Abstract 4120458: Predictors of School Non-Engagement in School Aged Children and Adolescents Born with Heart Disease

Introduction: School engagement, or caring about doing well and doing required homework, is an important factor for academic success and may contribute to poorer academic outcomes in children born with heart disease (HD), compared to heart-healthy peers. Factors that influence lack of school engagement in children born with HD are not well known. Research Question: What factors predict school non-engagement in students with HD? Aims: To identify factors that predict school non-engagement in students with HD to assist in earlier detection and support for students at increased risk. Methods: We analyzed data from the 2022 National Survey of Children’s Health (NSCH), using procedures for complex weighted survey data. School-related outcomes in children ages 6 to 17 years born with and without HD were compared using Chi-square tests. Multivariate logistic regression was used to examine predictors of school non-engagement in students with HD. Results/Data: Of 54,065 NSCH responses, 34,284 were children ages 6 to 17 years, and 826 of these were born with HD. Children born with HD had lower school engagement (p<0.001) and missed more days of school (p<0.001) than peers not born with HD, but grades were not different between groups. Students born with HD were more likely than peers not born with HD to be bullied (p = 0.001), have a diagnosis of anxiety (3.71% vs 1.95%, p<0.001) or depression (3.56% vs 2.09%, p =0.012), require a Special Education Plan (34.9% vs 16.1%, p<0.001), or to receive mental health services (23% vs 14%, p <0.001). Multivariate logistic regression identified factors that significantly predicted school non-engagement in students born with HD, including diagnosis of attention deficit/hyperactivity disorder (ADHD) (aOR 1.94, 95% CI [1.20, 4.58], p=0.013), behavior/conduct problems (aOR 2.77, 95% CI [1.46, 5.23], p=0.002), or learning disability (aOR 3.44, 95% CI [1.79, 6.59], p<0.001). Sociodemographic variables, days of missed school, anxiety, depression, intellectual disability, autism spectrum disorder, and speech disorder were not significant predictors of school non-engagement. Special healthcare needs status neared significance in predicting lack of school engagement (p = 0.056) Conclusions: We identified ADHD, behavior/conduct problems, and learning disabilities as predictors of school non-engagement in students with HD. This information can be used to identify at-risk students born with HD who may benefit from proactive screening and support.