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.