Attention Deficit and Hyperactivity Disorder Symptoms in Children Undergoing Ablation Therapy

Attention Deficit and Hyperactivity Disorder Symptoms in Children Undergoing Ablation Therapy | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Attention Deficit and Hyperactivity Disorder Symptoms in Children Undergoing Ablation Therapy Tuğba Doğaç, Özlem Elkıran, Serdar Akın Maraş, Mehmet Öncül, Özlem Doğan This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7874588/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: Ablation therapy is a frequently used invasive procedure in the treatment of pediatric arrhythmias such as tachycardia. Such interventions may affect both physiological and psychological well-being in children. Recently, there has been growing interest in examining symptoms of attention deficit and hyperactivity disorder (ADHD) among children exposed to chronic or repeated medical procedures. Methods: This cross-sectional study included 59 children (34 girls, 57.6%; 25 boys, 42.4%) who had undergone ablation therapy. The mean age was 12.41 ± 3.12 years (median 13; range 10–15). ADHD-related symptoms were assessed using a parent-rated behavioral evaluation form comprising Inattention, Hyperactivity, Oppositional, and Conduct subscales. Clinical cut-off scores for inattention and hyperactivity were set at ≥10 points. Statistical analyses were performed using the Mann–Whitney U and Spearman correlation tests; p < 0.05 was considered statistically significant. Results: The mean inattention score was 4.31 ± 3.64 and the mean hyperactivity score was 4.05 ± 3.98. Boys had significantly higher inattention scores than girls (p = 0.008), while other subscales showed no sex differences (p > 0.05). Inattention (r = 0.373, p = 0.004) and conduct problems (r = 0.301, p = 0.021) were positively correlated with age. Clinically significant inattention symptoms (≥10 points) were observed in 13.6% (n = 8) and hyperactivity in 10.2% (n = 6) of participants, with no sex-based difference. Conclusions: ADHD symptoms in children after ablation therapy were comparable to general population rates; however, boys showed higher inattention levels, and attentional difficulties tended to increase with age. These findings underscore the need for neuropsychiatric follow-up following invasive cardiac procedures in pediatric populations. Pediatrics Cardiac & Cardiovascular Systems Psychiatry Ablation Arrhythmia Attention deficit Hyperactivity Pediatric cardiology Introduction Cardiac arrhythmias are among the most frequent causes of hospital admissions in children and adolescents, often requiring interventional procedures for rhythm correction. Catheter ablation, using radiofrequency or cryoenergy, has become the preferred treatment for supraventricular tachycardia and other arrhythmias, offering high success and low complication rates [ 1 , 2 ]. However, despite its clinical efficacy, ablation represents a significant medical event that can influence the child’s emotional and neurocognitive well-being through procedural stress, hospitalization, and altered illness perception [ 3 ]. Children exposed to repeated or invasive medical procedures are known to be at greater risk for attentional, emotional, and behavioral difficulties. Neuroimaging studies have shown that chronic illness and procedural stress may disrupt neural circuits involved in executive functioning, particularly within prefrontal and parietal cortices [ 4 , 5 ]. Attention Deficit and Hyperactivity Disorder (ADHD), characterized by inattention, hyperactivity, and impulsivity, is one of the most common neurodevelopmental disorders in childhood, with a global prevalence of approximately 5–7% [ 6 , 7 ]. Emerging evidence indicates that stress-related physiological mechanisms — such as dysregulated cortisol response, sleep disturbances, and systemic inflammation — may contribute to attentional dysregulation and behavioral symptoms in medically vulnerable populations [ 8 ]. Nonetheless, research on ADHD symptomatology in children following cardiac interventions, particularly ablation therapy, remains scarce. Therefore, the present study aimed to assess the frequency of ADHD-related symptoms and their associations with age and sex among children who underwent ablation therapy. This investigation seeks to enhance understanding of the neuropsychological outcomes of invasive cardiac procedures and inform integrated follow-up strategies in pediatric cardiology care. Materials and Methods Study Design and Participants The ablation procedures were performed at the Department of Pediatric Cardiology, İnönü University Hospital, Malatya, Turkey. Necessary institutional permissions were obtained from the hospital administration prior to data collection. Ethical approval for the study was granted by the Ethics Committee of Malatya Turgut Özal University (Approval No: add number here, Date: add date here). This was a cross-sectional observational study