Specific patterns of executive functioning weaknesses among children after heart transplant

Abstract

Background Children with a history of heart transplant (HT) are at risk of executive functioning weaknesses secondary to heart disease and associated morbidity. However, specific executive functioning weaknesses have not been identified. Method The present study, anchored in Anderson's (2002) Developmental Model of Executive Functioning, provides a detailed, retrospective analysis of executive functioning in the areas of goal setting, cognitive flexibility, attentional control, and information processing for a clinically referred sample of 53 pediatric HT recipients who underwent neuropsychological evaluations as part of typical clinical care. Results Broadly, the sample demonstrated mild‐to‐moderate deficits across cognitive, adaptive behavior, executive functioning, and academic domains, as well as elevated parent‐reported concerns for depression and anxiety. Executive functioning weaknesses, while global, persisted after controlling for the effects of depression and anxiety and were most prominent in cognitive flexibility. In addition, poor cognitive flexibility predicted lower adaptive behavior, IQ, and academic outcomes among this population, placing them at considerable risk of extensive impairment in several domains of their lives. Conclusions Taken together, children with a history of HT demonstrated broad difficulties across several areas of functioning, with particular concerns for working memory. As such, interventions and accommodations specifically targeting working memory may help provide the most optimal outcomes for this population.

Heart disease symptoms and health‐related quality of life in pediatric heart transplant recipients: A serial multiple mediator analysis

“…In examining the path coefficients in the multivariate mediation analysis, not only was there a direct effect of heart disease symptoms on HRQOL, there was also evident a significant direct effect on cognitive problems. This direct effect of patient heart disease symptoms on their cognitive problems is consistent with the extant empirical literature for pediatric heart disease in general, 39,40 as well as neurocognitive findings for pediatric heart transplant recipients 41–44 . Investigations on pathophysiological mechanisms which potentially account for the deleterious impact of heart disease on patient cognition for both pediatric and adult patients have encompassed alterations in white matter microstructure, brain volumes, regional brain injury, and regional cerebral blood flow alterations 45–48 .…”

Associations between executive functioning, personality, and posttraumatic stress symptoms in adolescent solid organ transplant recipients

“…Additionally, adolescents with EF deficits may exhibit greater difficulties with emotion regulation, thereby contributing to the development of maladaptive regulation strategies, including rumination, catastrophizing, and thought suppression 42 . Pediatric transplant recipients are also at increased susceptibility for experiencing internalizing disorders, which may further relate to EF impairments and subsequently influence the development of PTSS, in addition to EF’s impact on general emotional and social functioning, independent of trauma (e.g., general difficulty with planning and organizing, and learning challenges) 15,43 44 .…”

“…42 Pediatric transplant recipients are also at increased susceptibility for experiencing internalizing disorders, which may further relate to EF impairments and subsequently influence the development of PTSS, in addition to EF's impact on general emotional and social functioning, independent of trauma (e.g., general difficulty with planning and organizing, and learning challenges). 15,43 The combination of these factors may exacerbate adolescents' negative thoughts and maladaptive coping strategies following their organ transplantation and in turn potentially increase their risk of developing PTSS. 44 Alternatively, it is plausible that PTSD-related structural brain differences (e.g., reduced hippocampal volume and hyperactive amygdala) or symptoms (e.g., hyperarousal and sleep difficulties) might impact EF and cognitive performance following trauma.…”

“…Extant literature has demonstrated that pediatric transplant recipients experience deficits in executive functioning (EF) when compared with healthy peers. 14 These EF deficits, which researchers have postulated arise from a combination of disease-specific-related factors (e.g., genetic syndromes contributing to organ failure and abnormal brain development in utero) 15 and transplant-related factors, including factors prior to transplantation (e.g., fewer environmentally stimulating experiences, and malnutrition), during transplantation (e.g., seizures and cardiac arrest), and post-transplantation (e.g., infections, medication toxicity, and rehospitalizations), might indicate susceptibility to difficulty coping with traumatic incidents compared to other youth. 4,[16][17][18] EF, which includes the mental processes of planning, cognitive flexibility, inhibitory function, working memory, and sustained attention, 4 has demonstrated robust relations with PTSS in adult organ transplant recipients, with one study demonstrating associations between greater cognitive deficits and elevated distress around PTSS.…”

“…Future research is needed to assess these constructs over time beginning prior to transplantation and inform possible clinical implications (e.g., incorporation of risk of PTSS into pre-transplant evaluation and provision of proactive intervention). Additionally, although a full examination of potential risk or resilience factors was beyond the scope of the current study, future studies should further explore additional medical and psychosocial determinants of PTSS among pediatric transplant recipients (e.g., emotional factors, EF difficulties, re-transplantation, rejection episodes, and physical/ sensory/learning issues), which may differentially impact outcomes over time based on the previous literature documenting associations between medical complications, EF difficulties, and internalizing symptoms in pediatric transplant recipients 3,15. The small sample size limits the number of factors that were assessed among adolescent transplant recipients in the current study.…”