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School Readiness in Preschool-Age Children with Critical Congenital Heart Disease

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Abstract

This study examined the nature, variability, and predictors of school readiness difficulties in young children with critical congenital heart disease (CCHD). We hypothesized that, compared to a community control (CC) group, children with CCHD would score less well on measures of readiness and that readiness would be associated with CCHD-related risk factors. Children (60 CCHD and 60 CC) were 4 to 5 years of age and not yet attending kindergarten. Readiness measures included tests of cognition, executive function, motor ability, and pre-academic skills. Caregivers provided child behavior ratings. Analyses examined group differences in readiness, readiness profiles, and associations of readiness with CCHD-related medical risk factors. The CCHD group had lower scores than the CC group on testing and higher caregiver ratings of problems in social communication, as well as higher rates of deficits on several of the measures. Latent class analysis provided evidence for different readiness profiles, with more children with CCHD displaying profiles characterized by weaknesses in readiness. CCHD-related medical risk factors associated with readiness problems in the CCHD group included a co-morbid genetic disorder, postnatal diagnosis of CCHD, major perioperative complication, and longer periods of hospitalizations, cardiopulmonary bypass, and aortic cross-clamp placements. Findings document multiple problems in school readiness in young children with CCHD. Deficits vary across individuals and are associated with higher medical risk. Results confirm the importance of screening for school readiness in these children and suggest areas to target in designing screening measures and providing early childhood interventions.

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Data Availability

The data that support the findings of this study are available from the authors. Although restrictions apply, they are available upon reasonable request and with the permission of Nationwide Children’s Hospital.

References

  1. Marelli AJ, Ionescu-Ittu R, Mackie AS, Guo L et al (2014) Lifetime prevalence of congenital heart disease in the general population from 2000 to 2010. Circulation 130(9):749–756. https://doi.org/10.1161/CIRCULATIONAHA.113.008396

    Article  PubMed  Google Scholar 

  2. Abda A, Bolduc ME, Tsimicalis A, Rennick J et al (2019) Psychosocial outcomes of children and adolescents with severe congenital heart defect: a systematic review and Meta-analysis. J Pediatr Psychol 44(4):463–477. https://doi.org/10.1093/jpepsy/jsy085

    Article  PubMed  Google Scholar 

  3. Cassidy AR, Ilardi D, Bowen SR, Hampton LE et al (2018) Congenital heart disease: a primer for the pediatric neuropsychologist. Child Neuropsychol 24(7):859–902. https://doi.org/10.1080/09297049.2017.1373758

    Article  PubMed  Google Scholar 

  4. Marino BS, Lipkin PH, Newburger JW, Peacock G et al (2012) Neurodevelopmental outcomes in children with congenital heart disease: evaluation and management: a scientific statement from the American Heart Association. Circulation 126(9):1143–1172. https://doi.org/10.1161/CIR.0b013e318265ee8a

    Article  PubMed  Google Scholar 

  5. Werninger I, Ehrler M, Wehrle FM, Landolt MA et al (2020) Social and behavioral difficulties in 10-Year-old children with congenital heart disease: prevalence and risk factors. Front Pediatr 8:604918. https://doi.org/10.3389/fped.2020.604918

    Article  PubMed  PubMed Central  Google Scholar 

  6. Dijkhuizen EI, de Munck S, de Jonge RCJ, Dulfer K et al (2023) Early brain magnetic resonance imaging findings and neurodevelopmental outcome in children with congenital heart disease: a systematic review. Dev Med Child Neurol. https://doi.org/10.1111/dmcn.15588

    Article  PubMed  Google Scholar 

  7. Gaudet I, Paquette N, Bernard C, Doussau A et al (2021) Neurodevelopmental outcome of children with congenital heart disease: a Cohort Study from Infancy to Preschool Age. J Pediatr 239:126–135e5. https://doi.org/10.1016/j.jpeds.2021.08.042

    Article  PubMed  Google Scholar 

  8. Brosig CL, Bear L, Allen S, Hoffmann RG et al (2017) Preschool Neurodevelopmental outcomes in children with congenital heart disease. J Pediatr 183:80–86e1. https://doi.org/10.1016/j.jpeds.2016.12.044

    Article  PubMed  PubMed Central  Google Scholar 

  9. Ware J, Butcher JL, Latal B, Sadhwani A et al (2020) Neurodevelopmental evaluation strategies for children with congenital heart disease aged birth through 5 years: recommendations from the cardiac neurodevelopmental outcome collaborative. Cardiol Young 30(11):1609–1622. https://doi.org/10.1017/s1047951120003534

