Intermediate neurodevelopmental outcome after repair of ventricular septal defect.

BACKGROUND: Children with congenital heart disease are at risk for impaired neurodevelopmental outcome. Despite the high prevalence of ventricular septal defects relative to other cardiac defects, few studies have specifically examined this population. The purpose of this study was to provide data on the intermediate neurodevelopmental outcome for children after repair of a ventricular septal defect. METHODS: Neurodevelopmental outcome was assessed for 31 children using standardized tests of IQ, memory, visual-motor ability, and academic achievement. Standardized parent and teacher reports of behavioral and psychosocial functioning were also examined. Patients were grouped into younger (less than 6 years old; n = 18) and older (6 years and older; n = 13) cohorts. RESULTS: Full-scale IQ scores were within the normal range. Although most other domains of neurodevelopmental and behavioral functioning were comparable to normative data, patient functioning was lower than population norms in the areas of performance IQ for the younger cohort (90.6 ± 16.1; p = 0.023), visual memory for the older cohort (84.5 ± 15.3; p = 0.003), and visual-motor ability (87.9 ± 14.2; p < 0.001) and adaptive behavior (94.3 ± 15.3; p = 0.050) for the entire cohort. CONCLUSIONS: After repair of ventricular septal defects, children function within the normal range in most areas. Three of the four domains in which lower functioning was observed tap into visual cognitive abilities rather than verbal abilities. Lower mean scores in these areas were, however, generally within one standard deviation of the population mean, suggesting mild weaknesses rather than significant impairments.

Couple power dynamics, systemic family functioning, and child adjustment: a test of a mediational model in a multiethnic sample.

Power dynamics in the marital dyad and systemic elements of whole-family functioning (cohesion, subsystem boundary formations) were examined in relation to each other and also in relation to child adjustment in a multiethnic sample of families. Support was found for a mediational model, such that family functioning was found to mediate the relationship between marital power dynamics and children's internalizing and externalizing behavior. Some support also was found for ethnicity as a moderator of the association between systemic family processes and children's adjustment. Disturbances in family cohesion and subsystem boundaries were more strongly related to internalizing symptomatology for children in European American families compared to children in Hispanic American families.