Behavioural Outcomes of Preschool Children with Congenital Heart Disease and Controls

BackgroundBehavioural outcomes may be suboptimal in school-age children and adolescents with congenital heart disease (CHD), but little is known about outcomes of preschool children. We aimed to compare the behavioural outcomes of preschool children with CHD with controls, and investigate whether a cognitively stimulating home environment impacts their outcomes. MethodsThis is a cross-sectional case-control study of fifty-six preschool children (4-6 years) with CHD and 215 controls. Questionnaires were used to assess temperament (Child Behavior Questionnaire), autism traits (Social Communication Questionnaire), ADHD symptoms (ADHD-Rating Scale-IV), empathy (EmQue), and behavioural difficulties (Strengths and Difficulties Questionnaire). The Cognitively Stimulating Parenting Scale was used to assess home environment. ResultsUnivariate robust regression analyses showed that children with CHD compared to controls had higher levels of hyperactivity-impulsivity (B=-0.467 p=0.023), inattention (B=-0.450, p=0.023) and peer relationship problems (B=-0.504, p=0.023), after controlling for age at assessment, gestational age at birth, sex and neighbourhood deprivation, with results surviving false discovery rate correction. Group significantly moderated the relationship between cognitively stimulating opportunities at home and the outcomes that differed between the groups: hyperactivity-impulsivity, inattention and peer problems. More cognitively stimulating opportunities at home were associated with more favourable behavioural outcomes in children with CHD (hyperactivity-impulsivity: B=-0.092, p<0.001; inattention: B=-0.088, p<0.001; peer problems: B=-0.124, p<0.001) but not in controls (hyperactivity-impulsivity: B=-0.005, p=0.727; inattention: B=-0.019, p=0.225; peer problems: B=-0.002, p=0.911). ConclusionsCompared to controls, preschool children with CHD have more hyperactivity-impulsivity, inattention and peer relationship problems. These behavioural problems are mitigated by a cognitively stimulating home environment.