(Center for the Advancement of Health) -- New research indicates that 4-year-olds who have had surgery to correct an inborn heart defect -- much like children without such health problems -- are more likely to have behavioral problems if their mothers and fathers find parenting highly stressful.

While the researchers anticipated this finding, they did not predict another observation: that reported rates of problem behaviors and levels of parenting stress are no higher, and possibly lower, in families coping with the heart defect than in average families.

According to lead author Karen J. Visconti, Ph.D., of Children's Hospital and Harvard Medical School, "These findings indicate that the parents [of children with the congenital heart defect] were capable of coping with having a sick child."

The study is published in the October issue of the Journal of Developmental and Behavioral Pediatrics.

Visconti and her colleagues followed 153 children born with transposition of the great arteries and their parents for four years. In every case, the heart defect was surgically corrected at an urban children's hospital before the age of 3 months.

The researchers administered questionnaires on which parents rated their levels of stress and social support when the children were 1 year old, and again when they were 4 years old. A separate survey, distributed only at age 4, asked parents to record all the behavioral and emotional problems they observed in their children.

The results reveal that how stressed parents feel when the children are 1 year old is a good predictor of both parental stress levels and the number of problem behaviors in their children three years later. This echoes previous research on normal children, Visconti notes, which "reported that parent stress over the first three years of children's lives was the best predictor of child behavior problems at 4 years of age."

The investigators also found that "families with less social support reported more stress at both 1 and 4 years."

According to Visconti, these results suggest that "Early detection of distressed families may assist in alleviating stress and reducing child behavior problems," and that bolstering social support might be a viable approach.

This approach seems particularly promising given the observation that parents whose children had the corrected heart defect reported higher levels of social support than typically seen among families in an urban community. This suggests that "these parents are willing to seek out sources of support and capable of securing them," Visconti says.

Ability to recruit support, she observes, may help explain why those parents don't seem unusually stressed, and their children don't seem to have an unusual number of behavioral problems, despite the pressures of illness and surgery.

Parental bias may also be a reason why the number of problem behaviors reported by the parents of children with heart defects was unremarkable. "When completing the [survey], parents might take into account the fact that the child has been sick and do not rate behaviors as aberrant," Visconti proposes.

While the researchers believe that the present study "indicates a favorable outcome for parents and children" with this type of congenital heart disease, they are careful to note that the same may not be true for other inborn heart defects.

Transposition of the arteries, "although a serious heart defect … generally involves a single reparative surgery, and parents are encouraged to consider the problem as corrected," they explain. "Parents may be able to adapt to having a child with critical congenital heart disease if they perceive the problem to be resolved."