including 59 pediatric patients who had previously undergone ablation therapy for supraventricular tachycardia or other arrhythmias. The sample consisted of 34 girls (57.6%) and 25 boys (42.4%), with a mean age of 12.41 ± 3.12 years (median = 13; range = 10–15 years). Inclusion criteria were: (1) age between 8–17 years, (2) history of successful ablation therapy, and (3) absence of pre-existing neurodevelopmental or psychiatric diagnoses. Children with neurological disorders or developmental delays were excluded. Assessment Tools ADHD-related behaviors were evaluated using the parent-rated behavioral assessment form comprising four subscales: Inattention, Hyperactivity, Oppositional, and Conduct Problems. Each item was rated on a standardized Likert-type scale, and higher scores indicated more severe symptoms. Clinical cut-off values for inattention and hyperactivity were defined as ≥ 10 points to identify clinically significant symptom levels. Statistical Analysis Data were analyzed using SPSS version 26.0 (IBM Corp., Armonk, NY, USA). The Kolmogorov–Smirnov test was used to examine normality. Due to non-normal distribution, non-parametric tests were applied. Between-group comparisons were performed using the Mann–Whitney U test. Correlations between continuous variables were evaluated using Spearman’s rho. Statistical significance was set at p < 0.05. Results Inattention and Hyperactivity Scores The mean inattention score among participants was 4.31 ± 3.64, and the mean hyperactivity score was 4.05 ± 3.98. Median values were 3 (IQR = 2–6) for inattention and 3 (IQR = 1–5) for hyperactivity. Sex-Based Comparison Significant sex differences were observed only in inattention scores, with boys scoring higher than girls (p = 0.008). No significant differences were found in hyperactivity, oppositional, or conduct problem subscales (p > 0.05). Age Correlations Age showed a positive correlation with inattention (r = 0.373, p = 0.004) and conduct problems (r = 0.301, p = 0.021). No significant correlations were identified between age and hyperactivity or oppositional behaviors (p > 0.05). Clinical Cut-off Analysis Eight children (13.6%) scored above the clinical threshold for inattention, and six (10.2%) for hyperactivity. These proportions did not differ significantly between boys and girls (p > 0.05). Discussion The present study revealed that ADHD symptoms among children undergoing ablation therapy were within the expected range for the general pediatric population. However, boys demonstrated significantly higher inattention scores, aligning with existing literature showing that males more frequently exhibit inattentive and combined ADHD subtypes [ 9 , 10 ]. Neurobiological studies suggest that sex differences in dopaminergic system maturation and cortical development trajectories may underlie this pattern [ 11 ]. The positive correlation between age and inattention or conduct problems suggests that attentional difficulties may become more apparent as children grow older and encounter increasing academic and social demands. This pattern is consistent with research on children with chronic medical conditions, where prolonged disease management and procedural stress can negatively affect sustained attention and self-regulation [ 12 ]. Moreover, growing evidence indicates a link between autonomic nervous system balance and attention control. Altered cardiac vagal activity, which may be affected by cardiac interventions, has been associated with attentional modulation and emotional regulation [ 13 , 14 ]. Although ablation is generally curative and safe, it may transiently influence autonomic tone, which could in turn impact neurobehavioral outcomes — a hypothesis that warrants further investigation. In addition to physiological mechanisms, psychosocial factors such as anxiety, parental stress, and disrupted sleep following hospitalization can influence attention and behavior regulation in children [ 15 , 16 ]. The absence of significant group differences in hyperactivity or oppositional symptoms may suggest that regulatory behaviors remain stable post-procedure, whereas attention processes are more sensitive to subtle psychosocial and physiological influences. These findings highlight the importance of incorporating psychological and cognitive screening into post-ablation follow-up programs. A multidisciplinary approach that includes both cardiology and child psychiatry perspectives may enhance long-term quality of life and academic functioning for affected children [ 17 , 18 ]. Limitations This study’s cross-sectional design limits causal inference. The relatively small sample size and lack of pre-procedure assessments also restrict generalizability. Future longitudinal studies with larger cohorts, including pre- and post-procedure neuropsychological testing and control groups, are recommended to clarify the causal links between ablation therapy and attentional functioning. Conclusion Children who