title: Prevalence and pattern of executive dysfunction in school age children with congenital heart disease.
abstract: OBJECTIVE
  Executive function, a set of cognitive skills important to social and academic outcomes, is a specific area of cognitive weakness in children with congenital heart disease (CHD). We evaluated the prevalence and profile of executive dysfunction in a heterogeneous sample of school aged children with CHD, examined whether children with executive dysfunction are receiving school services and support, and identified risk factors for executive dysfunction at school age.
  
  
  METHODS
  Ninety-one school aged patients completed questionnaires, including the Behavior Rating Inventory of Executive Function (BRIEF) and a medical history questionnaire. An age- and gender- matched control sample was drawn from a normative database.
  
  
  RESULTS
  Children with CHD had a higher rate of parent reported executive dysfunction (OR = 4.37, P < .0001), especially for working memory (OR = 8.22, P < .0001) and flexibility (OR = 8.05, P < .0001). Those with executive dysfunction were not more likely to be receiving school services (P > .05). Gender, premature birth (≤37 weeks), and CHD with aortic obstruction were predictive of executive dysfunction, especially for behavior regulation skills.
  
  
  CONCLUSIONS
  School aged children with CHD have an increased prevalence of executive dysfunction, especially problems with working memory and flexibility, and are underserved by the school system. The increased risk for executive dysfunction in those with CHD and prematurity or CHD with aortic obstruction suggests an etiology of delayed brain development in the fetal and neonatal periods, while male gender may increase susceptibility to brain injury. This study highlights the need for regular neurodevelopmental follow up in children with CHD, and a need to better understand mechanisms that contribute to adverse neurodevelopmental outcomes.
authors.affiliation: Division of Neuropsychology, Children's National Health System, Washington, District of Columbia, USA.|Departments of Psychiatry and Behavioral Sciences & Pediatrics, The George Washington University School of Medicine, Washington, District of Columbia, USA.
authors.forename: Jacqueline H
authors.initials: JH
authors.lastname: Sanz
authors.affiliation: Division of Neuropsychology, Children's National Health System, Washington, District of Columbia, USA.|Departments of Psychiatry and Behavioral Sciences & Pediatrics, The George Washington University School of Medicine, Washington, District of Columbia, USA.
authors.forename: Madison M
authors.initials: MM
authors.lastname: Berl
authors.affiliation: Division of Neuropsychology, Children's National Health System, Washington, District of Columbia, USA.
authors.forename: Anna C
authors.initials: AC
authors.lastname: Armour
authors.affiliation: Biostatistics, Children's National Health System, Washington, District of Columbia, USA.|Epidemiology and Biostatistics, George Washington University, Washington, District of Columbia, USA.
authors.forename: Jichuan
authors.initials: J
authors.lastname: Wang
authors.affiliation: Biostatistics, Children's National Health System, Washington, District of Columbia, USA.
authors.forename: Yao I
authors.initials: YI
authors.lastname: Cheng
authors.affiliation: Division of Cardiology, Children's National Health System, Washington, District of Columbia, USA.|Department of Pediatrics, The George Washington University School of Medicine, Washington, District of Columbia, USA.
authors.forename: Mary T
authors.initials: MT
authors.lastname: Donofrio
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior; D041923:Adolescent Development; D000367:Age Factors; D002648:Child; D002652:Child Behavior; D002657:Child Development; D003071:Cognition; D003072:Cognition Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology / Q000628:therapy; D056344:Executive Function; D005260:Female; D005865:Gestational Age; D006297:Health Services Accessibility; D006330:Heart Defects, Congenital / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology; D006801:Humans; D016015:Logistic Models; D008297:Male; D008570:Memory, Short-Term; D015999:Multivariate Analysis; D016017:Odds Ratio; D047928:Premature Birth / Q000453:epidemiology; D015995:Prevalence; D012307:Risk Factors; D012572:School Health Services; D012737:Sex Factors; D011795:Surveys and Questionnaires; D014481:United States / Q000453:epidemiology
keywords: congenital heart disease; executive function; neurodevelopment; outcomes