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Heitzer AM, Schreiber JE, Yuan X, Wang F, Pan H, Graff JC, Murphy L, Rupff R, Russell K, Wang W, Estepp JH, Hankins JS, Porter JS, Jacola LM. Working memory and school readiness in preschool children with sickle cell disease compared to demographically matched controls. Br J Haematol 2023; 200:358-366. [PMID: 36264030 PMCID: PMC9852012 DOI: 10.1111/bjh.18507] [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: 07/01/2022] [Revised: 09/07/2022] [Accepted: 09/28/2022] [Indexed: 01/22/2023]
Abstract
Children diagnosed with sickle cell disease (SCD) are at risk of the development of neurobehavioural problems early in life. Specific impairments in executive function skills, including working memory, have been documented in school-aged children with SCD. These executive skills are known to strongly contribute to early academic skills and preparedness for entering kindergarten. This study examined working memory and school readiness in preschool children with SCD compared to a healthy control group matched for race, sex and parent education. A total of 84 patients diagnosed with SCD (61.9% haemoglobin [Hb]SS/HbSβ0 -thalassaemia) and 168 controls completed testing. The mean (SD) ages of patients and controls at testing were 4.53 (0.38) and 4.44 (0.65) years respectively. The SCD group performed worse than controls on measures of executive function, working memory and school readiness (p < 0.01; Cohen's D range: 0.32-0.39). Measures of working memory were associated with school readiness after accounting for early adaptive development. Multiple linear regression models among patients diagnosed with SCD revealed that college education of the primary caregiver was positively associated with school readiness (p < 0.001) after controlling for sex, genotype, age and early adaptive development. These results highlight the need to implement school readiness interventions in young children diagnosed with SCD emphasising executive function skills.
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Affiliation(s)
- Andrew M. Heitzer
- Department of Psychology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Jane E. Schreiber
- Child & Adolescent Psychiatry and Behavioral Sciences, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Xiaomeng Yuan
- Department of Biostatistics, St. Jude Children’s Research Hospital, Memphis, TN
| | - Fang Wang
- Department of Biostatistics, St. Jude Children’s Research Hospital, Memphis, TN
| | - Haitao Pan
- Department of Biostatistics, St. Jude Children’s Research Hospital, Memphis, TN
| | - J. Carolyn Graff
- College of Nursing, University of Tennessee Health Science Center, Memphis, TN
| | - Laura Murphy
- Department of Psychiatry, University of Tennessee Health Science Center, Memphis, TN
| | - Rebecca Rupff
- Alabama College of Osteopathic Medicine, Dothan, AL, USA
| | - Kathryn Russell
- Department of Psychology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Winfred Wang
- Department of Hematology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Jeremie H. Estepp
- Department of Hematology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Jane S. Hankins
- Department of Hematology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Jerlym S. Porter
- Department of Psychology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Lisa M. Jacola
- Department of Psychology, St. Jude Children’s Research Hospital, Memphis, TN
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Sahu T, Pande B, Sinha M, Sinha R, Verma HK. Neurocognitive Changes in Sickle Cell Disease: A Comprehensive Review. Ann Neurosci 2022; 29:255-268. [PMID: 37064288 PMCID: PMC10101159 DOI: 10.1177/09727531221108871] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 06/02/2022] [Indexed: 11/15/2022] Open
Abstract
Background: Sickle cell disease (SCD) is a type of hemoglobinopathy characterized by abnormal hemoglobin molecules, which includes numerous acute and chronic complications. Ischemic stroke, silent cerebral infarction, headache, and neurocognitive impairment are the most common neurological complications associated with SCD. Summary: Acute anemia because of SCD can cause cognitive impairments because of cerebral hypoxia. Cognitive abnormalities in SCD manifest in various aspects such as working memory, verbal learning, executive functions, and attention. These neurocognitive impairments have been associated with poor functional results, such as transitioning from juvenile to adult care, adherence to medications, and unemployment. Key message: In this review, we focus on neurocognitive aspects of SCD patients based on different imaging techniques, psychological batteries, associated neuromarkers, and interventions for managing of cognitive deficiencies..