undergo ablation therapy exhibit ADHD symptom levels comparable to those of the general population, though boys display higher inattention scores. Furthermore, inattention and conduct problems increase with age, suggesting developmental and environmental influences. These findings emphasize the importance of neuropsychiatric monitoring and supportive interventions in the comprehensive care of pediatric patients undergoing invasive cardiac procedures. Declarations Written informed consent was obtained from the parents/legal guardians of all participants. The study was approved by the relevant ethics committee, and all procedures were conducted in accordance with the principles of the Declaration of Helsinki. References Kugler JD, Erickson CC, Cain N et al (2021) Catheter ablation for pediatric supraventricular tachycardia: 25 years of evolution. Heart Rhythm 18(5):745–752 Salerno JC, Seslar SP (2022) Pediatric catheter ablation: current perspectives. Curr Opin Cardiol 37(1):66–72 Uzun O, Wilson DG, Hornung TS (2023) Psychosocial impact of cardiac catheterization and ablation in children. Pediatr Cardiol 44(3):601–610 Cortese S et al (2020) Neural substrates of attention control in children with ADHD and chronic illness. Neuroimage Clin 28:102420 Mulder H et al (2021) Executive functioning after pediatric cardiac surgery: a meta-analysis. Dev Med Child Neurol 63(6):697–708 Polanczyk GV et al (2015) The worldwide prevalence of ADHD: a systematic review. Am J Psychiatry 172(10):942–948 Thomas R et al (2022) Prevalence of ADHD: updated global estimates and regional differences. Lancet Psychiatry 9(4):284–296 Becker SP et al (2020) Sleep and attention in medically ill children: a systematic review. J Pediatr Psychol 45(3):263–277 Willcutt EG (2021) Sex differences in ADHD: new insights and implications. J Clin Child Adolesc Psychol 50(2):147–162 Martel MM (2020) The role of sex in ADHD symptom presentation: review and meta-analysis. Clin Psychol Rev 81:101912 Lenartowicz A et al (2023) Dopamine system development and ADHD pathophysiology. Neurosci Biobehav Rev 149:105177 Forcada-Guex M et al (2020) Long-term cognitive outcomes in children with chronic medical conditions. Child Neuropsychol 26(1):73–88 Tonhajzerova I et al (2021) Heart rate variability and ADHD: autonomic correlates of attention. Front Neurosci 15:657764 Vitiello B (2022) The interface between ADHD and cardiac autonomic regulation. J Child Psychol Psychiatry 63(9):1035–1045 Palermo TM et al (2021) Anxiety and attention outcomes after pediatric medical procedures: a longitudinal study. Health Psychol 40(6):421–430 Faraone SV et al (2023) Environmental and familial stress in ADHD symptom persistence. Psychol Med 53(8):3507–3516 Becker M et al (2024) Psychosocial support in pediatric arrhythmia care: integrating mental health. Cardiol Young 34(2):210–218 Lubitz SA et al (2024) Multidisciplinary care in pediatric electrophysiology: outcomes and perspectives. Heart Rhythm O2 5(1):100130 Additional Declarations The authors declare no competing interests. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Therapy\u003c/strong\u003e\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eCardiac arrhythmias are among the most frequent causes of hospital admissions in children and adolescents, often requiring interventional procedures for rhythm correction. Catheter ablation, using radiofrequency or cryoenergy, has become the preferred treatment for supraventricular tachycardia and other arrhythmias, offering high success and low complication rates [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. However, despite its clinical efficacy, ablation represents a significant medical event that can influence the child\u0026rsquo;s emotional and neurocognitive well-being through procedural stress, hospitalization, and altered illness perception [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eChildren exposed to repeated or invasive medical procedures are known to be at greater risk for attentional, emotional, and behavioral difficulties. Neuroimaging studies have shown that chronic illness and procedural stress may disrupt neural circuits involved in executive functioning, particularly within prefrontal and parietal cortices [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Attention Deficit and Hyperactivity Disorder (ADHD), characterized by inattention, hyperactivity, and impulsivity, is one of the most common neurodevelopmental disorders in childhood, with a global prevalence of approximately 5\u0026ndash;7% [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eEmerging evidence indicates that stress-related physiological mechanisms \u0026mdash; such as dysregulated cortisol response, sleep disturbances, and systemic inflammation \u0026mdash; may contribute to attentional dysregulation and behavioral symptoms in medically vulnerable populations [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Nonetheless, research on ADHD symptomatology in children following cardiac interventions, particularly ablation therapy, remains scarce.