News release

From: Frontiers

Preschool children born with heart defects have greater risk of developing behavioral problems

Cognitively stimulating home can protect against higher risk of ADHD and peer relationship problems in preschoolers with congenital heart disease

Congenital heart disease is the most common congenital anomaly. Here, scientists in the UK showed that preschool children with serious or critical CHD have greater odds of developing clinically relevant impulsivity/inattention problems and peer relation problems than their healthy peers. The mechanism is not yet known, but the results showed that a stimulating home environment can reduce the risk of developing these problems.

Congenital heart disease (CHD) which is a problem with how the heart forms before birth -- occurs in approximately 1% of newborns. It has previously been shown that school-age children, adolescents, and young adults with CHD are more likely to display traits of autism. Now, a team of researchers in the UK has shown that preschool children with CHD are also at risk of developing behavioral problems. They published their results in Frontiers in Pediatrics.

“Here we show that, although children with congenital heart disease show higher levels of attention difficulties and poor peer relationships compared to healthy children during the preschool years, greater cognitive stimulation within the home environment may reduce the risk of developing such difficulties,” said corresponding author Chiara Nosarti, Professor of Neurodevelopment and Mental Health at King's College London.

Nosarti and colleagues focused on 56 children between four and six years of age with CHD and enrolled between 2014 and 2020 in the Congenital Heart Imaging Project, led by Prof Serena Counsell, King’s College London. These children either had critical CHD, for example transposition of the great arteries; or serious CHD, including any noncritical heart lesion that had required catheterization or surgery before one year of age.

The researchers compared these children with a cohort of 215 healthy control children enrolled in an unrelated program, the UK’s Developing Human Connectome Project.

Measuring problematic behavior

The authors invited all parents to fill out five tried-and-tested questionnaires to measure their child’s comprehensive behavioral profile, such as the Children’s Behavior Questionnaire, the Social Communication Questionnaire, and the Empathy Questionnaire. Higher scores on these questionnaires indicate more severe behavioral difficulties.

The researchers used the Index of Multiple Deprivation, based on postal code, as a proxy for the parents’ socio-economic status. And to measure how much the children’s environment stimulated their cognitive development, parents were asked to complete the 28-item Cognitively Stimulating Parenting Scale. This rates the degree of verbal interaction and educational activities at home, as well as the availability of materials like child-size tables and chairs, storybooks, coloring books, and musical instruments.

The analyses showed that after correction for the effects of sex, gestational age at birth, and neighborhood deprivation, children with CHD had higher odds of ADHD and peer relationship problems than their healthy peers.

Close to home

Importantly, the results also showed that a highly stimulating home can protect against developing these problematic behavioral outcomes.

“It remains unclear whether cognitively stimulating environments influence child behaviors, or whether child behavior, in turn, affects the degree of cognitive stimulation provided by caregivers,” wrote the authors.

The study did not look at the mechanisms which might cause the observed differences. However, they noted in their study that peer relationship problems may be driven by a lower capacity of children with CHD to recognize facial emotion expressions and identify false beliefs, which has previously been shown in school-age children.

“Clinically, these findings suggest that behavior in preschool children with CHD should be assessed regularly so that any problems can be identified and children can be supported as soon as possible,” said Nosarti.

“Alongside cardiac care, environmental factors such as fostering a stimulating home learning environment should be taken into account when designing support plans for children with CHD,” concluded Nosarti.