Risk-taking behavior among adolescents with congenital heart disease
Date
2021
Authors
Journal Title
Journal ISSN
Volume Title
Publisher
University of Delaware
Abstract
The field of pediatric cardiology has undergone rapid advancement since the 1970s, and survival outcomes for children with congenital heart diseases (CHDs) have greatly improved. More children with CHDs are entering adolescence. Since 2010, the population of adolescents in the United States has increased by nearly 65%. The effect of CHDs on adolescence is not fully understood. ☐ Adolescence is a unique period of neurobiological and socio-emotional development. During this time, the developmentally immature prefrontal cortex structures moderate executive functions. This temporal gap in development could perpetuate risk-taking behavior, because may be prone to act without thinking. Acting without thinking is considered a serious type of impulsive behavior. ☐ Risk-taking behavior is a concern among adolescents with CHD. All adolescents, regardless of CHD severity, have pre-existing delays in brain growth from in utero or postnatal complications. The normative delay in brain maturation during adolescence may be amplified among this population, especially if they have neurobehavioral Sequalae. Adolescents with neurobehavioral Sequalae may be more impulsive and fail to consider the consequences of risk-taking behavior. Risk-taking behavior may exaggerate CHD-related complications and have an untoward effect on their functional daily living, morbidity and mortality. ☐ The aims of this dissertation were to generate pilot data examining the relationship between risk-taking behavior and impulsivity among adolescents with CHD using self-report and performance-based measures and address gaps in the literature to inform recommendations for future research and clinical interventions. A scoping review, study one (Chapter two), was conducted to address a literature gap specific to risk-taking behaviors among adolescents with chronic cardiac conditions by mapping risk-taking behavior in adolescents with chronic cardiac conditions and comparing them with six health-related behaviors in the Youth Risk Behavior Survey (YRBS). These findings indicated that that adolescents with chronic cardiac conditions engaged in risk-taking behaviors that were consistent with the YRBS but did not address the relationship between impulsivity and risk-taking behavior among adolescents with CHD. ☐ Study two (Chapter three) described the characteristics of self-reported risk-taking behavior and impulsivity among adolescents with CHD using selected questions from the YRBS and the Barratt Impulsiveness Scale 11 (BIS 11), respectively, and examined factors influencing these characteristics. Adolescents with CHD were found to engage in risky driving behaviors, alcohol and other drug use, tobacco use, and risky sexual behaviors. Over half of all participants had normal BIS 11 scores. Age was not associated with YRBS or BIS 11 scores. The total number of neurobehavioral sequalae reported among participants was inversely correlated with YRBS scores, but not BIS 11 scores. There were no group differences between gender or type of CHD and YRBS or BIS 11 scores. Findings from this study indicate that while most adolescents with CHD are not highly impulsive, they engage in risk-taking behaviors that may increase the risk of disease complications and mortality. ☐ Study three (Chapter four) examined the association between performance-based risk-taking behaviors and impulsivity levels among adolescents with CHD using The Balloon Analogue Risk Task for Youth (BART-Y) and Stop Signal Task (SST), respectively, and factors influencing this relationship. BART-Y and SST scores were not significantly associated among adolescents with CHD while controlling for age, gender, type of CHD, and the total number of neurobehavioral sequalae. Mean SST scores were significantly higher among participants with cyanotic CHD, however, there were no group differences between gender and BART-Y or SST scores. Neither age nor the total number of neurobehavioral sequalae were significantly associated with BART-Y or SST scores. Findings from this study indicate that although performance based risk-taking and impulsivity among adolescents with CHD are not correlated, participants with cyanotic CHD were found to be significantly more impulsive. The BART-Y and SST offer one method of examining performance-based risk-taking behavior and impulsivity; however, higher BART-Y or SST scores alone do not guarantee that adolescents with CHD will engage in risk-taking behaviors or are more impulsive. ☐ Findings from this dissertation indicate that adolescents with CHD who engage in risk-taking behaviors have varying levels of impulsivity. Self-report measures of risk-taking behavior and impulsivity offer insight into the types of risk-taking behaviors that adolescents with CHD engage in, and whether they perceive themselves to be impulsive. Performance-based measures of risk-taking behavior and impulsivity reflect motivation or willingness to engage in these behaviors. Yet, high scores on performance-based measures of risk-taking and impulsivity may not always result in high frequencies of self-reported behaviors or vice versa. Rather, self-report and performance-based measures of risk-taking behavior and impulsivity may offer healthcare providers the tools to assess past, present, and future actions among adolescents to help them avoid these consequences.
Description
Keywords
Adolescent, Congenital Heart Disease, Impulsivity, Risk-taking behavior