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Predictors of behavioural and emotional outcomes in toddlers with congenital heart disease

Published online by Cambridge University Press:  22 September 2021

Elizabeth Jilek ,
Ashley Shields ,
Liyun Zhang ,
Pippa Simpson ,
Laurel Bear ,
Sydney Allen Martins ,
Kathleen A. Mussatto  and
Cheryl L. Brosig Open the ORCID record for Cheryl L. Brosig [Opens in a new window]
Elizabeth Jilek
Affiliation:
Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA
Ashley Shields
Affiliation:
UVA Children’s, Charlottesville, VA, USA
Liyun Zhang
Affiliation:
Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA
Pippa Simpson
Affiliation:
Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA
Laurel Bear
Affiliation:
Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA Herma Heart Institute, Children’s Wisconsin, Milwaukee, WI, USA
Sydney Allen Martins
Affiliation:
Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA
Kathleen A. Mussatto
Affiliation:
Department of Nursing, Milwaukee School of Engineering, Milwaukee, WI, USA
Cheryl L. Brosig*
Affiliation:
Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA Herma Heart Institute, Children’s Wisconsin, Milwaukee, WI, USA
*
Author for correspondence: C. Brosig, PhD, Children’s Wisconsin, 9000 W. Wisconsin Avenue, P.O. Box 1997, MS 713, Milwaukee, WI53201-1997, USA. Tel: 414-266-2948; Fax: 414-266-3261. E-mail: cbrosig@chw.org
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Abstract

Objectives:

Children with congenital heart disease (CHD) are at risk for psychological challenges, including internalising (e.g., depression, anxiety) and externalising (e.g., aggression, inattention) problems. The present study aimed to investigate the development of psychological concerns in early childhood by identifying predictors of behavioural and emotional problems in toddlers with CHD.

Methods:

Children with CHD who were seen for neurodevelopmental (ND) evaluation at 12 ± 3 months of age, who completed the Bayley Scales of Infant Development–III (BSID-III) and whose parents completed the Child Behavior Checklist (CBCL), a standardised measure of emotional/behavioural problems at age 24–36 months, were included in the study (n = 144). CBCL scores were compared to test norms and classified as normal or abnormal. A classification tree was used to assess the association between CBCL scores and demographic and clinical variables.

Results:

Multi-variable tree analyses revealed lower BSID-III language composite scores at age 9–15 months predicted clinical CBCL internalising (p < 0.001), externalising (p = 0.004) and total scores (p < 0.001) at age 24–36 months. Lower maternal education levels also predicted clinical CBCL internalising (p < 0.0001), externalising (p < 0.001) and total scores (p < 0.0001).

Conclusions:

Lower language abilities and lower maternal education predict increased behavioural and emotional problems in toddlers with CHD. These risk factors should be considered during routine ND evaluations to allow for earlier identification of children with CHD and their families who may benefit from psychological support.

Keywords

Congenital heart disease/defectsdevelopmental outcomeschild development
Type
Original Article
Information
Cardiology in the Young , Volume 32 , Issue 8 , August 2022 , pp. 1216 - 1221
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Copyright
© The Author(s), 2021. Published by Cambridge University Press

