Behaviour Problems in Children with Congenital Heart Disease
Abstract
As more children survive with congenital heart diseases, management of their behavioural problems are becoming increasingly important. In this article we aim to review the current status of knowledge on this aspect. Children with congenital heart diseases have more behavioural problems compared to children without chronic illnesses. Behavioural problems in children can be classified into externalizing behaviours and internalizing behaviours. Externalizing behaviours are marked by defiance, impulsivity, hyperactivity, disruptiveness, aggression and antisocial features. Internalizing behaviours are evidenced by withdrawal, dysphoria and anxiety. Boys with congenital heart diseases have more externalizing problems compared to girls. Preoperative hypoxia as well as peri and postoperative cardiocirculatory insufficiency can lead to internalizing and externalizing behavioral problems in future. High treatment intensity and palliative interventions are associated with poor behavioral outcomes. Children who underwent open heart surgery at very young age are prone to develop attention-deficit hyperactivity disorder on reaching school age. A comprehensive approach in this field is essential, so that effective early interventions and guidance can be planned.References
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25. Sarrechia I1, Miatton M, De Wolf D, François K, Vingerhoets G. Neurobehavioural functioning in school-aged children with a corrected septal heart defect. Acta Cardiol. 2013 Feb;68(1):23-30.
26. Janus M., Goldberg S. Treatment characteristics of congenital heart disease and behaviour problems of patients and healthy siblings. J Paediatr Child Health. 1997; 33, 219 -25.
27. McCusker CG, Doherty NN, Molloy B, Casey F, Rooney N, Mulholland C, Sands A, Craig B, Stewart M. Determinants of neuropsychological and behavioural outcomes in early childhood survivors of congenital heart disease. Arch Dis Child. 2007;92:137-41.
28. Hovels-Gurich 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;83:1425-30.
29. Shillingford AJ, Glanzman MM, Ittenbach RF, Clancy RR, Gaynor JW, Wernovsky G. Inattention, hyperactivity, and school perormance in a population of school-age children with complex congenital heart disease. Pediatrics. 2008;121:759-67.
30. Yamada DC1, Porter AA, Conway JL, LeBlanc JC, Shea SE, Hancock-Friesen CL, Warren AE. Early repair of congenital heart disease associated with increased rate of attention deficit hyperactivity disorder symptoms. Can J Cardiol. 2013 ;29:1623-8.
31. Hansen E1, Poole TA, Nguyen V, Lerner M, Wigal T, Shannon K, Wigal SB, Batra AS. Prevalence of ADHD symptoms in patients with congenital heart disease. Pediatr Int. 2012;54:838-43.
2. Lavigne JV, Faier-Routman J. Psychological adjustment to pediatric physical disorders: a meta-analytic review. J Pediatr Psychol 1992;17:133–57.
3. Knapp PK, Harris ES. Consultation-liaison in child psychiatry: a review of the past 10 years. Part I: Clinical findings. J Am Acad Child Adolesc Psychiatry. 1998;37:17-25.
4. Wallander JL, Varni JW. Effects of pediatric chronic physical disorders on child and family adjustment. J Child Psychol Psychiatr 1998;39:29–46.
5. Cadman D, Boyle M, Szatmari P, Offord DR. Chronic illness, disability, and mental and social well-being: findings of the Ontario Child Health Study. Pediatrics. 1987;79:805-13.
6. Janus M., Goldberg S. Sibling empathy and behavioural adjustment of children with chronic illness. Child Care Health Dev. 1995; 21, 321 -31.
7. Achenbach TM, Edelbrock CS. The classification of child psychopathology: a review and analysis of empirical efforts. Psychol Bull. 1978;85:1275-1301.
8. Fredriksen PM, Mengshoel AM, Frydenlund A, Sorbye O, Thaulow E. Follow-up in patients with congenital cardiac disease more complex than haemodynamic assessment. Cardiol Young. 2004;14:373-9.
9. Hovels-Gurich HH, Konrad K, Wiesner M, Minkenberg R, Herpertz-Dahlmann B, Messmer BJ, Von Bernuth G. Long term behavioural outcome after neonatal arterial switch operation for transposition of the great arteries. Arch Dis Child. 2002;87:506-10.
10. Janus M., Goldberg S. Sibling empathy and behavioural adjustment of children with chronic illness. Child Care Health Dev. 1995; 21, 321 -31.
11. Utens EM, Verhulst FC, Meijboom FJ, Duivenvoorden HJ, Erdman RA, Bos E, Roelandt JT, Hess J. Behavioural and emotional problems in children and adolescents with congenital heart disease. Psychol Med. 1993;23:415-24.
