Intellect

How do congenital heart conditions affect intellectual functioning?

In most children with most types of congenital heart disease, intellectual functioning is usually normal. There are, however, some aspects of the condition that can influence the child's mental development. For example, while having cyanosis for a long time doesn't seem to affect IQ, if it continues for decades, there may be an effect on intelligence. Some children go on to have learning disabilities, or "developmental delay," which may be connected with the oxygen loss (hypoxia) they experienced as a result of their heart condition or during surgery.

One recent study found that there was no difference in IQ between healthy children and children with congenital heart disease, however researchers found that these children had more behavioural and motor skills problems. And while the IQ scores were similar in both groups, they were slightly lower in children who had been on circulatory arrest for a longer period of time.

How will your child do at school?

Generally children with congenital heart disease do well at school. Academic concerns used to be more of a concern in years gone by, when surgery and medical management weren't as advanced and were, as a result, riskier. Studies support that these children are for the most part of normal intelligence and have normal cognitive ability. Depending on the nature of the congenital heart disease, though, and the side effects of intervention, some may face more challenges than others and may need extra schooling. One study found that just over one quarter of adults with congenital heart disease needed special education.

In some cases, however, children with congenital heart disease over-achieve. One study found that children with congenital heart disease who had surgery to repair a defect often excel more than would be expected, perhaps because they tried so hard to catch up or in response to not being able to focus as much on sports.

What can be done?

Experience has shown that the best way to teach children is using direct, one-on-one instruction. If your child is not getting extra resources, find out what she is entitled to have and try to find ways to make sure she gets it.

Early intervention is important. (In some cases, meeting with a neuropsychologist can be helpful. She can do some testing and determine where problems may lie and provide you with information.) In general, children in kindergarten and Grade 1 need to develop their basic reading, writing, and math skills as much as they can – even beyond what their classmates are doing. Extra tutoring or other supports are important even at this stage, before you see any changes.

In the classroom setting, discuss the following suggestions with teachers:

• Seat your child near the front of the classroom to help focus and avoid distraction
• Provide less written work
• use visual tools to teach such as charts and illustrations
• use tape-recorded textbooks
• allow extra time for tests and assignments
• provide extra help with problem areas
• develop a modified learning regime
• provide special education
• ask the teacher to “check in” with your child each day to see how she is doing

In some instances, special education may be required. Older children may do well in a special vocational program at the high school level.

At home, children can benefit from an environment rich in language and numbers. As much as possible, reading lots of stories, doing number rhymes and counting together, and working on math and reading exercise books will help. School-aged siblings may be able to help as well. Teachers or a school liaison person may be able to recommend good resources to use at home.

Finally, you can help your child find a skill or interest that they are good at. For example, your child’s creativity may be the same or even greater. Focus on your child’s successes.

Children may find it difficult to learn a second or third language. This may be an issue for families who speak more than one language, or who do not speak English at home. The treatment team may have suggestions to deal with this issue.

Some of the learning problems that children can experience are:

• Handwriting problems
• Spelling problems
• Reading problems
• Math problems
• Attention and concentration problems – A child may be inattentive, hyperactive, or both. She may not be able to concentrate for more than short periods of time.
• Slowness – It takes a child longer to do tasks or understand things than before, or compared to other children.
• Memory – A child may study a topic many times, but not remember it the next day.
• Planning and organizing – A child might have difficulty finishing assignments, expressing ideas in writing or verbally, or finding the way to school.
• Drop in IQ (intelligence quotient)

What is the emotional impact of learning problems?

It can be hard on your child if he does develop learning problems as a result of his heart condition or its treatment. Tasks that he once did routinely may become more difficult. He may see his classmates moving ahead at a faster pace than he can. It can be helpful to talk to your child about these problems, to understand how he feels and to figure out how you can help deal with any issues. Some other ideas that may help your child are:

• Focus on your child’s other skills and talents. This can help enhance creativity. Consider providing opportunities for him to show off his skills.
• Advocate for your child in school. Creating a supportive environment in school with his teacher and classmates will make it easier for your child. Ensuring that extra supports are available will help his learning.
• Emphasize your child’s personality. Rather than focusing on grades, praise your child when it’s appropriate for his actions and efforts.