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Affiliation(s)
- Tarun Sahu
- Department of Physiology, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
| | - Babita Pande
- Department of Physiology, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
| | - Meenakshi Sinha
- Department of Physiology, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
| | - Ramanjan Sinha
- Department of Physiology, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
| | - Henu Kumar Verma
- Department of Immunopathology, Institute of lungs Biology and Disease, Comprehensive Pneumology Center, Helmholtz Zentrum, Neuherberg, Munich, Germany
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Heitzer AM, Cohen DL, Okhomina VI, Trpchevska A, Potter B, Longoria J, Porter JS, Estepp JH, King A, Henley M, Kang G, Hankins JS. Neurocognitive functioning in preschool children with sickle cell disease. Pediatr Blood Cancer 2022; 69:e29531. [PMID: 34971013 PMCID: PMC9207743 DOI: 10.1002/pbc.29531] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 11/12/2021] [Accepted: 11/23/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND Children with sickle cell disease (SCD) experience neurodevelopmental delays; however, there is limited research with preschool-age children. This study examined neurocognitive risk and protective factors in preschoolers with SCD. PROCEDURE Sixty-two patients with SCD (60% HbSS/HbSβ0 -thalassemia; 40% HbSC/HbSβ+ -thalassemia) between the ages of 3 and 6 years (mean = 4.77 years) received a neuropsychological evaluation as routine systematic surveillance. Patients were not selected for disease severity, prior central nervous system findings, or existing cognitive concerns. Thirty-four patients (82% HbSS/HbSβ0 -thalassemia) were prescribed hydroxyurea (HU) at the time of their neuropsychological evaluation. On average, these patients had been prescribed HU at 2.15 (standard deviation = 1.45) years of age. The average dose was 28.8 mg/kg/day. Besides genotype, there were no group differences in medical or demographic factors based on HU treatment status. RESULTS Patients with HbSS/HbSβ0 -thalassemia scored below normative expectations on measures of intelligence, verbal comprehension, and school readiness (false discovery rate-adjusted p-value [pFDR ] < .05). Age, sickle genotype, and HU treatment exposure were not associated with measured neurocognitive outcomes (pFDR > .05). Greater social vulnerability at the community level was associated with poorer performance on measures of intellectual functioning, verbal comprehension, visuomotor control, and school readiness, as well as parent report of executive dysfunction (pFDR < .05). Greater household socioeconomic status was positively associated with academic readiness. CONCLUSIONS Preschoolers with severe SCD (HbSS/HbSβ0 -thalassemia) perform below age expectations on measures of intelligence and academic readiness. Sociodemographic factors were stronger drivers of neurocognitive performance than disease severity or disease-modifying treatment. Neurodevelopmental interventions targeting the home and broader community environment are needed.
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Affiliation(s)
- Andrew M. Heitzer
- Department of Psychology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Diana L. Cohen
- Department of Psychology, St. Jude Children’s Research Hospital, Memphis, TN
| | | | - Ana Trpchevska
- Department of Psychology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Brian Potter
- Department of Psychology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Jennifer Longoria
- Department of Psychology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Jerlym S. Porter
- Department of Psychology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Jeremie H. Estepp
- Department of Hematology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Allison King
- Program in Occupational Therapy and Departments of Pediatrics and Medicine, Washington University, St. Louis, MO
| | - Misham Henley
- Department of Hematology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Guolian Kang
- Department of Biostatistics, St. Jude Children’s Research Hospital, Memphis, TN
| | - Jane S. Hankins
- Department of Hematology, St. Jude Children’s Research Hospital, Memphis, TN
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Mulchan SS, Wakefield EO, Martin SR, Ayr-Volta L, Krenicki K, Zempsky WT. Navigating Ethical Challenges for Pediatric Sickle Cell Pain Management in the Context of the Opioid Epidemic. Clin J Pain 2021; 38:88-94. [PMID: 34803155 DOI: 10.1097/ajp.0000000000001007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 11/02/2021] [Indexed: 01/19/2023]
Abstract
OBJECTIVES The aim was to describe the impact of the opioid epidemic on pain management practices in pediatric sickle cell disease (SCD) and propose a conceptual framework for navigating ethical decision-making in pediatric sickle cell pain management. METHODS A review of the literature on ethical challenges in the management of sickle cell pain was conducted and considered in the context of the opioid epidemic and psychosocial factors affecting youth with SCD. The Integrated Ethical Framework for Pain Management (IEFPM) was applied to pediatric sickle cell pain management using a clinical case example. RESULTS Implicit bias, health-related stigma, and potential neurocognitive impairment all present unique challenges in ethical decision-making for youth with SCD. National guidelines for prescribing opioid medication may complicate providers' clinical decision-making and affect their sickle cell pain management practices. The IEFPM was found to be applicable to ethical decision-making for pediatric sickle cell pain and captures both patient-related and provider-related aspects of clinical pain management. DISCUSSION The opioid epidemic has exacerbated existing ethical challenges for pain management among youth with SCD. The IEFPM provides a conceptual model that can be integrated into health care settings to facilitate ethical decision-making and promote greater health equity in the clinical management of pediatric sickle cell pain.
