Research Matters: Psychosocial Functioning of Adolescents with D-Transposition of the Great Arteries

October 6th, 2016 by Amy Basken

Continuing our theme of Research, CCHD welcomes back pediatric psychologist Dr. Erica Sood. Dr. Sood provides an overview of research studies that highlight the importance of monitoring children and adolescents with CHD for psychosocial issues and that further reveal how parent/caregiver stress can affect the emotional and behavioral functioning of a child with CHD.

Psychosocial functioning of adolescents with d-transposition of the great arteries

By Erica Sood, PhD, Pediatric Psychologist

The Journal of Pediatrics published a study examining rates of emotional and behavioral disorders and overall psychosocial functioning among adolescents with d-transposition of the great arteries (d-TGA).* Findings highlight the importance of monitoring and attending to the psychosocial health of children and adolescents with CHD in addition to their physical health. You can find the complete study here.

About this Study:

This study compared adolescents with d-TGA to healthy adolescents with respect to rates of emotional and behavioral disorders and overall psychosocial functioning.
The d-TGA group consisted of 139 adolescents who were enrolled in the Boston Circulatory Arrest Study during infancy and have since been assessed at 1, 4, 8, and 16 years of age. Learn more about the Boston Circulatory Arrest Study here. The comparison group consisted of 61 healthy adolescents.
Adolescents and their parents completed psychiatric interviews and questionnaires evaluating diagnoses and symptoms of mood, anxiety and disruptive behavior disorders. Parents also reported on symptoms of post-traumatic stress related to raising a child with d-TGA. Stress within the parent-child relationship and cognitive functioning were previously assessed at age 8.

Main Findings:

Adolescents with d-TGA had higher rates of attention-deficit/hyperactivity disorder (ADHD) compared with healthy adolescents (16% versus 3%).
Rates of mood and anxiety disorders were similar between the two groups based on psychiatric interview. Adolescents with d-TGA reported more symptoms of depression and anxiety on questionnaires, although these were still considered within the “normal” range for their age.
Adolescents with impaired cognitive functioning had worse psychosocial functioning.
Parental stress, but not severity of illness, was associated with adolescent psychosocial functioning.
- Parents who reported more stress within the parent-child relationship and more post-traumatic stress symptoms had adolescents with worse psychosocial functioning.
- Severity of illness (for example, length of hospitalization, subsequent operations, seizures in the hospital) was not associated with adolescent psychosocial functioning

What this Means:

The psychosocial health of children and adolescents with CHD should be monitored in addition to physical health.
- Children and adolescents with CHD are at higher risk for ADHD, as demonstrated in this study as well as many prior studies.^1,2
- Although adolescents with d-TGA did not exhibit higher rates of mood or anxiety disorders, they did report more symptoms of depression and anxiety. These symptoms could potentially increase their risk for a mood or anxiety disorder as they face new challenges during the transition to adulthood.
- Periodic surveillance, screening and evaluation of emotional and behavioral functioning should be standard of care for children and adolescents with CHD,³ as recommended by the American Heart Association and the American Academy of Pediatrics.
It is important for parents of children with CHD to care for themselves and manage their own stress.
- This study and several prior CHD studies ^4,5have found a relationship between parental stress and child emotional and behavioral functioning.
- Raising a child with CHD comes with more than its fair share of stress. While it is certainly not easy to prioritize self-care, taking care of yourself is an important aspect of caring for your child and family.

If you have concerns about your child’s emotional or behavioral functioning, we encourage you to discuss these concerns with your child’s healthcare providers.

* DeMaso DR, Labella M, Taylor GA, Forbes PW, Stopp C, Bellinger DC, Rivkin MJ, Wypij D, Newburger JW. Psychiatric disorders and function in adolescents with d-transposition of the great arteries. J Pediatr. 2014;165:760-766.

References:

Shillingford AJ, Glanzman MM, Ittenbach RF, Clancy RR, Gaynor JW, Wernovsky G. Inattention, hyperactivity, and school performance in a population of school-age children with complex congenital heart disease. Pediatrics. 2008;121:e759–e767.

Hövels-Gürich HH, Konrad K, Skorzenski D, Herpertz-Dahlmann B, Messmer BJ, Seghaye MC. Attentional dysfunction in children after corrective cardiac surgery in infancy. Ann Thorac Surg. 2007;83:1425–1430.

Marino BS, Lipkin PH, Newburger JW, et al. Neurodevelopmental outcomes in children with congenital heart disease: Evaluation and management: A scientific statement from the American Heart Association. Circulation. 2012;126:1143-1172.

Visconti KJ, Saudino KJ, Rappaport LA, Newburger JW, Bellinger DC. Influence of parental stress and social support on the behavioral adjustment of children with transposition of the great arteries. J Dev Behav Pediatr. 2002;23:314-321.

Goldberg S, Janus M, Washington J, Simmons RJ, MacLusky I, Fowler RS. Prediction of preschool behavioral problems in healthy and pediatric samples. J Dev Behav Pediatr. 1997;18:304-313.

Dr. Sood is a pediatric psychologist in the Nemours Cardiac Center and Assistant Professor of Pediatrics at Sidney Kimmel Medical College at Thomas Jefferson University. She received her PhD in Clinical Psychology from Temple University and completed residency and fellowship in Pediatric Psychology at Nemours/duPont Hospital for Children. She directs the Nemours Cardiac Learning and Early Development (LEAD) Program and provides psychological consultation and therapy for children with congenital heart disease and their families. Dr. Sood also conducts research on neurodevelopmental outcomes, developmental care and family psychosocial interventions for this patient population. She serves on the editorial board for Clinical Practice in Pediatric Psychology and is an active member of the Society of Pediatric Psychology’s Cardiology Special Interest Group and the Cardiac Neurodevelopmental Outcomes Collaborative. Dr. Sood provides supervision and mentorship to psychology fellows working within the Nemours Cardiac Center to promote psychologist involvement in the field of pediatric cardiology.