Social Cognition and Competence in Preschoolers With Congenital Heart Disease

Objective: Children born with congenital heart disease (CHD) are at an increased risk for various neurodevelopmental impairments. However, little is known regarding social outcomes associated with CHD, particularly during early childhood. The present study aimed to characterize the sociocognitive profile and to assess the contribution of language, executive functions (EF), and social cognition to social competence (SC) in preschoolers with CHD. Method: Five-year-old children with CHD (n = 55) completed a standardized neuropsychological assessment. Performance on sociocognitive skills was compared to test norms using one-sample t tests. Hierarchical regression was conducted to examine the associations between language skills, affect recognition (AR), theory of mind (ToM), EF (performance-based and parent-rated), and social competence. Results: Children with CHD performed significantly worse than norms in language and ToM, whereas EF and social competence appeared generally preserved in our sample. In hierarchical regression analysis, cognitive functions (language score, AR, ToM, EF performance) accounted for a significant 24.3% of the variance. Parent-rated EF added another 24.8% to the total explained variance. Conclusions: These findings provide new evidence for understanding social cognition and competence among preschoolers with CHD, showing vulnerability in social cognition and language skills but not in social competence more generally. The model suggests a combined contribution of social cognition, language, and EF on social outcomes. Remedial programs addressing these intervention targets could be useful in promoting social development in this vulnerable population.