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Affiliation(s)
- Siddika S Mulchan
- Connecticut Children's, Hartford
- Department of Pediatrics, University of Connecticut School of Medicine, Farmington, CT
| | - Emily O Wakefield
- Connecticut Children's, Hartford
- Department of Pediatrics, University of Connecticut School of Medicine, Farmington, CT
| | - Sarah R Martin
- Department of Anesthesiology & Perioperative Care, University of California, Irvine School of Medicine, Orange, CA
| | - Lauren Ayr-Volta
- Connecticut Children's, Hartford
- Department of Pediatrics, University of Connecticut School of Medicine, Farmington, CT
| | - Kayla Krenicki
- Department of Psychology, Southern Connecticut State University, New Haven, CT
| | - William T Zempsky
- Connecticut Children's, Hartford
- Department of Pediatrics, University of Connecticut School of Medicine, Farmington, CT
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Knight LM, King AA, Strouse JJ, Tanabe P. Pediatric Neurodevelopmental Delays in Children 0 to 5 Years of Age With Sickle Cell Disease: A Systematic Literature Review. J Pediatr Hematol Oncol 2021; 43:104-111. [PMID: 33560086 PMCID: PMC8254873 DOI: 10.1097/mph.0000000000002091] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 12/28/2020] [Indexed: 12/28/2022]
Abstract
INTRODUCTION Sickle cell disease (SCD) is the most common abnormal genetic blood disease that affects ∼100,000 Americans. Approximately 20% to 37% of children with sickle cell anemia have silent cerebral infarcts by the age of 14 years old. Neurocognitive deficits are identified in infants and preschool children with SCD. The purpose of this systematic literature review is to provide a comprehensive understanding of the prevalence, severity, and the associated risk factors for neurodevelopmental delays (NDDs) in children with SCD 5 years of age and younger. METHODS Systematic search of 6 databases identified 2467 potentially relevant publications and 8 were identified through a manual search. Only 24 articles met the inclusion criteria. RESULTS We identified an increased prevalence of NDDs (cognitive, motor, or both). Children experienced deficits with language, attention and behavior, executive functioning, school readiness and/or academic performance, and motor skills (fine and gross motor functioning). Risk factors include silent cerebral infarcts and strokes, SCD genotype (HbSS>HbSC), other biologic, and social factors. CONCLUSION NDDs are common in children ages 0 to 5 years old with SCD. There is an opportunity to improve adherence to national guideline recommendations and early detection practices by pediatricians, hematologists, and other health care providers.