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References

Marino, BS, Lipkin, PH, Newburger, JW, et al. Neurodevelopmental outcomes in children with congenital heart disease: evaluation and management: a scientific statement from the American Heart Association. Circulation 2012; 126: 1143–1172. DOI 10.1161/CIR.0b013e318265ee8a.CrossRefGoogle ScholarPubMed
Latal, B, Helfricht, S, Fischer, JE, Bauersfeld, U, Landolt, MA. Psychological adjustment and quality of life in children and adolescents following open-heart surgery for congenital heart disease: a systematic review. BMC Pediatr 2009; 9: 6. DOI 10.1186/1471-2431-9-6.CrossRefGoogle ScholarPubMed
Brosig, CL, Bear, L, Allen, S, et al. Preschool neurodevelopmental outcomes in children with congenital heart disease. J Pediatr 2017; 183: 80–86.e1. DOI 10.1016/j.jpeds.2016.12.044.CrossRefGoogle ScholarPubMed
Abda, A, Bolduc, M, Tsimicalis, A, Rennick, J, Vatcher, D, Brossard-Racine, M. Psychosocial outcomes of children and adolescents with severe congenital heart defects: a systematic review and meta-analysis. J Pediatr Psychol 2019; 44: 463–477.CrossRefGoogle ScholarPubMed
Miatton, M, De Wolf, D, François, K, Thiery, E, Vingerhoets, G. Neuropsychological performance in school-aged children with surgically corrected congenital heart disease. J Pediatr 2007; 151: 73–78.e1. DOI 10.1016/j.jpeds.2007.02.020.CrossRefGoogle ScholarPubMed
Miatton, M, De Wolf, D, François, K, Thiery, E, Vingerhoets, G. Behavior and self-perception in children with a surgically corrected congenital heart disease. J Dev Behav Pediatr 2007; 28: 294–301. DOI 10.1097/DBP.0b013e3180cabc3c.CrossRefGoogle ScholarPubMed
Karsdorp, PA, Everaerd, W, Kindt, M, Mulder, BJ. Psychological and cognitive functioning in children and adolescents with congenital heart disease: a meta-analysis. J Pediatr Psychol 2007; 32: 527–541. DOI 10.1093/jpepsy/jsl047.CrossRefGoogle ScholarPubMed
Torowitz, D, Irving, S, Hanlon, A, Sumpter, D, Medoff-Cooper, B. Infant temperament and parental stress in 3-month-old infants after surgery for complex congenital heart disease. J Dev Behav Pediatr 2010; 31: 202–208.CrossRefGoogle Scholar
Clancy, T, Jordan, B, de Weerth, C, Muscara, F. Early emotional, behavioural and social development of infants and young children with congenital heart disease: a systematic review. J Clin Psychol Med Settings 2020; 27: 686–703. DOI 10.1007/s10880-019-09651-1.CrossRefGoogle ScholarPubMed
DeMaso, DR, Calderon, J, Taylor, GA, et al. Psychiatric disorders in adolescents with single ventricle congenital heart disease. Pediatrics 2017; 139: e20162241. DOI 10.1542/peds.2016-2241.CrossRefGoogle ScholarPubMed
Re, JM, Dean, S, Mullaert, J, Guedeney, A, Menahem, S. Maternal distress and infant social withdrawal following infant cardiac surgery for congenital heart disease. World J Pediatr Congenit Heart Surg 2018; 9: 624–637. DOI 10.1177/2150135118788788.CrossRefGoogle ScholarPubMed
Sadhwani, A, Asaro, LA, Goldberg, C, et al. Impact of tight glycemic control on neurodevelopmental outcomes at 1 year of age for children with congenital heart disease: a randomized controlled trial. J Pediatr 2016; 174: 193–198.e2. DOI 10.1016/j.jpeds.2016.03.048.CrossRefGoogle ScholarPubMed
Tahirović, E, Begić, H, Tahirović, H, Varni, JW. Quality of life in children after cardiac surgery for congenital heart disease. Coll Antropol 2011; 35: 1285–1290.Google ScholarPubMed
Mussatto, K, Hoffmann, RG, Hoffman, G, et al. Risk and prevalence of developmental delay in young children with congenital heart disease. Pediatrics 2014; 133: e570–e577.CrossRefGoogle ScholarPubMed
Mussatto, K, Hoffmann, RG, Hoffman, G, et al. Risk factors for abnormal developmental trajectories in young children with congenital heart disease. Circulation 2015; 132: 755–776. DOI 10.1161/CIRCULATIONAHA.114.014521.CrossRefGoogle ScholarPubMed
Favilla, E, Faerber, J, Hampton, L, et al. Early evaluation and the effect of socioeconomic factors on neurodevelopment in infants with Tetralogy of Fallot. Pediatr Cardiol 2021; 42: 643–653.CrossRefGoogle ScholarPubMed
Achenbach, TM, Ruffle, TM. The child behavior checklist and related forms for assessing behavioral/emotional problems and competencies. Pediatr Rev 2000; 21: 265–271. DOI 10.1542/pir.21-8-265.CrossRefGoogle ScholarPubMed
Bayley, N. The Bayley Scales of Infant Development-III. The Psychological Corporation, San Antonio, TX, 2006.Google Scholar
Steinberg, D, Colla, P. CART—Classification and Regression Trees. Salford Systems, San Diego, CA, 1997.Google Scholar
Henrichs, J, Rescorla, L, Donkersloot, C, et al. Early vocabulary delay and behavioral/emotional problems in early childhood: the generation R study. J Speech Lang Hear Res 2013; 56: 553–566. DOI 10.1044/1092-4388(2012/11-0169).CrossRefGoogle ScholarPubMed
Petersen, IT, Bates, JE, DʼOnofrio, BM, et al. Language ability predicts the development of behavior problems in children. J Abnorm Psychol 2013; 122: 542–557. DOI 10.1037/a0031963.CrossRefGoogle ScholarPubMed
Nuru-Jeter, AM, Sarsour, K, Jutte, DP, Boyce, WT. Socioeconomic predictors of health and development in middle childhood: variations by socioeconomic status measure and race. Issues Compr Pediatr Nurs 2010; 33: 59–81. DOI 10.3109/01460861003663953.CrossRefGoogle Scholar
Patra, K, Greene, MM, Patel, AL, Meier, P. Maternal education level predicts cognitive, language, and motor outcome in preterm infants in the second year of life. Am J Perinatol 2016; 33: 738–744. DOI 10.1055/s-0036-1572532.Google ScholarPubMed
Acton, BV, Biggs, WS, Creighton, DE, et al. Overestimating neurodevelopment using the Bayley-III after early complex cardiac surgery. Pediatrics 2011; 128: e794–e800. DOI 10.1542/peds.2011-033.CrossRefGoogle ScholarPubMed
Anderson, PJ, De Luca, CR, Hutchinson, E, Roberts, G, Doyle, LW. Underestimation of developmental delay by the new Bayley-III scale. Arch Pediatr Adolesc Med 2010; 164: 352–356. DOI 10.1001/archpediatrics.2010.20.CrossRefGoogle ScholarPubMed
Goldstone, AB, Baiocchi, M, Wypij, D, et al. The Bayley-III scale may underestimate neurodevelopmental disability after cardiac surgery in infants. Eur J Cardiothorac Surg 2020; 57: 63–71. DOI 10.1093/ejcts/ezz123.CrossRefGoogle ScholarPubMed
Dahlawi, N, Milnes, LJ, Swallow, V. Behaviour and emotions of children and young people with congenital heart disease: a literature review. J Child Health Care 2020; 24: 317–332. DOI 10.1177/1367493519878550.CrossRefGoogle Scholar