Abstract
Children with congenital heart defects (CHDs) exhibit attention and executive functioning (EF) difficulties resulting in increased risk for attention-deficit/hyperactivity disorder (ADHD). Anesthesia events are also associated with worsened cognitive outcomes. This study aims to elucidate how ADHD and cardiovascular surgeries (CVS) in children with CHDs impact attention and EF performance. Attention and EF measures (Continuous Performance Test, 3rd edition [CPT-3], Delis Kaplan Executive Function System [DKEFS], Test of Everyday Attention in Children [TEA-Ch], A Developmental Neuropsychological Assessment, 2nd edition [NEPSY-II]) were used in 58 children ages 8-17years (mean = 11.44years; 48.3% male; 70.7% Caucasian) with CHDs. MANOVAs were utilized to assess if children with ADHD diagnoses demonstrated poorer cognitive outcomes. Correlations were performed within subgroups to assess the relationship between number of CVS and measures. ADHD subgroups did not statistically differ on attention and EF outcomes. Number of CVS approached significance with DKEFS Verbal Fluency Category Accuracy for children without ADHD diagnoses but was significantly negatively correlated with NEPSY Auditory Attention (r = -0.628, p < 0.05) and Response Set (r = -0.601, p < 0.05) for those with ADHD. Results suggest clinical ADHD diagnoses are not related to worse attention and EF outcomes in a pediatric CHD population. The number of cardiovascular surgeries impacted performance on different measures irrespective of diagnosis. Discrepancies may reflect use of multiple data points in deciding on a diagnosis, the behavioral nature of ADHD, poor construct validity of measures, patient medical comorbidities, and/or differences in clinical judgment. Future studies should explore weightage of objective measures in clinical decision-making in medically complex populations.
Published Version
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