Visual-spatial processing style is associated with psychopathology in adolescents with critical congenital heart disease

Abstract

Objective: To determine whether visual-spatial processing style is associated with psychopathology in a large sample of adolescents with critical congenital heart disease (CHD). Local (part-oriented) style was hypothesized to increase risk for internalizing (but not externalizing) forms of psychopathology.

Method: Participants included 278 adolescents with critical CHD (dextro-transposition of the great arteries = 134, tetralogy of Fallot = 58, single-ventricle cardiac anatomy requiring the Fontan procedure = 86). Visual-spatial processing style was indexed using Copy Style Ratings from the Rey-Osterrieth Complex Figure-Developmental Scoring System. The Schedule for Affective Disorders and Schizophrenia for School-Aged Children–Present & Lifetime Version was used to determine presence/absence of diagnosable DSM-IV psychiatric disorder(s). Processing style and psychopathology were assessed concurrently.

Results: Thirty-three percent of the sample had a part-oriented processing style. In multivariable binary logistic regression models, part-orientation was associated with more than twice the odds of having an anxiety disorder (lifetime: OR = 2.2, p = .02, 95% CI = 1.1–4.1; current: OR = 2.7, p = .03, 95% CI = 1.1–6.5) but was not associated with an increased risk for ADHD, disruptive behavior, or mood disorders (ps > .05).

Conclusions: Adolescents with critical CHD who approach complex visual-spatial materials in a local, part-oriented fashion are more likely to meet criteria for an anxiety disorder than those who approach complexity more holistically. Part-orientation may make it more difficult for individuals to judge the relative importance of isolated details and engage in more adaptive perspective-taking.

Keywords:

• ADHD
• anxiety
• cardiac
• cognitive style
• pediatric

Acknowledgments

The authors thank the adolescents and parents who participated in this study and Megan Cassidy, PhD for her insight around psychotherapeutic implications.

Disclosure statement

No potential conflict of interest was reported by the authors.

Funding

This work was supported in part by grants from the National Heart, Lung, and Blood Institute (HL77681, HL74734, and HL096825); the Farb Family Fund; and the National Center for Research Resources (RR02172).