scores for preschool attention problems (P = 0.018), school age attention problems (P = 0.001), and attention deficits hyperactivity problems (P = 0.027) were significantly worse. Prematurity, surrogate markers of disease severity, non-white race, and public insurance status were associated with worse neurobehavioral dysfunction in bivariable analysis.
Conclusions:
The majority of preschool and school age CDH survivors have age-appropriate executive, adaptive and behavioral functioning. CDH survivors, however, have lower executive function and attention scores compared with the general population.
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