Related Experiment Video
Updated: Jun 10, 2025
Measuring Cardiac Autonomic Nervous System ANS Activity in Toddlers - Resting and Developmental Challenges
Published on: February 25, 2016
Attentional development is altered in toddlers with congenital heart disease
Alexandra F Bonthrone1, Vanessa Kyriakopoulou1, Luke Mason2
1Centre for the Developing Brain School of Biomedical Engineering and Imaging Sciences King's College London London UK.
Insights
Toddlers with Congenital Heart Disease (CHD) show altered visual attention and executive function. Eye-tracking offers a feasible method for early assessment of these crucial developmental areas in infants with CHD.
Area of Science:
- Pediatric Neurology
- Developmental Psychology
- Cardiology
Background:
- Congenital Heart Disease (CHD) is the most common congenital abnormality, affecting over 90% of infants.
- Infants with CHD are at high risk for attention and executive function impairments.
- Assessing these abilities in toddlers is challenging due to reliance on language skills, often delayed in CHD.
Purpose of the Study:
- To characterize visual attention in toddlers with CHD compared to typically developing controls.
- To identify associations between visual attention behaviors and parent-rated effortful control in toddlers with CHD.
- To explore the utility of eye-tracking for assessing attention and executive function in early childhood.
Main Methods:
- Utilized eye-tracking tasks to assess multiple components of visual attention in 30 toddlers with CHD and 66 controls.
- Employed analyses of covariance and regressions to compare groups and examine relationships between gaze behaviors and effortful control.
- Included parent-rated effortful control measures and controlled for cognitive and socioeconomic status.
Main Results:
- Toddlers with CHD demonstrated less accurate set-shifting and slower reaction times in selective and exogenous attention tasks compared to controls.
- Endogenous attention was less mature in toddlers with CHD, evidenced by prolonged looks at facial stimuli.
- Worse set-shifting accuracy in CHD was associated with lower parent-rated effortful control, but this relationship was not observed in controls.
Conclusions:
- Identified a distinct profile of altered attention and early executive functioning development in toddlers with CHD.
- Eye-tracking presents a clinically feasible and objective method for early assessment of attention and executive function in this population.
- These findings highlight the potential for early intervention to support cognitive development in infants with CHD.
Background:
Congenital Heart Disease (CHD) is the most common congenital abnormality. Survival rates are over 90%, however infants with CHD remain at high risk of attention and executive function impairments. These abilities are difficult to assess in toddlers because clinical assessments rely on language abilities which are commonly delayed in CHD. Our aim was to characterise visual attention in toddlers with CHD compared to controls and identify associations with parent-rated effortful control.
Methods:
Thirty toddlers with CHD (19 male, median (IQR) age at assessment 22.2 (22-23.1) months) and 66 controls from the developing human connectome project (36 male, age at assessment 22 (21.5-23.8) months) using eye-tracking tasks designed to assess multiple components of visual attention. Analyses of co-variance and regressions were used to identify differences between groups and relationships between gaze behaviours and parent-rated effortful control.
Results:
Toddlers with CHD were less accurate when switching behaviours (set-shifting) [median (IQR) 79%, (28-100)] compared to controls [100% (86-100), pFDR = 0.032], with worse accuracy associated with lower parent-rated effortful control in CHD but not controls (interaction pFDR = 0.028). Reaction times were slower during selective [CHD 1243 ms (986-1786), controls 1065 ms (0851-1397), pFDR<0.001] and exogenous attention tasks [CHD 312 ms (279-358), control 289 (249-331), (pFDR = 0.032) and endogenous attention was less mature (prolonged looks at facial stimuli CHD 670 ms (518-885), control 500 ms (250-625), (pFDR = 0.006). These results were unrelated to differences in cognition or socioeconomic status. In contrast, the allocation of attentional resources was preserved in CHD.
Conclusions:
We identified a profile of altered attention and early executive functioning development in CHD. Eye-tracking may provide clinically feasible, early objective measures of attention and executive function development in CHD.
Related Concept Videos
01:27Development of the Heart
As the embryo undergoes lateral folding, these paired tubes approach each other, merging into a single primitive heart...
01:30Attention-Deficit/Hyperactivity Disorder
Diagnostic Criteria and Symptoms
To diagnose ADHD, symptoms must manifest before age 12 and be evident across multiple settings....