Undergoing surgery to treat congenital heart disease in the first year of life may increase the risk for attention-deficit hyperactivity disorder in later childhood, researchers have found.

Results of an ADHD screening questionnaire administered to children aged 7 to 15 years show that 29% of those who underwent cardiac surgery had a score suggestive of ADHD compared with 3% of controls (P<0.001) Aisling Porter, MD, of the IWK Health Center in Halifax, Nova Scotia, and colleagues reported in the Canadian Journal of Cardiology.

“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,” the researchers wrote.

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The study involved 56 children and teens with ADHD who had undergone surgery for congenital heart disease as infants and 60 who had not. The researchers used the Swanson, Nolan, and Pelham IV (SNAP-IV) Teacher and Parent Rating Scale to assess ADHD symptoms.

Average overall scores were higher in the surgical group vs. the nonsurgical group (0.93 vs. 0.30, P<0.001), the researchers found. Similar trends were noted for hyperactivity (0.83 vs. 0.24, P<0.001) and inattention (1.04 vs. 0.37, P<0.001), separately.

Although birth weight, gestational age, family income and parental level of education were all lower among participants with congenital heart disease, the association between cardiac surgery in the first year of life and ADHD remained after adjusting for these differences (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.”


  1. Yamada D et al. Can J Cardiol. 2013; doi: 10.1016/j.cjca.2013.07.007.