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Children who underwent surgery for congenital heart disease in the first year of life appeared to carry an increased risk of attention deficit hyperactivity disorder (ADHD) once they reached school age, researchers found.

On a screening questionnaire administered at ages 7 to 15, 29% of those who had undergone surgery and 3% of healthy controls had scores suggestive of ADHD (P<0.001), according to Aisling Porter, MD, of the IWK Health Center in Halifax, Nova Scotia, and colleagues.

Average scores for both hyperactivity and inattention were higher for those with congenital heart disease, the researchers reported online in the .

"Though screening tests are, by definition, not diagnostic, these study findings support the significant potential increased risk of ADHD in children undergoing early repair of congenital heart disease," they wrote.

"Although there is some controversy surrounding the treatment of ADHD in patients with congenital heart disease [by using stimulants, in particular], it is still important to identify those at risk of ADHD in the congenital heart disease population," they wrote, pointing to a study showing that children with ADHD have greater risks of dropping out of school, having few friends, participating in antisocial activities, getting pregnant as a teenager, and contracting sexually transmitted diseases.

Thus, children and teens with congenital heart disease should be screened for ADHD, they added, noting that the American Heart Association issued a scientific statement last year that called for evaluation and follow-up for developmental problems in children with congenital heart disease and provided a framework for doing so.

A focus has been placed on neurodevelopmental outcomes in children with congenital heart disease because of an increasing number who are surviving surgery.

In the current study, Porter and colleagues assessed ADHD symptoms in 56 children and teens who underwent open-heart surgery for congenital heart disease as infants and 60 who did not. Symptoms were assessed using the Swanson, Nolan, and Pelham IV (SNAP-IV) Teacher and Parent Rating Scale, a screening tool that is not used to diagnose ADHD.

The average overall score was higher in the surgical group compared with the controls (0.93 versus 0.30, P<0.001), and there were similar differences in the scores for hyperactivity (0.83 versus 0.24, P<0.001) and inattention (1.04 versus 0.37, P<0.001).

Birth weight, gestational age, family income, and level of parental education were all lower in the participants with congenital heart disease, but even after accounting for those differences, having surgery for a heart defect was associated with an increased likelihood of having a positive screening score suggestive of ADHD (OR 7.21, 95% CI 1.49-34.81).

"The potential for ADHD and other developmental disorders in patients who undergo early cardiac surgery should be conveyed to parents and prospective parents," the researchers wrote. "Parents should be counseled regarding the increased positive screening rate for ADHD in these children and this information should be included in antenatal discussions with parents who have fetuses with antenatally diagnosed congenital heart disease."

They acknowledged that the study was limited by the use of a screening test that is not diagnostic for ADHD, the assessment of symptoms in the home environment but not in school, and the relatively low response rate (33%).

From the American Heart Association:

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