ADHD symptomatology of children with congenital heart disease 10 years after cardiac surgery: the role of age at operation

Abstract

Background The aim of the present study was to investigate the differences in ADHD symptomatology between healthy controls and children who underwent cardiac surgery at different ages. Methods Altogether, 133 children (54 patients with congenital heart disease undergoing first cardiac surgery under 3 years of age, 26 operated at the age of 3 or later, and 53 healthy controls) were examined. Patients completed the Youth Self Report (YSR), while their parents completed the Child Behaviour Checklist (CBCL) and the ADHD Rating Scale-IV. Results Children receiving surgery for the first time under the age of 3 years were more likely diagnosed with cyanotic type malformation and have undergone to a greater number of operations. However, ADHD symptoms of those treated surgically at or above 3 years of age were more severe than that of the control group or those who were treated surgically at a younger age. The control group and those treated surgically below the age of three did not differ across any of the ADHD symptom severity indicators. Conclusions The age at the time of cardiac surgery might be associated with later ADHD symptom severity – with lower age at operation associated with better outcomes. Further, adequately powered studies are needed to confirm these exploratory findings and investigate the moderators of this relationship.

Are congenital heart defects connected to more severe attention-deficit/hyperactivity disorder?: A systematic review and meta-analysis

“…The age at the time of cardiac surgery makes a difference too, the lower the age at operation, the better the outcomes. [17,18]…”

“…The age at the time of cardiac surgery makes a difference too, the lower the age at operation, the better the outcomes. [17,18] According to the American Psychiatric Association, ADHD symptoms come with 3 presentations: ADHD-combined, ADHD-inattention, and ADHD-hyperactivity. Many different types of scales are available to determine the type and assess the severity of ADHD.…”

“…They reported 15% of all T-scores were above 65 In the CHD group to 4% of the T-scores in the control group and end up with patients with a simple CHDs have a higher symptom burden across all ADHD scores (ADHD-combined: P = .007, ADHD-inattention: P = .002, and ADHD-hyperactivity: P = .03) and all symptom subscores (inattention/memory problems: P = .001, hyperactivity/ restlessness: P = .03, impulsivity/emotional lability: P = .001) therefore they emphasize the importance of the routine screening for ADHD symptoms to facilitate adequate help as these symptoms are easily overlooked. Czobor et al [23] investigate the differences in ADHD symptoms between children who underwent cardiac surgery at different ages and controls. The results indicted better outcomes with the lower age at the first cardiac surgery and significantly higher severity of ADHD symptoms in children who underwent cardiac surgery at or above the age of 3 compared to non-operated children or children who operated at a younger age.…”

Safety of stimulant medications for attention deficit hyperactivity disorder in paediatric congenital heart disease

“…Children with cardiac conditions are reported to have increased behavioural concerns 13 . This could be related to hypoxia in the newborn period or minor brain injury in post‐operative CHD patients 14,15 . Of these behavioural issues, ADHD is a common condition which affects quality of life 2,16 …”

“…13 This could be related to hypoxia in the newborn period or minor brain injury in post-operative CHD patients. 14,15 Of these behavioural issues, ADHD is a common condition which affects quality of life. 2,16 The first line medications used in the treatment of ADHD are stimulants.…”