SUPPORTING COGNITIVE DEVELOPMENT IN HEART CHILDREN
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1 SUPPORTING COGNITIVE DEVELOPMENT IN HEART CHILDREN PARENTING YOUR HEART CHILD CONFERENCE NOVEMBER 3, 2018 DR. NNEKA ALEXANDER PEDIATRIC PSYCHOLOGIST
2 OUTLINE Risk factors for cognitive differences Defining and measuring cognitive development Typical cognitive profile of children with CHD Cognitive milestones from infancy to adolescence Supporting cognitive development as a parent
3 RISK FACTORS Heart and brain connection Abnormalities in oxygenated blood flow prenatally Additional risk factors: Neurological injury Use and duration of ECMO Extended length of hospital stay Prematurity (< 37 weeks) Comorbid genetic disorder Inadequate nutrition Limited family resources
4 WHAT IS COGNITIVE DEVELOPMENT How a person perceives, thinks, and gains understanding of his or her world through the interaction of genetic and learned factors Areas of cognitive development Intelligence Verbal and Nonverbal Reasoning Information Processing Memory Executive Functioning
5 WHAT IS COGNITIVE DEVELOPMENT Executive functions are self-regulatory skills that affect: Planning Organization Flexibility Generation of Information Inhibition of Impulses Self Monitoring Working memory
6 HOW IS COGNITIVE DEVELOPMENT MEASURED Developmental Tests Bayley Scales of Infant and Toddler Development Mullen Scales of Early Learning Intelligence (IQ) Tests Wechsler Preschool and Primary Scale of Intelligence (WPPSI) Wechsler Intelligence Scale for Children (WISC) Differential Ability Scales (DAS) Executive Functioning Tests/ Measures Delis-Kaplan Executive Function System (DKEFS) Behavior Rating Inventory of Executive (BRIEF)
7 COGNITIVE PROFILE FOR CHD Infants Cognition not significantly different from norms Toddlers and Preschoolers Cognitive scores varied but fall in the lower reaches of the average range School age children IQ scores in lower reaches of the average range Nonverbal IQ lower than verbal IQ Adolescence Any deficits persist or worsen
8 COGNITIVE PROFILE FOR CHD Mild cognitive impairment overall Areas most at risk: Executive functioning Memory Attention Visual spatial processing Visual motor integration
9 COGNITIVE MILESTONES: INFANCY 0-6 months Listens attentively to sounds and voices Coordinates eye movements Discovers hands and feet Explores objects by mouthing Smiles at image in mirror 6-12 months Finds hidden objects Imitates gestures and actions Manipulates objects purposefully
10 COGNITIVE MILESTONES: TODDLERHOOD months Remembers where things are kept Enjoys cause and effect relationship Shows brief interest in picture books Attempts simple puzzles months Sorts shapes and colors Imitates adults 2-3 years Comprehends size Begins to understand time sequences Counts and manipulates objects
11 COGNITIVE MILESTONES: PRESCHOOL 3-4 years Completes patterns Begins to understand reasoning Distinguishes between fact and fiction 4-5 years Understands opposites Engages in imaginary play Completes more complex puzzles
12 COGNITIVE MILESTONES: SCHOOL AGE 5-6 years Exhibits increased attention span and concentration Understands simple classifications Places blocks and nesting toys in order 6-9 years Accepts and understands rules Draws symbolic pictures Enjoys hobbies and collections 9-12 years Recognizes problems and can identify solutions Has increased memory Can understand others perspective
13 COGNITIVE MILESTONES: ADOLESCENCE years Growing capacity for abstract thought Mostly interested in present with limited thought to the future Interests expand and become more important years Greater capacity for setting goals Interest in moral reasoning Thinking about the meaning of life
14 COGNITIVE MILESTONES: PIAGET STAGES
15 SUPPORTING COGNITIVE DEVELOPMENT Infancy Read early and often Provide developmentally appropriate toys for sensory play Practice with learning object permanence (peek-a-boo, popup toys) Play music and sing nursery rhymes Toddlerhood and Preschool Practice counting, shapes, and colors Play with household objects Encourage make believe play Introduce working memory games (concentration, go fish, Simon Says) Introduce sorting and classifying activities
16 SUPPORTING COGNITIVE DEVELOPMENT School age Use planning and organization tools Establish a routine Offer choices Ask questions to help with problem solving Encourage hobbies Adolescence Discuss goal setting and attainment Encourage classes that emphasize perceptual and verbal reasoning skills (geometry, algebra, debate, philosophy) Create opportunities to practice daily living skills
17 SUPPORTING COGNITIVE DEVELOPMENT Participate in neurodevelopmental evaluations and reevaluations Seek intervention for clinically significant problems with executive functioning Medication management or behavioral therapy for ADHD Working memory training (Cogmed) Mindfulness training Academic accommodations
18 CHOA CARDIAC NEURODEVELOPMENTAL PROGRAM
19 RESOURCES
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