Executive Function in Preschool Children with Congenital Heart Disease and Controls: The Role of a Cognitively Stimulating Home Environment

Andrew T M Chew; Alexandra F Bonthrone; Arezoo Alford; Christopher Kelly; Kuberan Pushparajah; Alexia Egloff; Joseph V Hajnal; John Simpson; Mary Rutherford; A David Edwards; Chiara Nosarti; Serena J Counsell

doi:10.1016/j.jpeds.2023.113897

Executive Function in Preschool Children with Congenital Heart Disease and Controls: The Role of a Cognitively Stimulating Home Environment

J Pediatr. 2024 Apr:267:113897. doi: 10.1016/j.jpeds.2023.113897. Epub 2024 Jan 1.

Affiliations

¹ Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom.
² Paediatric Cardiology Department, Evelina London Children's Healthcare, London, United Kingdom.
³ Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom; Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.
⁴ Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom. Electronic address: serena.counsell@kcl.ac.uk.

PMID: 38171471
DOI: 10.1016/j.jpeds.2023.113897

Abstract

Objective: To assess the relationships between (1) environmental and demographic factors and executive function (EF) in preschool children with congenital heart disease (CHD) and controls and (2) clinical and surgical risk factors and EF in preschool children with CHD.

Study design: At 4-6 years of age, parents of children with CHD (n = 51) and controls (n = 124) completed the Behavior Rating Inventory of Executive Function, Preschool Version questionnaire and the Cognitively Stimulating Parenting Scale (CSPS). Multivariable general linear modeling assessed the relationship between Behavior Rating Inventory of Executive Function, Preschool Version composite scores (Inhibitory Self-Control Index [ISCI], Flexibility Index [FI], and Emergent Metacognition Index [EMI]) and group (CHD/control), sex, age at assessment, gestational age, Index of Multiple Deprivation, and CSPS scores. The relationships between CHD type, surgical factors, and brain magnetic resonance imaging injury rating and ISCI, FI, and EMI scores were assessed.

Results: The presence of CHD, age at assessment, sex, and Index of Multiple Deprivation were not associated with EF scores. Lower gestational age was associated with greater ISCI and FI scores, and age at assessment was associated with lower FI scores. Group significantly moderated the relationship between CSPS and EF, such that CSPS significantly predicted EF in children with CHD (ISCI: P = .0004; FI: P = .0015; EMI: P = .0004) but not controls (ISCI: P = .2727; FI: P = .6185; EMI: P = .3332). There were no significant relationships between EF scores and surgical factors, CHD type, or brain magnetic resonance imaging injury rating.

Conclusions: Supporting parents to provide a cognitively stimulating home environment may improve EF in children with CHD. The home and parenting environment should be considered when designing intervention studies aimed at improving EF in this patient group.

Keywords: Cognitively Stimulating Parenting Scale; congenital heart disease; controls; executive function.

MeSH terms

Child, Preschool
Executive Function*
Heart Defects, Congenital* / complications
Home Environment
Humans
Parenting
Parents