Objectives. To determine the prevalence and risk factors for behavioral psychopathology in children with congenital heart lesions of differing medical severity.

Subjects. Subjects (mean age 10.3±3.7yr) included 93 children after repair of atrial septal defect (ASD, n=26), after Mustard procedure or arterial switch for transposition of the great arteries (TGA, n=40) and after Fontan procedure for univentricular heart (FON, n=27).

Measurements. Parent interviews included: [1] demographic and clinical data (hospitalization, surgeries, complications, limitations, etc.) from which a medical severity score rated 0 to 10 was derived, [2] parental perceived severity rated 1 to 6, [3] Impact on Family Scale (IFS), and [4] Child Behavior Checklist (CBCL). Medical and perceived parental severity scales were normalized as Z scores, and differences calculated. Groups were compared in ANOVA and MANOVA.

Results. Medical severity (ASD, 2.0±1.3; TGA, 4.3±2.1; FON, 6.4±1.5) and perceived parental severity (ASD, 1.5±1.0; TGA, 2.3±1.4; FON, 3.5±1.8) differed significantly between groups (MANOVA p<.001). Medical and parental severity scores were correlated for TGA (r=.23, p=.16) and FON (r=.40, p<.05), but not for ASD (r=.01). Parents overestimated severity for ASD (0.4±0.8), neutral for TGA (-0.1±1.1), and underestimated for FON(-0.2±1.0; p=.06). IFS scores were highest for FON (40±9) vs. TGA (35±10) and ASD (35±11). Behavior problems (CBCL scores>60) were noted in 35% of ASD, 40% of TGA and 22% of FON, with a prevalence higher than normal (18%) for ASD (p<.05) and TGA (p<.001). Parental overestimation of severity was greater for patients with behavior problems in the TGA and FON but not the ASD group. For ASD, lower parental perceived severity was associated with higher externalizing CBCL scores. For TGA, higher parental perceived severity and higher IFS were associated with higher total and internalizing CBCL scores. For FON, higher medical severity and higher IFS were associated with higher internalizing CBCL scores.

Conclusions. Children with mild to moderate heart problems may be at increased risk for behavior problems, and parental misperception of severity may be an important risk factor.