“…It is now established that individuals with complex CHD are at high risk for neurodevelopmental delays (Gaudet et al, 2021; Ilardi et al, 2020; Ware et al, 2020), due to reduced fetal cerebral blood flow or oxygenation, sequelae of the heart condition itself (e.g., severe cyanosis, cardiac arrests), and medical and surgical therapies required (e.g., perioperative hypoxic ischemic injury, prolonged hospitalization; Marelli et al, 2007; McQuillen et al, 2010; Nattel et al, 2017). Developmental delays arise in multiple domains, such as gross and fine motor skills (Bolduc et al, 2020; Fourdain et al, 2020; Majnemer et al, 2006), language and core communication skills (Fourdain et al, 2019; Hövels-Gürich et al, 2008; Majnemer et al, 2008; Sananes et al, 2012; Sommariva et al, 2020), attention and executive abilities (Calderon, Jambaqué, et al, 2014; Cassidy et al, 2015; Jackson et al, 2021; Sanz et al, 2017, 2018), and global intellectual functioning (Bellinger, Wypij, et al, 2003; Forbess et al, 2001; Gaynor et al, 2014; Majnemer et al, 2008) leading to academic underachievement (Bellinger, Bernstein, et al, 2003; Hövels-Gürich et al, 2002; Oster et al, 2017; Wypij et al, 2003) and behavioral maladjustment (internalizing and externalizing problems) (Abda et al, 2019; Bellinger et al, 2009; Hövels-Gürich et al, 2002; Sarrechia et al, 2016). While an extensive body of literature addresses neurocognitive delays in this population, very few studies have explored the implications of CHD for social cognition and competence, especially in early childhood (Clancy et al, 2019).…”