(PS4-A13) Understanding the Role of Negative Peer Interactions and Social Support in the Emotional Adjustment of Youth with Congenital Heart Defects Relative to Healthy Classmates

Introduction: Congenital heart defects (CHD) are among the most common birth anomalies, affecting almost 1% of children born each year in the United States. Although surgical advances ensure that most children survive into adulthood, questions remain about the behavioral consequences of CHD, particularly for youth with ‘critical’ forms of CHD that carry neurodevelopmental risk. In elementary school, these children demonstrate social difficulties and may have more internalizing symptoms than typically developing youth as they enter adolescence. Our study aims  to examine the effects of critical CHD on internalizing symptoms in late elementary school and investigate whether higher negative peer interactions account for differences in emotional well-being relative to healthy, comparison classmates. Secondly, we wanted to explore whether available support from parents, teachers, or friends would moderate the direct or indirect relationships between critical CHD, negative peer interactions, and internalizing symptoms for children with and without CHD.

Methods: Children with critical CHD (N=100, M_age=10.58, 62% Male, 84% White) and healthy comparison classmates (CC) (N=57, M_age =10.70, 70.2% Male, 88% White) completed the Social Experiences Questionnaire (SEQ) to assess physical and relational aggression from peers and the Social Support Scale for Children (SSSC) to assess support from parents, teacher, and friends. Mothers (N_CHD=95, N_CC=55) and fathers (N_CHD=64, N_CC=30) completed the Child Behavior Checklist (CBCL) and raw scores on the Internalizing Problems scale were averaged when two parents participated. Analyses included hierarchical multiple regression with post-hoc bootstrapping (10,000 samples) of indirect effects and interactions to test moderated indirect effects of CHD on Internalizing Problems. It was hypothesized that negative peer experiences would at least partially account for elevations in Internalizing Problems for youth with CHD and that this indirect effect would be weaker when support was high.

Results: Children with CHD were found to have significantly higher Internalizing Problems than healthy CC (B=1.84, p=.041). SEQ total scores significantly improved prediction of Internalizing Problems. Contrary to expectations, group differences in the SEQ were not significant and negative peer interaction did not account for group differences in Internalizing Problems. Significant interactions of the SEQ with parent and teacher support were found (B = -.053, p=.001; B= -.026 p=.010), but not between friend support and SEQ (p =.807). This suggests a general benefit of adult support not specific to youth with CHD.

Conclusions: Although youth with critical CHD showed higher levels of internalizing symptoms, this was not explained by perceived negative treatment by peers.  Parent and teacher support moderated the relationship between negative peer interactions and internalizing symptoms for youth, including those with and without CHD. Further work should try to investigate longitudinal trajectories of internalizing risk over time for youth with CHD and consider other mechanisms, such as coping responses, that may affect the emotional adjustment of youth with critical CHD.