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Peer relationships and social-affective functioning of children with critical congenital heart defects and comparison

Olivia G Ritchey1, Amber T Riggs1,2, Andrea Goard1

  • 1Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH, United States.

Journal of Pediatric Psychology
|February 12, 2026
PubMed

Insights

Children with critical congenital heart defects (cCHD) experience more peer relationship difficulties, linked to both social-affective and executive functioning (EF) deficits. Early intervention in social-emotional skills is recommended.

Area of Science:

  • Pediatric Cardiology
  • Developmental Psychology
  • Neuroscience

Background:

  • Critical congenital heart defects (cCHD) are associated with increased neurodevelopmental impairment risks.
  • Deficits in executive functioning (EF) and social-affective abilities may co-occur in children with cCHD, impacting peer relationships.
  • Social difficulties in children with cCHD require detailed description and linkage to specific cognitive or social-affective skills.

Purpose of the Study:

  • To compare social-affective abilities, EF, and peer relationship difficulties in children with cCHD versus healthy classmates.
  • To determine if social-affective deficits predict peer relationship difficulties independently of EF impairments.

Main Methods:

  • A comparative study involving 134 children with cCHD and 92 healthy comparison classmates (CC).
  • Utilized multiple assessment methods including child, caregiver, and peer reports.
  • Evaluated social-affective abilities, EF, peer interactions, and social adjustment in school and home settings.

Main Results:

  • Children with cCHD exhibited greater peer relationship difficulties and deficits in both social-affective skills and EF compared to CC.
  • Social-affective skills partially explained peer relationship difficulties in children with cCHD.
  • Group differences in social-affective skills remained significant even after accounting for EF.

Conclusions:

  • Peer relationship difficulties in cCHD are likely multifactorial, stemming from social-affective and neurocognitive deficits.
  • Clinical screening should extend beyond neurocognitive deficits to include social and emotional skills.
  • Further longitudinal research is necessary to elucidate causal pathways and identify targets for intervention.
Abstract

Keywords:
critical congenital heart defectspeer relationshipssocial adjustmentsocial-affective

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