12. Kramer HH, Awiszus D, Sterzel U, van Halteren A, Classen R. Development of personality and intelligence in children with congenital heart disease. J Child Psychol Psychiatry. 1989;30:299-308.
13. Fredriksen PM, Diseth TH, Thaulow E. Children and adolescents with congenital heart disease: Assessment of behavioural and emotional problems. Eur Child Adolesc Psychiatry. 2009;18:292-300.
14. Yang LL, Liu ML, Townes BD. Neuropsychological and behavioural status of Chinese children with acyanotic congenital heart disease. Int J Neurosci. 1994; 74, 1 – 4.
15. Gupta S, Giuffre RM, Crawford S, Waters J. Covert fears, anxiety and depression in congenital heart disease. Cardiol Young. 1998;8:491-9.
16. Zuo CY, Yang LL, Townes BD. Neuropsychological status of patients with congenital and rheumatic heart diseases: preoperative and postoperative comparison. Int J Neurosci. 1985;26:59-65.
17. Utens EM, Versluis-Den Bieman HJ, Witsenburg M, Bogers AJJC, Verhulst FC, Hess J. Cognitive, and behavioural and emotional functioning of young children awaiting elective cardiac surgery or catheter intervention. Cardiol Young. 2001;11:153-60.
18. Loup O, von Weissenfluh C, Gahl B, Schwerzmann M, Carrel T, Kadner A. Quality of life of grown-up congenital heart disease patients after congenital cardiac surgery. Eur J Cardiothorac Surg. 2009;36:105-11.
19. O'Dougherty M, Wright FS, Garmezy N, Loewenson RB, Torres F. Later competence and adaptation in infants who survive severe heart defects. 1: Child Dev. 1983;54:1129-42.
20. Latal B, Helfricht S, Fischer JE, Bauersfeld U, Landolt MA. Psychological adjustment and quality of life in children and adolescents following open-heart surgery for congenital heart disease: a systematic review. BMC Pediatr. 2009;9:6.
21. Vingerhoets G, Van Nooten G, Vermassen F, De Soete G, Jannes C. Short-term and long-termneuropsychological consequences of cardiac surgery with extracorporeal circulation. Eur J Cardiothorac Surg. 1997;11:424-31.
22. Bellinger DC, Newburger JW, Wypij D, Kuban KC, duPlesssis AJ, Rappaport LA. Behaviour at eight years in children with surgically corrected transposition: The Boston Circulatory Arrest Trial. Cardiol Young. 2009;19:86-97.
23. Oates R.K., Turnbull J.A., Simpson J.M., Cartmill T.B. Parent and teacher perceptions of child behaviour following cardiac surgery. Acta Paediatrica. 1994; 83, 1303 -07.
24. Spijkerboer AW1, Utens EM, Bogers AJ, Verhulst FC, Helbing WA. Long-term behavioural and emotional problems in four cardiac diagnostic groups of children and adolescents after invasive treatment for congenital heart disease. Int J Cardiol. 2008;125:66-73.
25. Sarrechia I1, Miatton M, De Wolf D, François K, Vingerhoets G. Neurobehavioural functioning in school-aged children with a corrected septal heart defect. Acta Cardiol. 2013 Feb;68(1):23-30.
26. Janus M., Goldberg S. Treatment characteristics of congenital heart disease and behaviour problems of patients and healthy siblings. J Paediatr Child Health. 1997; 33, 219 -25.
27. McCusker CG, Doherty NN, Molloy B, Casey F, Rooney N, Mulholland C, Sands A, Craig B, Stewart M. Determinants of neuropsychological and behavioural outcomes in early childhood survivors of congenital heart disease. Arch Dis Child. 2007;92:137-41.
28. Hovels-Gurich 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;83:1425-30.
29. Shillingford AJ, Glanzman MM, Ittenbach RF, Clancy RR, Gaynor JW, Wernovsky G. Inattention, hyperactivity, and school perormance in a population of school-age children with complex congenital heart disease. Pediatrics. 2008;121:759-67.
30. Yamada DC1, Porter AA, Conway JL, LeBlanc JC, Shea SE, Hancock-Friesen CL, Warren AE. Early repair of congenital heart disease associated with increased rate of attention deficit hyperactivity disorder symptoms. Can J Cardiol. 2013 ;29:1623-8.
31. Hansen E1, Poole TA, Nguyen V, Lerner M, Wigal T, Shannon K, Wigal SB, Batra AS. Prevalence of ADHD symptoms in patients with congenital heart disease. Pediatr Int. 2012;54:838-43.
