Determinants of neuropsychological and behavioural outcomes in early childhood survivors of congenital heart disease

Abstract

Aims: To evaluate the relative effect of cyanosis, surgical interventions and family processes on neuropsychological and behavioural outcomes in 4-year-old survivors of serious congenital heart disease (CHD). Methods: 90 children with a range of cyanotic and acyanotic conditions, who underwent either corrective or palliative surgery, completed a neuropsychological and behavioural evaluation. Families of participants were also profiled by evaluation of maternal mental health, worry, social support, parenting style and family functioning. Results: Compromised neuropsychological outcomes were associated with a combination of cyanotic conditions and open-heart surgery, but this was not exacerbated by having a complex, palliative, status. Both cyanotic and acyanotic conditions were associated with specific sensorimotor delays, regardless of method of the correction. Only children with complex conditions and palliative interventions seemed at risk of poor behavioural outcomes; indeed, children with cyanosis with complete repair showed favourable behavioural outcomes compared with controls. Multivariate analyses highlighted the sometimes greater relevance of family processes (eg parenting style, maternal mental health and worry), rather than disease or surgical factors, in predicting especially behavioural outcomes. Conclusions: The findings (1) suggest a more complex relationship between cyanosis, surgical methods of correction, neuropsychological and behavioural outcomes than previously charted, (2) highlight that family processes may be aetiologically more important than disease and surgical factors, and (3) indicate specific targets for secondary prevention programmes for this at-risk population.

Congenital Heart Defects and Developmental and Other Psychiatric Disorders

“…However, given previous research demonstrating an increased risk of neurodevelopmental disorders 3,5,6 and psychological maladjustment, 11,47 as well as the strength of the associations in our study, we do not believe that this potential bias explains our results. Psychiatric hospitalization is a recognized outcome measure in research on psychiatric disorders with high validity.…”

“…43 The results from an Irish study of children with a range of cyanotic and acyanotic defects who underwent either corrective or palliative surgery highlight the sometimes greater relevance of family processes (eg, parenting style, maternal mental health, and worry) rather than disease or surgical factors, in predicting behavioral outcomes in this context. 11 Thus, interactions among several biological and psychological risk factors are likely.…”

“…Factors identified as affecting the mental health of CHD patients in this context include coexisting syndromes (eg, Down and DiGeorge syndromes) 9,10 and familial processes (parenting styles, maternal mental health, and worry). 11 Little is known about the mental health of CHD patients who have not undergone surgery or a catheter-based intervention, although risk factors for developmental and other psychiatric disorders unrelated to surgical treatment, such as preterm birth, 12,13 occur more often than expected among CHD patients. 14 Psychiatric disorders for the purposes of this study included the full array of neurodevelopmental and psychiatric diagnoses included in the psychiatric chapter of the International Classification of Diseases, 10th revision (ICD-10).…”

Exploring causal pathways of child behavior and maternal mental health in families with a child with congenital heart disease: a longitudinal study

“…It is noteworthy that this finding was present in both samples, hence not showing any specific mutual influence from mother to child in families with a child with CHD. Negative effects of maternal distress on child behavior have previously been shown in families of a child with CHD (Gupta et al 1998;Visconti et al 2002;McCusker et al 2007;Spijkerboer et al 2010) and also in families with healthy children (Elgar et al 2004). A study among adolescents with depressive symptoms and antisocial behavior reported a corresponding effect of the same size (Pike et al 1996).…”

“…However, their relative importance has not previously been studied in families with a child with CHD or another life-threatening congenital condition. There are studies available on the negative influence of maternal mental health problems on the child with CHD (Gupta et al 1998;Visconti et al 2002;McCusker et al 2007;Spijkerboer et al 2010), but none of these studies examined the relative importance of individual experiences, shared experiences and mutual influences between the parents and the child. Moreover, there are no studies that address whether the covariation of psychological distress in families of children with CHD is specific for families with a sick child or reflects processes that can also be found in families with healthy children.…”