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Downes M, Keenan L, Duane Y, Duffy K, Fortune G, Geoghegan R, Conroy H, McMahon C. Executive function in children with sickle cell anemia on transfusion: NIH toolbox utility in the clinical context. Clin Neuropsychol 2020; 36:1573-1588. [PMID: 33200651 DOI: 10.1080/13854046.2020.1847325] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The aim of this study was to establish the utility of the NIH Toolbox as a cognitive screener of executive functions in the clinical context. Additionally, we aimed to investigate whether age and time on transfusion were related to executive function performance. Method: Twenty-eight children and adolescents with sickle cell anemia (SCA) between 8 and 18 years (M = 13.28, SD = 3.05) on transfusion treatment were included. Participants completed five NIH Toolbox tasks (three executive function tasks and two non-executive function control tasks). Results: Mean scores on one of the three executive function measures (inhibitory control) fell below the average range (M = 81.36, SD = 14.01) with approximately 70% of children from both groups below the average range. Scores for processing speed (M = 86.82, SD = 22.01) and cognitive flexibility (M = 85.75, SD = 12.67) were low averages. As expected, scores on non-executive measures (language and memory) fell within the average range. No significant differences were observed between children with silent stroke and no stroke on executive function measures. Older age (p < .01) and length of time on transfusion (p < .05) predicted lower inhibitory control scores. Conclusions: Findings provide evidence for poor development of inhibitory control with age in this patient population. As the NIH Toolbox successfully highlighted expected deficits in this patient population, this study supports the use of this tool as a brief screening measure for children with SCD. The clinical and theoretical implications of the findings are discussed.
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Affiliation(s)
- M Downes
- School of Psychology, University College Dublin, Dublin, Ireland
| | - L Keenan
- School of Psychology, University College Dublin, Dublin, Ireland
| | - Y Duane
- Children's Health Ireland at Crumlin, Dublin, Ireland
| | - K Duffy
- School of Psychology, University College Dublin, Dublin, Ireland.,Children's Health Ireland at Crumlin, Dublin, Ireland
| | - G Fortune
- Children's Health Ireland at Crumlin, Dublin, Ireland
| | - R Geoghegan
- Children's Health Ireland at Crumlin, Dublin, Ireland
| | - H Conroy
- Children's Health Ireland at Crumlin, Dublin, Ireland
| | - C McMahon
- Children's Health Ireland at Crumlin, Dublin, Ireland
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Jensen CD, Jacola LM, Schatz J. Introduction to the Special Issue on Neural Processes and Pediatric Health: Creating a Pediatric Health Neuroscience Research Agenda. J Pediatr Psychol 2018; 43:815-820. [PMID: 30007324 DOI: 10.1093/jpepsy/jsy045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 06/05/2018] [Indexed: 11/14/2022] Open
Affiliation(s)
| | - Lisa M Jacola
- Department of Psychology, St. Jude Children's Research Hospital, and
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Downes M, Kirkham FJ, Berg C, Telfer P, de Haan M. Executive performance on the preschool executive task assessment in children with sickle cell anemia and matched controls. Child Neuropsychol 2018; 25:278-285. [PMID: 29954249 DOI: 10.1080/09297049.2018.1491962] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Executive deficits are commonly reported in children with sickle cell anemia. Earlier identification of executive deficits would give more scope for intervention, but this cognitive domain has not been routinely investigated due to a lack of age-appropriate tasks normed for preschool children. In particular, information relating to patient performance on an executive task that reflects an everyday activity in the classroom could provide important insight and practical recommendations for the classroom teacher at this key developmental juncture as they enter the academic domain. The performance of 22 children with sickle cell anemia was compared to 24 matched control children on the Preschool Executive Task Assessment. Findings reveal that children with sickle cell anemia are performing poorer than their matched peers on this multi-step assessment. In particular, children with sickle cell anemia required more structured support to shift focus after a completed step, as reflected by poorer scores in the quantitative Sequencing and Completion domains. They also required more support to stay on task, as seen by poorer ratings in the qualitative Distractibility domain. Abbreviations:PETA: Preschool Executive Task Assessment; SCA: Sickle Cell Anemia; EF: Executive Functioning.
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Affiliation(s)
- Michelle Downes
- a School of Psychology , University College Dublin , Dublin , Ireland.,b Developmental Neurosciences , UCL Great Ormond Street Institute of Child Health , London , UK
| | - Fenella J Kirkham
- b Developmental Neurosciences , UCL Great Ormond Street Institute of Child Health , London , UK
| | - Christine Berg
- c School of Medicine , Washington University in St. Louis , MO , USA
| | - Paul Telfer
- d Barts Health NHS Trust , Royal London Hospital , London , UK
| | - Michelle de Haan
- b Developmental Neurosciences , UCL Great Ormond Street Institute of Child Health , London , UK
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