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Executive Function in Preschool Children with Congenital Heart Disease and Controls: The Role of a Cognitively
Andrew T M Chew1, Alexandra F Bonthrone1, Arezoo Alford1
1Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom.
Insights
A stimulating home environment may improve executive function (EF) in children with congenital heart disease (CHD). Parenting interventions focusing on cognitive stimulation are recommended for this vulnerable population.
Area of Science:
- Pediatric Cardiology
- Developmental Psychology
- Neuroscience
Background:
- Congenital heart disease (CHD) can impact neurodevelopmental outcomes.
- Executive function (EF) is crucial for cognitive and behavioral development in preschool children.
- Understanding factors influencing EF in children with CHD is vital for early intervention.
Purpose of the Study:
- To examine environmental, demographic, and clinical factors associated with EF in preschool children with CHD.
- To compare EF in children with CHD versus healthy controls.
- To identify potential targets for interventions to enhance EF in children with CHD.
Main Methods:
- Parents of 51 children with CHD and 124 controls (aged 4-6 years) completed the Behavior Rating Inventory of Executive Function (BIEF) and Cognitively Stimulating Parenting Scale (CSPS).
- Multivariable general linear modeling assessed relationships between BIEF composite scores (Inhibitory Self-Control Index [ISCI], Flexibility Index [FI], Emergent Metacognition Index [EMI]) and various factors.
- Clinical and surgical factors, including CHD type and brain MRI findings, were also evaluated for their association with EF.
Main Results:
- Lower gestational age was linked to higher ISCI and FI scores; older age at assessment correlated with lower FI scores.
- Cognitively Stimulating Parenting Scale (CSPS) scores significantly predicted all EF measures (ISCI, FI, EMI) in children with CHD, but not in controls.
- No significant associations were found between EF scores and CHD type, surgical factors, or brain MRI injury ratings.
Conclusions:
- Cognitively stimulating parenting plays a significant role in enhancing executive function in children with CHD.
- Intervention studies should consider the home and parenting environment to improve EF in this population.
- Targeting parenting practices may be a promising strategy for supporting cognitive development in children with CHD.
Objective:
To assess the relationships between (1) environmental and demographic factors and executive function (EF) in preschool children with congenital heart disease (CHD) and controls and (2) clinical and surgical risk factors and EF in preschool children with CHD.
Study Design:
At 4-6 years of age, parents of children with CHD (n = 51) and controls (n = 124) completed the Behavior Rating Inventory of Executive Function, Preschool Version questionnaire and the Cognitively Stimulating Parenting Scale (CSPS). Multivariable general linear modeling assessed the relationship between Behavior Rating Inventory of Executive Function, Preschool Version composite scores (Inhibitory Self-Control Index [ISCI], Flexibility Index [FI], and Emergent Metacognition Index [EMI]) and group (CHD/control), sex, age at assessment, gestational age, Index of Multiple Deprivation, and CSPS scores. The relationships between CHD type, surgical factors, and brain magnetic resonance imaging injury rating and ISCI, FI, and EMI scores were assessed.
Results:
The presence of CHD, age at assessment, sex, and Index of Multiple Deprivation were not associated with EF scores. Lower gestational age was associated with greater ISCI and FI scores, and age at assessment was associated with lower FI scores. Group significantly moderated the relationship between CSPS and EF, such that CSPS significantly predicted EF in children with CHD (ISCI: P = .0004; FI: P = .0015; EMI: P = .0004) but not controls (ISCI: P = .2727; FI: P = .6185; EMI: P = .3332). There were no significant relationships between EF scores and surgical factors, CHD type, or brain magnetic resonance imaging injury rating.
Conclusions:
Supporting parents to provide a cognitively stimulating home environment may improve EF in children with CHD. The home and parenting environment should be considered when designing intervention studies aimed at improving EF in this patient group.
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