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Deficits in executive functioning (EF) and social-affective abilities may co-occur, undermining peer relationships. Social difficulties faced by children with cCHD have not yet been described in detail nor linked to specific cognitive or social-affective skills. This study compares children with cCHD and healthy classmates on these outcomes and examines whether social-affective deficits predict peer relationship difficulties independently of impairment in EF.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Children with cCHD (N\u2009=\u2009134; Mage =10.2) were compared to healthy comparison classmates (CC; N\u2009=\u200992, Mage =10.0) recruited through schools. Social-affective abilities, EF, peer interactions, and social adjustment were measured using multiple methods, including child, caregiver, and peer reports in school and home settings.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Children with cCHD had more peer relationship difficulties and deficits in both social-affective skills and EF than CC. Social-affective skills accounted for some, but not all, peer relationship difficulties for children with cCHD. Group differences in social-affective skills, and indirect effects involving those skills, often remained significant when taking EF into account.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Peer relationship difficulties associated with cCHD likely result from an array of social-affective deficits and neurocognitive deficits. Clinicians might consider screening beyond traditional neurocognitive deficits and refer for early intervention of social and emotional skills. Longitudinal research is needed to clarify causal pathways and identify protective factors that could be targeted by tailored interventions.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/jpepsy\/jsag010","type":"journal-article","created":{"date-parts":[[2026,1,23]],"date-time":"2026-01-23T12:39:08Z","timestamp":1769171948000},"page":"504-515","source":"Crossref","is-referenced-by-count":1,"title":["Peer relationships and social-affective functioning of children with critical congenital heart defects and comparison classmates"],"prefix":"10.1093","volume":"51","author":[{"given":"Olivia G","family":"Ritchey","sequence":"first","affiliation":[{"name":"Abigail Wexner Research Institute, Nationwide Children\u2019s Hospital , Columbus, OH,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amber T","family":"Riggs","sequence":"additional","affiliation":[{"name":"Abigail Wexner Research Institute, Nationwide Children\u2019s Hospital , 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