Executive functioning in toddlers with congenital heart disease

Julia Rohde, BA

Boston Children’s Hospital
Executive functioning in toddlers with congenital heart disease

Scientific Abstract

Background & Purpose: Children with congenital heart disease (CHD) are at risk for neurodevelopmental (ND) morbidities, with executive function (EF) impairments among the most frequent. The primary aim of this study is to examine EF in toddlers with CHD. We also seek to identify concurrent associations with ND and assess risk factors for EF impairment.

Methods: As part of a longitudinal fetal brain MRI study, participants prenatally diagnosed with CHD and socio-demographically matched controls underwent ND assessment at age 2 years. ND functioning was evaluated with the Bayley Scales of Infant and Toddler Development and Receptive-Expressive Emergent Language Test (REEL-3). EF was assessed using a Working Memory (WM) Task and a Delay of Gratification (DOG) Task. An initial, immediate memory task established immediate recall. Two WM trials were averaged, while total score on four DOG trials measured inhibitory control. T-tests assessed group differences, and Pearson correlations evaluated relationships between EF, ND variables, and patient characteristics.

Results: The CHD group scored lower on the immediate memory task (M=2.69, SD=.69, N=48) than controls (M=2.97, SD=.18, N=31; p< 0.01). No group differences in EF were found. The REEL-3 expressive language domain positively correlated with immediate memory (r= 0.45, P=0.002) and WM (r= 0.35, P=0.023) in children with CHD as well as WM (r=0.46, P= 0.017) in controls. Older age positively correlated with WM (r=.30, P=0.045) and DOG (r=.48, P=0.001) in the CHD group.

Conclusion & Significance: The CHD group had lower immediate memory scores than same-aged controls. Expressive language was associated with immediate memory, suggesting that better language skills may benefit mental representation of simple auditory instructions and thereby facilitate memory encoding. EF scores did not differ between groups, suggesting that the early EF developmental trajectory may be preserved in toddlers with CHD, although it cannot be excluded that the measures were insensitive to detect subtle differences. Longitudinal studies are needed to define the trajectory of EF over time.

Live Zoom Session – April 21st

Executive Functioning Task

research Areas


Julia Rohde, BA, Johanna Calderon, PhD, Valerie Rofeberg, MSc, Ali Gholipour, PhD, David Wypij, PhD, Cynthia Ortinau, MD, Caitlin Rollins, MD, Anjali Sadhwani, PhD

Principal Investigator

Caitlin Rollins, MD