Date of Award

2025

Document Type

Dissertation

Degree Name

Doctor of Philosophy in Clinical Psychology

Department

Psychology

Committee Chair and Members

Kevin Meehan, Chair

Sara Haden

Michelle Gurvitz

Keywords

Congenital heart disease, d-TGA, Emerging adulthood, Executive functioning, Psychosocial maturity, Social cognition

Abstract

As survival rates for individuals with complex congenital heart disease (CHD), such as dextro-Transposition of the Great Arteries (d-TGA), increase, there is a growing need to examine neurocognitive and psychosocial challenges from a lifespan perspective. However, research often overlooks the integration of these factors, despite evidence from other chronic illness populations suggesting their interplay influences psychosocial functioning in adulthood. This study assessed psychosocial maturity in emerging adults with d-TGA and explored its relationship with executive functioning (EF) and social cognition (SC) longitudinally. Data were drawn from the Boston Circulatory Arrest Study (BCAS) cohort at age 16 (n = 80) and adulthood (n = 87, mean age = 28.95 ± 1.26), along with an adult age-matched control group (n = 41) to assess 1) EF and SC longitudinally, respectively, 2) the relationship between age 16 EF and adult SC, and 3) the mediating effects of SC on the relationship between EF and adult psychosocial maturity. Within the d-TGA group, EF and SC remained stable from age 16 to adulthood; however, age 16 EF did not predict adult SC. SC did not mediate the relationship between EF and adult psychosocial maturity in either group. Across both groups, EF emerged as the strongest predictor of adult psychosocial maturity, with no effect of group membership. Findings highlight the importance of a biopsychosocial framework in understanding developmental trajectories in d-TGA, emphasizing EF as a key predictor of long-term psychosocial outcomes and a potential target for intervention across the lifespan.

Keywords: congenital heart disease, d-TGA, executive functioning, social cognition, emerging adulthood, psychosocial outcomes, psychosocial maturity

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