Predictors of learning and memory in pediatric critical congenital heart disease: the important role of working memory

Learning and memory are crucial neuropsychological skills, linked with the development of play, adaptive skills, and academic functioning. Children and adolescents with critical congenital heart disease (cCHD) are at risk for a range of neurodevelopmental difficulties. Here, we examine visual and verbal learning and memory skills in a school-age sample of children and adolescents with cCHD, and explore how medical, neuropsychological, and social variables predict school-age learning and memory. This is a retrospective observational study of 189 patients with cCHD (age 5-18 years) who attended a neuropsychological evaluation through the Cardiac Neurodevelopmental Program. Results demonstrate that on average, children and adolescents with cCHD show relatively poorer performance on tasks of visual learning and memory and list learning and memory, skills with a higher executive burden, whereas there are no differences in story learning and memory compared to normative samples. Working memory is identified as the most consistent predictor of learning and memory. Medical variables also contribute to learning and memory at school age, whereas social determinants of health are less closely linked. These findings demonstrate the importance of considering downstream effects of core aspects of attention and executive functioning skills on other neurodevelopmental abilities.