    Article  PubMed  Google Scholar 

  10. Ilardi D, Ono KE, McCartney R, Book W et al (2017) Neurocognitive functioning in adults with congenital heart disease. Congenit Heart Dis 12(2):166–173. https://doi.org/10.1111/chd.12434

    Article  PubMed  Google Scholar 

  11. Selvanathan T, Smith JMC, Miller SP, Field TS (2022) Neurodevelopment and Cognition across the Lifespan in patients with single-ventricle physiology: abnormal brain maturation and Accumulation of Brain injuries. Can J Cardiol 38(7):977–987. https://doi.org/10.1016/j.cjca.2022.02.009

    Article  PubMed  Google Scholar 

  12. High PC (2008) School readiness. Pediatrics 121(4):e1008–e1015. https://doi.org/10.1542/peds.2008-0079

    Article  PubMed  Google Scholar 

  13. Pan Q, Trang KT, Love HR, Templin J (2019) School Readiness profiles and Growth in Academic achievement [Original Research]. Front Educ. 4https://doi.org/10.3389/feduc.2019.00127

    Article  Google Scholar 

  14. Williams PG, Lerner MA (2019) School Readiness. Pediatrics 144(2). https://doi.org/10.1542/peds.2019-1766

  15. Ghandour RM, Hirai AH, Moore KA, Robinson LR et al (2021) Healthy and ready to learn: prevalence and correlates of School readiness among United States preschoolers. Acad Pediatr 21(5):818–829. https://doi.org/10.1016/j.acap.2021.02.019

    Article  PubMed  PubMed Central  Google Scholar 

  16. Pagani LS, Fitzpatrick C, Archambault I, and Janosz M (2010) School readiness and later achievement: a French Canadian replication and extension. Dev Psychol 46(5):984–994. https://doi.org/10.1037/a0018881

    Article  PubMed  Google Scholar 

  17. Sabol TJ, Pianta RC (2012) Patterns of school readiness forecast achievement and socioemotional development at the end of elementary school. Child Dev 83(1):282–299. https://doi.org/10.1111/j.1467-8624.2011.01678.x

    Article  PubMed  Google Scholar 

  18. Pritchard VE, Bora S, Austin NC, Levin KJ et al (2014) Identifying very preterm children at educational risk using a school readiness framework. Pediatrics 134(3):e825–e832. https://doi.org/10.1542/peds.2013-3865

    Article  PubMed  Google Scholar 

  19. Roberts G, Lim J, Doyle LW, Anderson PJ (2011) High rates of school readiness difficulties at 5 years of age in very preterm infants compared with term controls. J Dev Behav Pediatr 32(2):117–124. https://doi.org/10.1097/DBP.0b013e318206d5c9

    Article  PubMed  Google Scholar 

  20. Shah PE, Kaciroti N, Richards B, Lumeng JC (2016) Gestational age and Kindergarten School Readiness in a National Sample of Preterm infants. J Pediatr 178:61–67. https://doi.org/10.1016/j.jpeds.2016.06.062

    Article  PubMed  PubMed Central  Google Scholar 

  21. Taylor HG, Vrantsidis DM, Neel ML, Benkart R et al (2022) School Readiness in 4-Year-old very Preterm Children. Child (Basel) 9(3). https://doi.org/10.3390/children9030323

  22. Bellinger DC, Wypij D, Kuban KC, Rappaport LA et al (1999) Developmental and neurological status of children at 4 years of age after heart surgery with hypothermic circulatory arrest or low-flow cardiopulmonary bypass. Circulation 100(5):526–532. https://doi.org/10.1161/01.cir.100.5.526

    Article  CAS  PubMed  Google Scholar 

  23. Cassidy AR, White MT, DeMaso DR, Newburger JW et al (2015) Executive function in children and adolescents with critical cyanotic congenital heart disease. J Int Neuropsychol Soc 21(1):34–49. https://doi.org/10.1017/S1355617714001027

    Article  PubMed  Google Scholar 

  24. Creighton DE, Robertson CM, Sauve RS, Moddemann DM et al (2007) Neurocognitive, functional, and health outcomes at 5 years of age for children after complex cardiac surgery at 6 weeks of age or younger. Pediatrics 120(3):e478–e486. https://doi.org/10.1542/peds.2006-3250

    Article  PubMed  Google Scholar 

  25. Mussatto KA, Hoffmann RG, Hoffman GM, Tweddell JS et al (2014) Risk and prevalence of developmental delay in young children with congenital heart disease. Pediatrics 133(3):e570–e577. https://doi.org/10.1542/peds.2013-2309

