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

Abstract

ObjectivesTo 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 DesignAt 4-6 years of age, parents of children with CHD (n=51) and controls (n=124) completed the BRIEF-P questionnaire and the Cognitively Stimulating Parenting Scale (CSPS). Multivariable general linear modelling assessed the relationship between BRIEF-P 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 (GA), index of multiple deprivation (IMD) and CSPS scores. The relationships between CHD type, surgical factors and brain MRI injury rating (BIR) and ISCI, FI, and EMI scores were assessed. ResultsPresence of CHD, age at assessment, sex, and IMD were not associated with EF scores. Lower GA was associated with higher 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=0.0004; FI: p=0.0015; EMI: p=0.0004) but not controls (ISCI: p=0.2727; FI: p=0.6185; EMI: p=0.3332). There were no significant relationships between EF scores and surgical factors, CHD type, or BIR. ConclusionsSupporting 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.