Are Children with Congenital Heart Defects at Higher Risk for Psychiatric Disorders?

What you need to know

• Children and adolescents with congenital heart defects (CHDs) have a higher prevalence of attention deficit hyperactivity disorder (ADHD) and autism compared to those without CHDs.
• The evidence for increased rates of depression and anxiety in children with CHDs is inconsistent.
• The risk of psychiatric disorders appears to be higher in children with complex CHDs compared to those with simple CHDs.

Understanding congenital heart defects and psychiatric disorders

Congenital heart defects (CHDs) are structural problems with the heart that are present at birth. They affect about 1% of newborns and can range from simple to complex conditions. Thanks to advances in medical care, more children with CHDs are surviving into adulthood. However, this has also revealed that these children may face various health challenges beyond their heart condition.

One area of concern is the potential for psychiatric disorders in children and adolescents with CHDs. Psychiatric disorders are conditions that affect a person’s thinking, emotions, or behavior. Common examples include attention deficit hyperactivity disorder (ADHD), autism, depression, and anxiety.

This article summarizes the findings of a systematic review that looked at the existing research on psychiatric disorders in children and adolescents with CHDs.

Higher rates of ADHD and autism

The review found strong evidence that children and adolescents with CHDs have higher rates of ADHD and autism compared to those without CHDs.

Attention Deficit Hyperactivity Disorder (ADHD)

ADHD is a condition characterized by difficulty paying attention, hyperactivity, and impulsive behavior. The review found that:

• Children with CHDs were 1.4 to 9 times more likely to have ADHD compared to those without CHDs.
• The increased risk was most evident in children with complex CHDs.
• Both self-reports and parent reports showed more ADHD symptoms in children with complex CHDs.

Autism

Autism is a developmental disorder that affects communication and behavior. The review found that:

• Children with CHDs were 1.8 to 5 times more likely to have autism compared to those without CHDs.
• This increased risk was seen across different types of CHDs.

Mixed findings on depression and anxiety

Unlike ADHD and autism, the evidence for increased rates of depression and anxiety in children with CHDs was less clear.

Depression

Depression is a mood disorder characterized by persistent feelings of sadness and loss of interest. The review found:

• Some studies reported higher rates of depression in children with CHDs, while others found no difference or even lower rates compared to children without CHDs.
• The results varied depending on whether the symptoms were self-reported or reported by parents.

Anxiety

Anxiety disorders involve excessive worry or fear. The review found:

• Children with complex CHDs tended to report more anxiety symptoms than those without CHDs.
• However, when parents reported on their children’s anxiety symptoms, there was generally no difference between children with and without CHDs.

Why might children with CHDs be at higher risk?

There are several potential reasons why children with CHDs might be at higher risk for certain psychiatric disorders:

1. Brain development: CHDs can affect blood flow to the brain during crucial periods of development, both before and after birth. This could potentially impact brain regions involved in attention, social interaction, and emotion regulation.

2. Genetic factors: Some of the genetic variations that contribute to CHDs might also play a role in neurodevelopmental disorders like ADHD and autism.

3. Medical experiences: Children with CHDs often undergo multiple medical procedures and hospitalizations, which can be stressful and potentially impact their mental health.

4. Chronic illness effects: Living with a chronic health condition can affect a child’s daily life, social interactions, and self-perception, potentially contributing to mental health challenges.

Importance of early detection and intervention

Recognizing and addressing psychiatric disorders in children with CHDs is crucial for several reasons:

1. Quality of life: Mental health issues can significantly impact a child’s overall well-being and quality of life.

2. Academic performance: Conditions like ADHD can affect a child’s ability to succeed in school.

3. Social relationships: Psychiatric disorders can make it harder for children to form and maintain friendships and other social connections.

4. Long-term outcomes: Early intervention for mental health issues can improve outcomes into adulthood, potentially reducing the risk of problems with employment, relationships, and overall life satisfaction.

What parents and caregivers can do

If you’re caring for a child with a CHD, here are some steps you can take:

1. Be aware of potential signs: Familiarize yourself with the symptoms of common psychiatric disorders in children.

2. Regular check-ins: Talk to your child about their feelings and experiences, and be open to discussions about mental health.

3. Communicate with healthcare providers: Share any concerns about your child’s behavior or emotions with their medical team.

4. Consider routine screening: Ask about including mental health screenings as part of your child’s regular medical care.

5. Seek support: Connect with support groups for families of children with CHDs, as they can be valuable sources of information and understanding.

Conclusions

• Children and adolescents with CHDs, especially complex CHDs, appear to be at higher risk for ADHD and autism.
• The relationship between CHDs and depression or anxiety is less clear and requires further research.
• Early detection and intervention for psychiatric disorders in children with CHDs is important for improving long-term outcomes.
• Parents and caregivers should be aware of potential mental health concerns and discuss any issues with their child’s healthcare team.