    Article  PubMed  PubMed Central  Google Scholar 

  26. Gaynor JW, Stopp C, Wypij D, Andropoulos DB et al (2015) Neurodevelopmental outcomes after cardiac surgery in infancy. Pediatrics 135(5):816–825. https://doi.org/10.1542/peds.2014-3825

    Article  PubMed  PubMed Central  Google Scholar 

  27. Ilardi D, Alexander N, Xiang Y, Figueroa J et al (2023) Social-environmental factors as mediators of IQ and achievement differences across race groups in adolescents with high risk congenital heart disease. Child Neuropsychol 29(7):1003–1020. https://doi.org/10.1080/09297049.2022.2117798

    Article  PubMed  Google Scholar 

  28. Jackson JL, Grant V, Barnett KS, Ball MK et al (2023) Structural racism, Social Determinants of Health, and Provider Bias: impact on Brain Development in critical congenital heart disease. Can J Cardiol 39(2):133–143. https://doi.org/10.1016/j.cjca.2022.11.001

    Article  PubMed  Google Scholar 

  29. Karsdorp PA, Everaerd W, Kindt M, Mulder BJ (2007) Psychological and cognitive functioning in children and adolescents with congenital heart disease: a meta-analysis. J Pediatr Psychol 32(5):527–541. https://doi.org/10.1093/jpepsy/jsl047

    Article  PubMed  Google Scholar 

  30. Mussatto KA, Hollenbeck-Pringle D, Trachtenberg F, Sood E et al (2018) Utilisation of early intervention services in young children with hypoplastic left heart syndrome. Cardiol Young 28(1):126–133. https://doi.org/10.1017/s104795111700169x

    Article  PubMed  Google Scholar 

  31. Harvey K (2023) Parents of children with congenital heart defects during the COVID-19 pandemic: an examination of mental health variables, risk factors, and protective factors. Heart Lung 57:130–139. https://doi.org/10.1016/j.hrtlng.2022.09.017

    Article  PubMed  Google Scholar 

  32. Elliott CD (2007) Differential Ability Scales (2nd ed.)

  33. Korkman M, Kirk U, Kemp S (2007) NEPSY - Second Edition. NEPSY - II

  34. Henderson SE, Sugden DA, Barnett A (2007) Movement Assessment Battery for Children - Second Edition (Movement ABC-2). Examiner’s manual

  35. Wilson SB, Lonigan CJ (2009) An evaluation of two emergent literacy screening tools for preschool children. Ann Dyslexia 59(2):115–131. https://doi.org/10.1007/s11881-009-0026-9

    Article  PubMed  PubMed Central  Google Scholar 

  36. Bracken BA (2007) Examiner’s Manual: Bracken School Readiness Assessment – 3rd Edition. San Antonio, TX: Psychological Corporation

  37. Wiley CP, Wedeking T, Galindo AM (2013) Test Review: C. K. Conners. Conners Early Childhood Manual. J Psychoeducational Assess 31(6):606–610. https://doi.org/10.1177/0734282913484558

    Article  Google Scholar 

  38. Gioia GA, Espy KA, Esquith PK (2003) BRIEF-P: Behavior Rating Inventory of Executive Function-Preschool Version

  39. Shields A, Cicchetti D (1997) Emotion regulation among school-age children: the development and validation of a new criterion Q-sort scale. Dev Psychol 33(6):906–916. https://doi.org/10.1037//0012-1649.33.6.906

    Article  CAS  PubMed  Google Scholar 

  40. Rutter M, Bailey A, Lord C (2003) The Social Communication Questionnaire: Manual

  41. Sinha P, Calfee CS, Delucchi KL (2021) Practitioner’s guide to latent class analysis: methodological considerations and common pitfalls. Crit Care Med 49(1):e63–e79. https://doi.org/10.1097/ccm.0000000000004710

    Article  PubMed  PubMed Central  Google Scholar 

  42. Weller BE, Bowen NK, Faubert SJ (2020) Latent class analysis: a guide to best practice. J Black Psychol 46(4):287–311. https://doi.org/10.1177/0095798420930932

    Article  Google Scholar 

  43. Chandler S, Charman T, Baird G, Simonoff E et al (2007) Validation of the social communication questionnaire in a population cohort of children with autism spectrum disorders. J Am Acad Child Adolesc Psychiatry 46(10):1324–1332. https://doi.org/10.1097/chi.0b013e31812f7d8d

