Symbolic talk in preschoolers who have had infant heart surgery

Most infants who are born with heart defects can be cured by surgical treatment, but may suffer learning difficulties, which are often identified only when they enter school. Research suggests that these potential adverse developmental outcomes are related to brain damage incurred during infant cardiac surgery. Currently, however, studies reveal conflicting results regarding the range of cognitive, motor, and language delays in children who have had early corrective heart surgery (ECHS). Often, these learning difficulties are subtle and not easily identified using standard cognitive tests. Nevertheless, given the prevalence of congenital heart disease and the wide range of developmental outcomes in children with ECHS, clinicians need tools for the early identification of children at risk for later academic difficulties.;While language abilities in the preschool period may be especially vulnerable in ECHS children, there is presently little research on language outcomes in these children. Standard language measures appear to overlook potential areas of difficulty; however, tasks examining extended discourse competence seem to identify subtle but significant language difficulties. For example, a few studies suggest that ECHS children produce fewer narrative events, evaluations, story play episodes, and overall, less symbolic play talk than a normative group.;In this project, the nature of these language difficulties is investigated during parent-child pretend play in four year old children with ECHS. This project is part of a larger research project at Children's Hospital in Boston, whose primary objective is to compare developmental sequelae of two surgical support techniques, total circulatory arrest (TCA) and low-flow bypass (LFB). Results show that ECHS children use predominantly early acquired verbal strategies to participate in pretend play with parents, including focus on concrete talk, production of few, mostly fragmented story episodes, and reliance on parents to initiate or maintain symbolic talk. These participation styles suggest difficulty with discourse skills. Children who had the TCA support technique showed worse status on symbolic talk outcomes than children who had LFB, and children who had early postoperative seizures showed worse performance than children who had no seizures.