Congenital heart disease (CHD) is associated with elevated neurodevelopmental risk. Data on mental health including anxiety and depression in children with CHD and their comorbidities remain unclear. We investigated neuropsychiatric internalizing and DSM-V autism spectrum symptoms and their association with executive functioning (EF) in children with CHD.

Neurodevelopmental assessment was conducted at the Cardiac Neurodevelopmental Center Necker Children's Hospital between November 2025 and February 2026, following the European Neurodevelopmental follow-up guidelines for CHD. Cognitive outcomes were measured by the WISC-V, WPPSI-IV or the Bayley-4, and EF by the BRIEF-P/2. Parent-reported neuropsychiatric symptoms included BASC-3 Anxiety, Depression and Somatization as well as SRS-2 DSM-5 autism scales. Descriptive data and correlation analyses are reported.

30 children with CHD were included (mean age 7 y ± 2 y; 50% male). 93% had cardiac surgery, including 57% as neonates. Cognitive scores were within norms (mean = 95.6 ± 13.2), however, executive dysfunction were frequent (BRIEF, mean = 62 ± 18.2, exceeding norms by ≥ 1 SD). BASC-3 Anxiety (mean = 47 ± 10), Depression (mean = 49 ± 12.3), and Somatization (mean = 52 ± 10) matched expected norms. Both SRS-2 DSM-V scales (Communication: mean = 63.8 ± 13.7; Restricted interest: mean = 67.4 ± 15) were abovenormative means. No association was found between neuropsychiatric symptoms and cognitive functioning. EF was associated with Anxiety ( r = 0.45, P < 0.01), Depression ( r = 0.46, P < 0.01) and Somatization ( r = 0.40, P = 0.03) from the BASC-3 and with DSM-V Communication ( r = 0.68, P < 0.001) and Restricted Interests ( r = 0.72, P < 0.001).

Neuropsychiatric internalizing symptoms are common in children with CHD with comorbid executive dysfunction, despite normal IQ.