Trajectories of behavioral and emotional problems in preschoolers with congenital heart disease.

OBJECTIVES

To characterize intraindividual trajectories of behavioral and emotional problems in children with congenital heart disease (CHD) between 2 and 5 years of age, and to explore the predictors of these trajectories.

METHODS

Sixty-six patients (42 boys) followed at the neurocardiac clinic of the Sainte-Justine University Hospital in Montréal, Québec, Canada were recruited. Their behavioral and emotional problems at 2, 3 ½, and 5 years of age were reported by parents.

RESULTS

Correlations revealed moderate to high rank-order stability in child behavioral and emotional problems across time. Multilevel growth curves indicated significant fluctuations in intraindividual levels of these problems across time, which were not explained by child aging. Lower gestational age was associated with higher levels of anxious/depressed symptoms at age 2 years, which persisted through time. Severe forms of CHD were associated with a time-related decrease in three types of problems: attention, attention deficit and hyperactivity, and oppositional and defiant.

CONCLUSIONS

Levels of parent-reported behavioral and emotional problems in children with CHD tend to persist from ages 2 to 5 years, suggesting the importance of early screening. However, unexplained intraindividual changes were also identified, highlighting the necessity to investigate other parental risk factors, for instance. Infants with a lower gestational age should be given special consideration since they continued to display more anxious/depressed symptoms up to school entry compared to children with CHD born at term. The decrease observed in some symptoms for children with severe CHD could result from altered parental perceptions or adverse effects of prolonged hospitalizations.