\u003c/p\u003e\u003cp\u003eTherefore, the present study aimed to assess the frequency of ADHD-related symptoms and their associations with age and sex among children who underwent ablation therapy. This investigation seeks to enhance understanding of the neuropsychological outcomes of invasive cardiac procedures and inform integrated follow-up strategies in pediatric cardiology care.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eStudy Design and Participants\u003c/h2\u003e\u003cp\u003eThe ablation procedures were performed at the Department of Pediatric Cardiology, İn\u0026ouml;n\u0026uuml; University Hospital, Malatya, Turkey. Necessary institutional permissions were obtained from the hospital administration prior to data collection. Ethical approval for the study was granted by the Ethics Committee of Malatya Turgut \u0026Ouml;zal University (Approval No: add number here, Date: add date here).\u003c/p\u003e\u003cp\u003eThis was a cross-sectional observational study including 59 pediatric patients who had previously undergone ablation therapy for supraventricular tachycardia or other arrhythmias. The sample consisted of 34 girls (57.6%) and 25 boys (42.4%), with a mean age of 12.41\u0026thinsp;\u0026plusmn;\u0026thinsp;3.12 years (median\u0026thinsp;=\u0026thinsp;13; range\u0026thinsp;=\u0026thinsp;10\u0026ndash;15 years). Inclusion criteria were: (1) age between 8\u0026ndash;17 years, (2) history of successful ablation therapy, and (3) absence of pre-existing neurodevelopmental or psychiatric diagnoses. Children with neurological disorders or developmental delays were excluded.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eAssessment Tools\u003c/h3\u003e\n\u003cp\u003eADHD-related behaviors were evaluated using the parent-rated behavioral assessment form comprising four subscales: Inattention, Hyperactivity, Oppositional, and Conduct Problems. Each item was rated on a standardized Likert-type scale, and higher scores indicated more severe symptoms. Clinical cut-off values for inattention and hyperactivity were defined as \u0026ge;\u0026thinsp;10 points to identify clinically significant symptom levels.\u003c/p\u003e\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\u003ch2\u003eStatistical Analysis\u003c/h2\u003e\u003cp\u003eData were analyzed using SPSS version 26.0 (IBM Corp., Armonk, NY, USA). The Kolmogorov\u0026ndash;Smirnov test was used to examine normality. Due to non-normal distribution, non-parametric tests were applied. Between-group comparisons were performed using the Mann\u0026ndash;Whitney U test. Correlations between continuous variables were evaluated using Spearman\u0026rsquo;s rho. Statistical significance was set at p\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\u003ch2\u003eInattention and Hyperactivity Scores\u003c/h2\u003e\u003cp\u003eThe mean inattention score among participants was 4.31\u0026thinsp;\u0026plusmn;\u0026thinsp;3.64, and the mean hyperactivity score was 4.05\u0026thinsp;\u0026plusmn;\u0026thinsp;3.98. Median values were 3 (IQR\u0026thinsp;=\u0026thinsp;2\u0026ndash;6) for inattention and 3 (IQR\u0026thinsp;=\u0026thinsp;1\u0026ndash;5) for hyperactivity.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eSex-Based Comparison\u003c/h2\u003e\u003cp\u003eSignificant sex differences were observed only in inattention scores, with boys scoring higher than girls (p\u0026thinsp;=\u0026thinsp;0.008). No significant differences were found in hyperactivity, oppositional, or conduct problem subscales (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eAge Correlations\u003c/h3\u003e\n\u003cp\u003eAge showed a positive correlation with inattention (r\u0026thinsp;=\u0026thinsp;0.373, p\u0026thinsp;=\u0026thinsp;0.004) and conduct problems (r\u0026thinsp;=\u0026thinsp;0.301, p\u0026thinsp;=\u0026thinsp;0.021). No significant correlations were identified between age and hyperactivity or oppositional behaviors (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e\n\u003ch3\u003eClinical Cut-off Analysis\u003c/h3\u003e\n\u003cp\u003eEight children (13.6%) scored above the clinical threshold for inattention, and six (10.2%) for hyperactivity. These proportions did not differ significantly between boys and girls (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe present study revealed that ADHD symptoms among children undergoing ablation therapy were within the expected range for the general pediatric population. However, boys demonstrated significantly higher inattention scores, aligning with existing literature showing that males more frequently exhibit inattentive and combined ADHD subtypes [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Neurobiological studies suggest that sex differences in dopaminergic system maturation and cortical development trajectories may underlie this pattern [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe positive correlation between age and inattention or conduct problems suggests that attentional difficulties may become more apparent as children grow older and encounter increasing academic and social demands. This pattern is consistent with research on children with chronic medical conditions, where prolonged disease management and procedural stress can negatively affect sustained attention and self-regulation [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eMoreover, growing evidence indicates a link between autonomic nervous system balance and attention control. Altered cardiac vagal activity, which may be affected by cardiac interventions, has been associated with attentional modulation and emotional regulation [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Although ablation is generally curative and safe, it may transiently influence autonomic tone, which could in turn impact neurobehavioral outcomes \u0026mdash; a hypothesis that warrants further investigation.\u003c/p\u003e\u003cp\u003eIn addition to physiological mechanisms, psychosocial factors such as anxiety, parental stress, and disrupted sleep following hospitalization can influence attention and behavior regulation in children [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. The absence of significant group differences in hyperactivity or oppositional symptoms may suggest that regulatory behaviors remain stable post-procedure, whereas attention processes are more sensitive to subtle psychosocial and physiological influences.\u003c/p\u003e\u003cp\u003eThese findings highlight the importance of incorporating psychological and cognitive screening into post-ablation follow-up programs. A multidisciplinary approach that includes both cardiology and child psychiatry perspectives may enhance long-term quality of life and academic functioning for affected children [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e].\u003c/p\u003e\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\u003ch2\u003eLimitations\u003c/h2\u003e\u003cp\u003eThis study\u0026rsquo;s cross-sectional design limits causal inference. The relatively small sample size and lack of pre-procedure assessments also restrict generalizability. Future longitudinal studies with larger cohorts, including pre- and post-procedure neuropsychological testing and control groups, are recommended to clarify the causal links between ablation therapy and attentional functioning.\u003c/p\u003e\u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eChildren who undergo ablation therapy exhibit ADHD symptom levels comparable to those of the general population, though boys display higher inattention scores. Furthermore, inattention and conduct problems increase with age, suggesting developmental and environmental influences. These findings emphasize the importance of neuropsychiatric monitoring and supportive interventions in the comprehensive care of pediatric patients undergoing invasive cardiac procedures.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cspan\u003eWritten informed consent was obtained from the parents/legal guardians of all participants. The study was approved by the relevant ethics committee, and all procedures were conducted in accordance with the principles of the Declaration of Helsinki.\u003c/span\u003e\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eKugler JD, Erickson CC, Cain N et al (2021) Catheter ablation for pediatric supraventricular tachycardia: 25 years of evolution. Heart Rhythm 18(5):745\u0026ndash;752\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSalerno JC, Seslar SP (2022) Pediatric catheter ablation: current perspectives. Curr Opin Cardiol 37(1):66\u0026ndash;72\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eUzun O, Wilson DG, Hornung TS (2023) Psychosocial impact of cardiac catheterization and ablation in children. Pediatr Cardiol 44(3):601\u0026ndash;610\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCortese S et al (2020) Neural substrates of attention control in children with ADHD and chronic illness. Neuroimage Clin 28:102420\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMulder H et al (2021) Executive functioning after pediatric cardiac surgery: a meta-analysis. Dev Med Child Neurol 63(6):697\u0026ndash;708\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePolanczyk GV et al (2015) The worldwide prevalence of ADHD: a systematic review. Am J Psychiatry 172(10):942\u0026ndash;948\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eThomas R et al (2022) Prevalence of ADHD: updated global estimates and regional differences. Lancet Psychiatry 9(4):284\u0026ndash;296\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBecker SP et al (2020) Sleep and attention in medically ill children: a systematic review. J Pediatr Psychol 45(3):263\u0026ndash;277\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWillcutt EG (2021) Sex differences in ADHD: new insights