Visuospatial processing in adolescents with critical congenital heart disease: Organization integration and implications for academic achievement

摘要

Among the most significant factors affecting quality of life in individuals with critical congenital heart disease (CCHD) are neurodevelopmental challenges, including deficits in visuospatial processing and academic achievement. Few studies have compared outcomes across CCHD subgroups, despite their significant differences in anatomy/physiology and medical/surgical courses. We compared visuospatial processing abilities (i.e., Developmental Scoring System, Rey Osterrieth Complex Figure; DSS-ROCF) across groups of adolescents with CCHD (d-transposition of the great arteries [TGA, n = 139], Tetralogy of Fallot [TOF, n = 68], single-ventricle cardiac anatomy requiring the Fontan operation [SVF, n = 145]) and a group of healthy referents (REF, n = 111), and examined the validity of visuospatial processing in predicting concurrent academic outcomes. The CCHD subgroups differed in Organization, ps < .001, Structural Accuracy, ps < .001, and Incidental Elements Accuracy scores, ps ≤ .008; post-hoc analyses showed that the SVF group tended to underperform other CCHD groups. With respect to academic skills, all CCHD groups had worse scores than the REF group, ps ≤ .007; CCHD groups were not different from each other, ps > .23. Regression results showed that DSS-ROCF Style rating (reflecting integration) accounted for a small yet statistically significant portion of unique variance in “assembled” academic outcomes, over and above the variance already accounted for by DSS-ROCF Organization, p < .01. Findings support the need for comprehensive neuropsychological assessment and monitoring of children and adolescents with CCHD, as well as targeted intervention for organization and integration deficits that may increase their risk for academic underachievement.