    Article  PubMed  Google Scholar 

  44. Sanz JH, Anixt J, Bear L, Basken A et al (2021) Characterisation of neurodevelopmental and psychological outcomes in CHD: a research agenda and recommendations from the cardiac neurodevelopmental outcome collaborative. Cardiol Young 31(6):876–887. https://doi.org/10.1017/s1047951121002146

    Article  PubMed  PubMed Central  Google Scholar 

  45. Bonnet D (2021) Impacts of prenatal diagnosis of congenital heart diseases on outcomes. Transl Pediatr 10(8):2241–2249. https://doi.org/10.21037/tp-20-267

    Article  PubMed  PubMed Central  Google Scholar 

  46. Segar DE, Zhang J, Yan K, Reid A et al (2023) The relationship between placental Pathology and Neurodevelopmental outcomes in Complex congenital heart disease. Pediatr Cardiol 44(5):1143–1149. https://doi.org/10.1007/s00246-022-03018-4

    Article  PubMed  Google Scholar 

  47. Bonthrone AF, Chew A, Kelly CJ, Almedom L et al (2021) Cognitive function in toddlers with congenital heart disease: the impact of a stimulating home environment. Infancy 26(1):184–199. https://doi.org/10.1111/infa.12376

    Article  PubMed  Google Scholar 

  48. Lisanti AJ (2018) Parental stress and resilience in CHD: a new frontier for health disparities research. Cardiol Young 28(9):1142–1150. https://doi.org/10.1017/s1047951118000963

    Article  PubMed  PubMed Central  Google Scholar 

  49. McCusker CG, Doherty NN, Molloy B, Rooney N et al (2012) A randomized controlled trial of interventions to promote adjustment in children with congenital heart disease entering school and their families. J Pediatr Psychol 37(10):1089–1103. https://doi.org/10.1093/jpepsy/jss092

    Article  PubMed  Google Scholar 

  50. Phillips JM, Longoria JN (2020) Addressing the neurodevelopmental needs of children and adolescents with congenital heart disease: a review of the existing intervention literature. Child Neuropsychol 26(4):433–459. https://doi.org/10.1080/09297049.2019.1682131

    Article  PubMed  Google Scholar 

  51. Cassidy AR, Butler SC, Briend J, Calderon J et al (2021) Neurodevelopmental and psychosocial interventions for individuals with CHD: a research agenda and recommendations from the Cardiac Neurodevelopmental Outcome Collaborative. Cardiol Young 31(6):888–899. https://doi.org/10.1017/S1047951121002158

    Article  PubMed  PubMed Central  Google Scholar 

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Acknowledgements

We appreciate the assistance of Charlotte Lubowe in preparing the IRB protocol and recruitment materials, as well as in initial project planning. We also thank other members of our research team, including Kerry Orton in overseeing study organization, Austin Kennemer in conducting caregiver interviews, and Adrien Winning, Ph.D. for help in editing the paper. We also acknowledge the assistance of the Ohio Perinatal Research Network in identifying eligible children with critical congenital heart disease from the total population of those treated in our hospital system. The study was funded by a grant from the Saving tiny Hearts Society.

Funding

This research was funded by a grant from the Saving tiny Hearts Society.

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Authors and Affiliations

  1. Abigail Wexner Research Institute at Nationwide Children’s Hospital, 700 Children’s Drive, Columbus, OH, 43205, USA

    H. Gerry Taylor, Jessica Quach, Josh Bricker, Amber Riggs, Julia Friedman, Megan Kozak, Kathryn Vannatta & Carl Backes

  2. Department of Pediatrics, The Ohio State University, Columbus, OH, USA

    H. Gerry Taylor, Kathryn Vannatta & Carl Backes

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  1. H. Gerry Taylor
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Contributions

HGT: Conceptualization, Data interpretation, Manuscript drafting JQ: Data collection, Statistical analysis, Manuscript preparation; JB: Statistical analysis, Manuscript preparation AR: Data collection JF: Data collection MK: Data collection KV: Contribution to research idea, manuscript preparation CB: Contribution to research idea and methodology Each author has reviewed and approved the final version of the manuscript.

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Correspondence to H. Gerry Taylor.

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Approval was obtained from the ethics committee of Nationwide Children’s Hospital. The procedure used in the study adhere to the tenets of the Declaration of Helsinki.

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Informed consent was obtained from legal guardians.

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The authors declare no competing interests.

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Taylor, H.G., Quach, J., Bricker, J. et al. School Readiness in Preschool-Age Children with Critical Congenital Heart Disease. Pediatr Cardiol (2024). https://doi.org/10.1007/s00246-024-03460-6

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