and implications. J Clin Child Adolesc Psychol 50(2):147\u0026ndash;162\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMartel MM (2020) The role of sex in ADHD symptom presentation: review and meta-analysis. Clin Psychol Rev 81:101912\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLenartowicz A et al (2023) Dopamine system development and ADHD pathophysiology. Neurosci Biobehav Rev 149:105177\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eForcada-Guex M et al (2020) Long-term cognitive outcomes in children with chronic medical conditions. Child Neuropsychol 26(1):73\u0026ndash;88\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eTonhajzerova I et al (2021) Heart rate variability and ADHD: autonomic correlates of attention. Front Neurosci 15:657764\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eVitiello B (2022) The interface between ADHD and cardiac autonomic regulation. J Child Psychol Psychiatry 63(9):1035\u0026ndash;1045\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePalermo TM et al (2021) Anxiety and attention outcomes after pediatric medical procedures: a longitudinal study. Health Psychol 40(6):421\u0026ndash;430\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eFaraone SV et al (2023) Environmental and familial stress in ADHD symptom persistence. Psychol Med 53(8):3507\u0026ndash;3516\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBecker M et al (2024) Psychosocial support in pediatric arrhythmia care: integrating mental health. Cardiol Young 34(2):210\u0026ndash;218\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLubitz SA et al (2024) Multidisciplinary care in pediatric electrophysiology: outcomes and perspectives. Heart Rhythm O2 5(1):100130\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"Malatya Turgut Özal Üniversitesi","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Ablation, Arrhythmia, Attention deficit, Hyperactivity, Pediatric cardiology","lastPublishedDoi":"10.21203/rs.3.rs-7874588/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7874588/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e Ablation therapy is a frequently used invasive procedure in the treatment of pediatric arrhythmias such as tachycardia. Such interventions may affect both physiological and psychological well-being in children. Recently, there has been growing interest in examining symptoms of attention deficit and hyperactivity disorder (ADHD) among children exposed to chronic or repeated medical procedures.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e This cross-sectional study included 59 children (34 girls, 57.6%; 25 boys, 42.4%) who had undergone ablation therapy. The mean age was 12.41 ± 3.12 years (median 13; range 10–15). ADHD-related symptoms were assessed using a parent-rated behavioral evaluation form comprising Inattention, Hyperactivity, Oppositional, and Conduct subscales. Clinical cut-off scores for inattention and hyperactivity were set at ≥10 points. Statistical analyses were performed using the Mann–Whitney U and Spearman correlation tests; p \u0026lt; 0.05 was considered statistically significant.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eThe mean inattention score was 4.31 ± 3.64 and the mean hyperactivity score was 4.05 ± 3.98. Boys had significantly higher inattention scores than girls (p = 0.008), while other subscales showed no sex differences (p \u0026gt; 0.05). Inattention (r = 0.373, p = 0.004) and conduct problems (r = 0.301, p = 0.021) were positively correlated with age. Clinically significant inattention symptoms (≥10 points) were observed in 13.6% (n = 8) and hyperactivity in 10.2% (n = 6) of participants, with no sex-based difference.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions:\u003c/strong\u003e ADHD symptoms in children after ablation therapy were comparable to general population rates; however, boys showed higher inattention levels, and attentional difficulties tended to increase with age. These findings underscore the need for neuropsychiatric follow-up following invasive cardiac procedures in pediatric populations.\u003c/p\u003e","manuscriptTitle":"Attention Deficit and Hyperactivity Disorder Symptoms in Children Undergoing Ablation Therapy","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-17 03:46:29","doi":"10.21203/rs.3.rs-7874588/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"cdd790ac-4868-45a5-a40c-09dc771c6ed1","owner":[],"postedDate":"October 17th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":56391011,"name":"Pediatrics"},{"id":56391012,"name":"Cardiac \u0026 Cardiovascular Systems"},{"id":56391013,"name":"Psychiatry"}],"tags":[],"updatedAt":"2025-10-17T03:46:29+00:00","versionOfRecord":[],"versionCreatedAt":"2025-10-17 03:46:29","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7874588","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7874588","identity":"rs-7874588","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}