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

Christopher G. McCusker ^1*, Nicola N Doherty ², Bernadette Molloy ², Frank Casey ², Nichola Rooney ², Connor Mulholland ², Andrew Sands ², Brian Craig ² and Moira Stewart ¹

¹ The Royal Belfast Hospital for Sick Children; The Queen's University of Belfast, United Kingdom
² The Royal Belfast Hospital for Sick Children, United Kingdom

^* To whom correspondence should be addressed. E-mail: c.mccusker{at}qub.ac.uk.

Accepted 30 September 2006

Abstract

Aims: To evaluate the relative impact of cyanosis, surgical interventions and family processes on neuropsychological and behavioural outcomes in 4 year old survivors of serious congenital heart disease (CHD).

Methods: Ninety children, with a range of cyanotic and acyanotic conditions, who had either corrective or palliative surgery, completed a neuropsychological and behavioural evaluation. Participant families 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 correction. Only children with complex conditions and palliative interventions appeared at risk for poor behavioural outcomes; indeed cyanotic children with complete repair showed favourable behavioural outcomes compared to controls. Multivariate analyses highlighted the sometimes greater significance of family processes (e.g. parenting style, maternal mental health and worry), rather than disease or surgical factors, in predicting especially behavioural outcomes.

Conclusions: Findings (a) suggest a more complex relationship between cyanosis, surgical methods of correction, neuropsychological and behavioural outcomes than previously charted (b) highlight that family processes may be aetiologically more important than disease and surgical factors and (c) indicate specific targets for secondary prevention programmes for this at risk population.

Keywords: behavioural outcomes, congenital heart disease, neuropsychology

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