Autism and Congenital Heart Disease: Evidence and Unresolved Questions

* Abbreviations: AuSD — : autism spectrum disorder CHD — : congenital heart disease OR — : odds ratio Neurodevelopmental and mental health impairments are now recognized as being among the most prevalent long-term morbidities in children with congenital heart disease (CHD).1,2 In 2012, the American Heart Association and the American Academy of Pediatrics published a scientific statement providing recommendations for routine neurodevelopmental evaluation and treatment of children with CHD.1 The identification of social and communication deficits, potentially related to autism spectrum traits, has only been recently identified as a concern in these patients, however, and there is emerging evidence of an association between CHD and autism spectrum disorders (AuSDs). In 2015, Razzaghi et al3 reported that children with CHD were more likely to have had a diagnosis of AuSD (crude odds ratio [OR] 4.6). In 2017, in a retrospective, nationwide, population-based case control study, Tsao et al4 found that children with CHD, compared with a non-CHD group matched for age and sex, had a nearly twofold greater risk of developing AuSD. These and other studies showing a higher risk of autism symptoms in CHD5 have … Address correspondence to Johanna Calderon, PhD, Department of Psychiatry, Boston Children’s Hospital, 21 Autumn St, Boston, MA 02015. E-mail: johanna.calderon{at}childrens.harvard.edu