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Longoria JN, Schreiber JE, Potter B, Raches D, MacArthur E, Cohen D, Brazley-Rodgers M, Hankins JS, Heitzer AM. A clinical evaluation program to monitor neurocognitive risk in children and adolescents with sickle cell disease. Clin Neuropsychol 2024:1-21. [PMID: 39233356 DOI: 10.1080/13854046.2024.2399861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Accepted: 08/29/2024] [Indexed: 09/06/2024]
Abstract
Objective: Sickle cell disease (SCD) is an inherited hematologic disorder that impacts approximately 100,000 Americans. This disease is associated with progressive organ damage, cerebral vascular accident, and neurocognitive deficits. Recent guidelines from the American Society of Hematology (ASH) recommend cognitive screening with a psychologist to help manage cerebrovascular risk and cognitive impairment in this population. SCD patients benefit from neuropsychology services and several institutions already have programs in place to monitor cognitive risk. Program Description: We describe a longitudinal neurocognitive evaluation program at our institution that serves all patients with SCD, regardless of disease severity or referral question. The Sickle Cell Assessment of Neurocognitive Skills (SCANS) program was established in 2012. We outline the program's theoretical framework, timepoints for evaluation, test battery, logistics, patient demographics, integration with research programming, and multidisciplinary collaboration to support optimal outcomes. Program Outcomes: Our program has provided 716 targeted neuropsychological evaluations for patients over the last decade. Nearly 26% of patients in the program have been followed longitudinally. The most common diagnoses generated across cross-sectional and longitudinal evaluations include cognitive disorder (n = 191), attention-deficit/hyperactivity disorder (n = 75), and specific learning disorder (n = 75). Approximately 87% of patients who participated in SCANS during late adolescence successfully transitioned from pediatric to adult care. Conclusion: We discuss considerations for developing programming to meet the needs of this population, including tiered assessment models, timing of evaluations, scope, and reimbursement. Program models that utilize prevention-based tiered models or targeted evaluations can assist with serving large volumes of patients.
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Affiliation(s)
- Jennifer N Longoria
- Department of Psychology and Biobehavioral Sciences, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Jane E Schreiber
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Brian Potter
- Department of Psychology and Biobehavioral Sciences, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Darcy Raches
- Department of Psychology and Biobehavioral Sciences, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Erin MacArthur
- Department of Psychology and Biobehavioral Sciences, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Diana Cohen
- Department of Psychology and Neuropsychology, Children's Hospital of Orange County, Orange, CA, USA
| | | | - Jane S Hankins
- Global Pediatric Medicine and Hematology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Andrew M Heitzer
- Department of Psychology and Biobehavioral Sciences, St. Jude Children's Research Hospital, Memphis, TN, USA
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Heitzer AM, MacArthur E, Tamboli M, Wilson A, Hankins JS, Hoyt CR. Awareness, access, and communication: provider perspectives on early intervention services for children with sickle cell disease. Front Pediatr 2024; 12:1366522. [PMID: 38590772 PMCID: PMC11000123 DOI: 10.3389/fped.2024.1366522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Accepted: 03/13/2024] [Indexed: 04/10/2024] Open
Abstract
Purpose This study aimed to identify determinants influencing the utilization of early intervention services among young children with sickle cell disease (SCD) based on perspectives from medical and early intervention providers. Design and methods Early intervention and medical providers from the catchment area surrounding St. Jude Children's Research Hospital and Washington University were recruited (20 total providers). Interviews were completed over the phone and audio recorded. All interviews were transcribed verbatim, coded, and analyzed using inductive thematic analysis. Results Three overarching themes were identified from both groups: Awareness (e.g., lack of awareness about the EI system and SCD), Access (e.g., difficulties accessing services), and Communication (e.g., limited communication between medical and early intervention providers, and between providers and families). Although these three themes were shared by medical and early intervention providers, the differing perspectives of each produced subthemes unique to the two professional fields. Conclusions Early intervention services can limit the neurodevelopmental deficits experienced by young children with SCD; however, most children with SCD do not receive these services. The perspectives of early intervention and medical providers highlight several potential solutions to increase early intervention utilization among young children with SCD.
