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Poster #49 - Direct and Indirect Effects of Congenital Heart Disease, Executive Functioning, and Support on Academic Achievement

Fri, March 24, 8:30 to 9:15am, Salt Palace Convention Center, Floor: 1, Hall A-B

Abstract

Purpose: Congenital heart defects are the most common birth anomaly, occurring in 9 of every 1000 births. Most affected children (90%) now reach adulthood, but children with critical congenital heart defects (cCHD) have neurodevelopmental risk due to cyanosis and early, life-saving surgeries. Within cCHD, executive functioning (EF) deficits are often documented (Siciliano 2020), but academic difficulties are reported inconsistently (Schaefer, 2013). Almost no published work has identified socio-environmental resources, such as adult or peer support, that affects academic risk. Aim 1 was to examine deficits in academic achievement using multiple methods relative to healthy-peers, and test whether EF accounts for differences in academic outcomes. Aim 2 was to explore if child-reported support from teachers, peers, friends, and parents moderates direct or indirect or effects of cCHD on academic achievement (Figure 1).

Method: Fourth and fifth graders with cCHD (N=85, Mage=10.7, SDage=1.3, 26% female; 84% White/Non-Hispanic, 7% Black, 9% other) were recruited from patient registries. Comparison classmates (CC) matched for gender and age (N=53, Mage=10.7, SDage=1.5, 35% female; 92% White/Non-Hispanic, 4% black, 4% other) were identified from classrooms of children with cCHD. Children completed the NIH Toolbox Cognitive Battery (EF composite), the Wide Range Achievement Test 5 (WRAT5), Harter Self-Perception Profile (SPPC) and Harter Social Support Scale for Children (SSSC). Parents (NcCHD=136, 60% female; NCC=78, 65% female) completed the Child Behavior Checklist (CBCL). CBCL Academic Competence scores were averaged when both parents participated. Using SPSS28 with PROCESS (v4), multiple regression with post-hoc bootstrapping (10,000 samples) was conducted to examine the direct and indirect (via EF) effects of group on academic achievement (Aim 1), as well as contingent effects involving support from parents, teachers, peers, and friends (Aim 2; Figure 1).

Results: Aim 1: Children with cCHD scored significantly lower than CC on the WRAT Math Computation (d=0.60) and Reading Composite (d=0.36), CBCL Academic Competence (d=0.59), SPPC Academic Self-Concept (d=0.52), and NIHToolbox EF composite (d=0.47) (Table 1). Indirect effects of group via EF were significant for each indicator of academic functioning (Table 1). Aim 2: Most indicators of academic functioning did not vary as a function of SSSC support variables (Table 1). In contrast, the indirect and residual direct effects of group on reading performance varied as a function of parental support. Lower reading performance was linked to EF deficits and directly to cCHD at low (-1SD), but not average or high (+1SD) levels, of parental support. Direct effects of cCHD on reading were also moderated by peer and friend support, with significant effects evident only when support was low.

Discussion: Results suggest that diminished EF consistently accounted for deficits in objective and subjective indicators of academic achievement for children with cCHD. Support from parents, and to some extent friends and peers, were linked to better reading achievement for children with cCHD. Findings suggest that general support may not be sufficient to negate academic risk due to lower EF skills in cCHD. Future studies should explore specific resources (e.g., parent and school educational interventions) to improve academic achievement in children with cCHD.

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