Conclusions
Results of this study suggest that a high proportion of children with SCD experience neurocognitive and academic difficulties. On cognitive testing, 59% of participants had one or more subtest scores fall at least one SD below age-based means; while on academic testing 52.5% of participants had at least one subtest score fall one SDor more below grade-based means. A concerning trend demonstrated lower academic mean scores by older age cohorts. Correlational analysis suggests that at least a portion of this academic difficulty is associated with missed school, suggesting that the increase in SCD symptomology over time42, combined with the cumulative impact of missed school, leads to a negative cycle of academic underachievement in children with SCD. Results of testing suggested a subset of patients with attention (25%) and executive functioning concerns (18%) and a similar range of patients (20-31%) with parent-reported concerns related to executive functioning. Difficulties on a subtest of attention were associated with lower cognitive scores, while difficulties on a subtest of executive functioning were associated with lower cognitive and academic scores.
In contrast to most previously published findings neither cognitive mean scores, academic mean scores, nor attention were associated with disease severity, hemoglobin, or TCD results in this sample. There was a correlation identified between mean cognitive scores and MCV, but MCV was not related to academic scores. It is possible that prior efforts in our program to identify and treat those are high medical risk of neurocognitive difficulties has served to mitigate this relationship. Cognitive mean scores were associated with SES as measured by
the ADI, but academic mean scores were not associated with SES. This finding could suggest that academic scores are more impacted by racial disparities, which are high in our region and can make it challenging for families to secure and maintain quality education, than by socioeconomic factors specifically, in line with prior research43,44.