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Affiliation(s)
- Andrew M. Heitzer
- Department of Psychology and Biobehavioral Sciences, St. Jude Children’s Research Hospital, Memphis, TN, United States
| | - Erin MacArthur
- Department of Psychology and Biobehavioral Sciences, St. Jude Children’s Research Hospital, Memphis, TN, United States
| | - Mollie Tamboli
- Department of Psychology and Biobehavioral Sciences, St. Jude Children’s Research Hospital, Memphis, TN, United States
| | - Ashley Wilson
- Program in Occupational Therapy, Washington University in St. Louis, St. Louis, MO, United States
| | - Jane S. Hankins
- Department of Global Pediatric Medicine, St. Jude Children’s Research Hospital, Memphis, TN, United States
- Department of Hematology, St. Jude Children’s Research Hospital, Memphis, TN, United States
| | - Catherine R. Hoyt
- Program in Occupational Therapy, Departments of Neurology and Pediatrics, Washington University in St. Louis, St. Louis, MO, United States
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Hoyt CR, Heitzer AM, Hardy SJ. Commentary on the ASH 2020 guidelines on cognitive screening and intervention in sickle cell disease. Blood Adv 2023; 7:3680-3682. [PMID: 37058485 PMCID: PMC10365932 DOI: 10.1182/bloodadvances.2023009851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 04/13/2023] [Accepted: 04/13/2023] [Indexed: 04/15/2023] Open
Affiliation(s)
- Catherine R. Hoyt
- Program in Occupational Therapy, Departments of Pediatrics and Neurology, Washington University School of Medicine, St. Louis, MO
| | - Andrew M. Heitzer
- Department of Psychology, St Jude Children’s Research Hospital, Memphis, TN
| | - Steven J. Hardy
- Divisions of Hematology and Oncology, Children’s National Hospital, Washington, DC
- Departments of Pediatrics and Psychiatry & Behavioral Sciences, George Washington University School of Medicine & Health Sciences, Washington, DC
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Heitzer AM, Longoria J, Porter JS, MacArthur E, Potter B, Ding J, Gossett J, Kang G, Hankins JS. Internalizing Symptoms in Adolescents With Sickle Cell Disease. J Pediatr Psychol 2023; 48:91-103. [PMID: 35980301 PMCID: PMC10120839 DOI: 10.1093/jpepsy/jsac068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 07/26/2022] [Accepted: 08/01/2022] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVE Sickle cell disease (SCD) is a genetic blood disorder that may affect patients' mood and behavior. However, measuring the prevalence of internalizing symptoms (anxiety and depression) in patients with SCD has been elusive. We assessed internalizing symptoms in adolescents with SCD to evaluate prevalence and to test whether neurocognitive performance and frequency of pain-related episodes were associated with internalizing concerns. METHODS One hundred eighty-five patients (57% HbSS/HbSß0-thalassemia, 43% HbSC/HbSß+-thalassemia), ages 12-18 years, received a neuropsychological evaluation as a part of a larger cohort study. Internalizing symptoms were measured using the Behavior Assessment System for Children, Second or Third Edition. Scores on the depression and anxiety scales were compared to normative values using Wilcoxon signed rank test. Spearman correlations examined associations between neurocognitive performances and internalizing symptoms. Robust multivariable regression models measured associations between internalizing symptoms and age, sex, sickle genotype, total hemoglobin, fetal hemoglobin, socioeconomic status, and frequency of pain episodes. RESULTS Parent- and self-reported ratings of internalizing symptoms were not elevated compared to normative expectations. Overall, 1.8% and 6.3% of the sample displayed clinically elevated symptoms of anxiety and depression based on self-report, respectively. There were no associations between internalizing symptoms and neurocognitive performance (all p > .05). In multivariable analyses, the frequency of pain episodes was positively associated with self-reported anxiety (p = .006) and parent-reported depressive symptoms (p = .017). CONCLUSIONS Adolescents with SCD do not report elevated internalizing symptoms compared to normative expectations. Further research is needed to examine the trajectory of internalizing symptoms and the bidirectional relationship between pain and psychosocial functioning in SCD.
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Affiliation(s)
- Andrew M Heitzer
- Department of Psychology, St. Jude Children’s Research Hospital, USA
| | - Jennifer Longoria
- Department of Psychology, St. Jude Children’s Research Hospital, USA
| | - Jerlym S Porter
- Department of Psychology, St. Jude Children’s Research Hospital, USA
| | - Erin MacArthur
- Department of Psychology, St. Jude Children’s Research Hospital, USA
| | - Brian Potter
- Department of Psychology, St. Jude Children’s Research Hospital, USA
| | - Juan Ding
- Department of Biostatistics, St. Jude Children’s Research Hospital, USA
| | - Jeffrey Gossett
- Department of Biostatistics, St. Jude Children’s Research Hospital, USA
| | - Guolian Kang
- Department of Biostatistics, St. Jude Children’s Research Hospital, USA
| | - Jane S Hankins
- Department of Hematology, St. Jude Children’s Research Hospital, USA
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Howell KE, Heitzer AM, Longoria JN, Potter B, Wang WC, Anderson S, Kang G, Hankins JS, Porter JS. Assessment of transition readiness to predict health care utilization during transition to adult care in sickle cell disease. Expert Rev Hematol 2022; 15:1063-1072. [PMID: 36356169 PMCID: PMC9809157 DOI: 10.1080/17474086.2022.2144216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 10/31/2022] [Indexed: 11/12/2022]
Abstract
BACKGROUND Transition-age patients with sickle cell disease (SCD) are at risk for poor outcomes associated with incomplete transition readiness and neurocognitive deficits. Study objectives were to: 1) test if a SCD-specific measure of self-management skills was associated with transition outcomes and 2) evaluate if caregiver-reported executive functioning was associated with self-management skills and transition outcomes among youth with SCD. RESEARCH DESIGN AND METHODS Youth/caregivers were selected from a longitudinal cohort study. Caregivers completed the Behavior Rating Inventory of Executive Function (BRIEF); caregivers and youth completed the Self-Management Skills Checklist (SMSC) at a median age of 16.8 ± 0.6 years. Non-parametric tests compared SMSC and transition outcomes. Regression assessed the incremental validity of SMSC in predicting transition outcomes. RESULTS In total, 95 participants (54% male, 55% severe genotype) completed the SMSC assessment. Most participants (87%) transferred to adult care within six months and 87% were retained for at least 12 months. BRIEF and caregiver-reported SMSC assessments were weakly, negatively correlated (ρ = -0.25, p = 0.0392) but were not significant in predicting transition outcomes (p > 0.05). CONCLUSIONS The SMSC and executive function did not predict adult care engagement. Development of readiness assessments that predict care engagement and reflect self-efficacy is important for monitoring transition-aged patients with SCD.
