Abstract
Background: Patients with congenital heart defects have a well-established risk of neuropsychiatric comorbidities. Inattention and hyperactivity are three to four times more frequent in children with complex congenital heart defects. We have previously shown a higher burden of overall attention deficit/hyperactivity disorder (ADHD) symptoms in adults with simple congenital heart defects as well. However, it is unknown whether the higher burden of ADHD symptoms is mainly driven by hyperactivity, inattention, or both.Methods: The participants [simple congenital heart defect = 80 (26.6 years old), controls = 36 (25.3 years old)] and a close relative for each (n = 107) responded to the long version of the Conners' Adults ADHD Rating Scales questionnaire. Our primary and secondary outcomes are mean T-scores in the ADHD scores and symptom sub-scores.Results: Patients with simple congenital heart defects reported a higher mean T-score at all three DSM-IV ADHD scores (ADHD—combined: 52.8 vs. 44.9, p = 0.007, ADHD—inattention: 55.5 vs. 46.4, p = 0.002, and ADHD—hyperactivity: 49.4 vs. 44.0, p = 0.03) and in all four ADHD symptom sub-scores (inattention/memory problems: 50.3 vs. 44.2, p = 0.001, hyperactivity/restlessness: 49.7 vs. 45.9, p = 0.03, impulsivity/emotional lability: 50.0 vs. 41.3, p = 0.001, and self-esteem problems: 53.8 vs. 46.3, p = 0.003). The results were maintained after the removal of outliers (incongruent responses), albeit the hyperactivity/restlessness ADHD symptom sub-score lost significance. Self- and informant ratings differed significantly on the ADHD—inattention score for the congenital heart defect group, where informants rated the ADHD—inattention scores better than the congenital heart defect patients rated themselves.Conclusions: Patients with a simple congenital heart defect have a higher symptom burden across all ADHD scores and all symptom sub-scores. The higher burden of ADHD is driven by both inattention and hyperactivity symptoms, though the inattention symptoms seem more prominent. Close relatives were less aware of the inattention symptoms than the congenital heart defect patients themselves. Routine screening for ADHD symptoms may be warranted to facilitate adequate help and guidance as these symptoms are easily overlooked.Clinical Trial Registration: www.ClinicalTrials.gov, identifier: NCT03871881.
Highlights
MATERIALS AND METHODSCongenital heart defects (CHDs) are the most common birth defect found in neonates (5.5–8/1,000 all births) [1, 2]
The higher burden of attention deficit/hyperactivity disorder (ADHD) is driven by both inattention and hyperactivity symptoms, though the inattention symptoms seem more prominent
As there were no differences in the mean T-scores between the ventricular septal defect (VSD) and the atrial septal defect (ASD) group in any of the ADHD scores or symptom sub-scores, we analyzed these two groups combined as a CHD group (Table 2)
Summary
MATERIALS AND METHODSCongenital heart defects (CHDs) are the most common birth defect found in neonates (5.5–8/1,000 all births) [1, 2]. With advancements in diagnostics and treatment, including pre-, peri, and postoperative care and operation techniques, neonates with CHDs survive until childhood and adulthood [3,4,5,6]. This alters the research focus from mortality to morbidity. We have previously shown a higher burden of overall attention deficit/hyperactivity disorder (ADHD) symptoms in adults with simple congenital heart defects as well. It is unknown whether the higher burden of ADHD symptoms is mainly driven by hyperactivity, inattention, or both
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