Cognitive disengagement syndrome and peer relationships of youth with critical congenital heart defects

Worldwide, approximately 1 in 100 children are born with a congenital heart defect, with 25% of those being classified as critical and posing risks for neurocognitive deficits due to cyanosis. Cognitive Disengagement Syndrome (CDS) has yet to be examined in children with critical congenital heart defects (cCHD) despite calls for research in pediatric populations with acquired brain injury and associated deficits. Children with cCHD, ages 9-13, were identified through patient registries and comparison classmates CC were matched after completing sociometric surveys of peer relationships in schools. Caregiver ratings of CDS symptoms and children's self-report of peer interaction and social adjustment were obtained at home visits with both groups (NcCHD = 108, NCC = 72). Children with cCHD exhibited greater CDS symptoms than CC (d = 0.31, p = .011). CDS symptoms were associated with peer and self-reports of social difficulty, in particular the experience of peer victimization and fewer reciprocated friendships at school relative to healthy peers. CDS symptoms partially accounted for higher self-reported victimization and social problems in cCHD survivors but did not account for group differences in peer-reported social difficulties. These indirect effects were no longer significant after controlling for parent reports of broader symptoms of attention deficit hyperactivity disorder (ADHD). Future research is needed to better disentangle the comparative influence of CDS and ADHD symptoms on the psychosocial outcomes of children with cCHD and other chronic conditions involving brain injury and heightened neurodevelopmental risk.