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Affiliation(s)
| | | | | | - Brian Potter
- Department of Psychology, St. Jude Children’s Research Hospital
| | - Winfred C. Wang
- Department of Hematology, St. Jude Children’s Research Hospital
| | - Sheila Anderson
- Department of Hematology, St. Jude Children’s Research Hospital
| | - Guolian Kang
- Department of Biostatistics, St. Jude Children’s Research Hospital
| | - Jane S. Hankins
- Department of Hematology, St. Jude Children’s Research Hospital
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Hayat A, Chaudhry HUR, Ahmad A. Comment on: Effects of hydroxyurea on brain function in children with sickle cell anemia. Pediatr Blood Cancer 2022; 69:e29624. [PMID: 35471593 DOI: 10.1002/pbc.29624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 02/09/2022] [Indexed: 11/06/2022]
Affiliation(s)
- Ahmad Hayat
- Punjab Medical College, Faisalabad, Pakistan
| | | | - Anees Ahmad
- Punjab Medical College, Faisalabad, Pakistan
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Hardy SJ, Forman S, Hardy KK, Schatz J. Sluggish Cognitive Tempo in Pediatric Sickle Cell Disease. Front Neurol 2022; 13:867437. [PMID: 35873765 PMCID: PMC9301245 DOI: 10.3389/fneur.2022.867437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 06/13/2022] [Indexed: 11/21/2022] Open
Abstract
Background Sickle cell disease (SCD) imparts risk for a range of neurodevelopmental and neurocognitive disorders. Sluggish cognitive tempo (SCT) is a distinct syndrome that often co-occurs with attention-deficit/hyperactivity disorder (ADHD) but has not been described in SCD. We investigated the reliability and validity of a SCT measure in SCD and examined associations with biopsychosocial risk factors and functional outcomes. Materials and Methods Caregivers (n = 85) of children with SCD ages 7-16 reported on socio-demographics and the Kiddie-Sluggish Cognitive Tempo (K-SCT) measure, Behavior Rating Inventory of Executive Function, and Conners 3. Disease-related characteristics were extracted from health records. Results The K-SCT demonstrated excellent internal consistency (α = 0.92) and test-retest reliability (r = 0.82, p < 0.001). K-SCT scores were correlated with ADHD-Inattention (r = 0.64, p < 0.001) and ADHD-Hyperactive/Impulsive (r = 0.46, p < 0.001) scores, as well as functional outcomes, including learning problems (r = 0.69, p < 0.001). In multivariate analyses controlling for ADHD symptoms, SCT accounted for unique variance in learning (b = 9.67, p < 0.01) and executive functioning (b = 5.93, p < 0.01). Nearly all participants (93%) with elevated levels of co-occurring SCT and ADHD-Inattention symptoms had significant learning problems. Conclusion The K-SCT is a reliable and valid measure of SCT in SCD. SCT symptoms are associated with learning difficulties even after controlling for ADHD symptoms. Further research is needed to understand the biopsychosocial factors that lead to SCT symptoms in SCD and examine long-term implications of SCT.
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Affiliation(s)
- Steven J. Hardy
- Divisions of Hematology and Oncology, Children's National Hospital, Washington, DC, United States
- Department of Psychiatry and Behavioral Sciences, The George Washington University School of Medicine and Health Sciences, Washington, DC, United States
- *Correspondence: Steven J. Hardy
| | - Sydney Forman
- Divisions of Hematology and Oncology, Children's National Hospital, Washington, DC, United States
| | - Kristina K. Hardy
- Department of Psychiatry and Behavioral Sciences, The George Washington University School of Medicine and Health Sciences, Washington, DC, United States
- Division of Neuropsychology, Children's National Hospital, Washington, DC, United States
| | - Jeffrey Schatz
- Department of Psychology, University of South Carolina, Columbia, SC, United States
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