Children with sickle cell disease (SCD) experience significant problems in neurocognitive development, including deficits in overall intellectual functioning and in specific areas such as attention and executive function. A number of disease-related factors have been shown to be predictive of the extent of neurocognitive problems including sickle cell genotype, history of overt stroke/cerebral infarct, history of silent infarct/micro infarcts, chronic hypoxia due to anemia, acute hypoxia, nutritional deficits, increased peak cerebral blood flow velocity, and sleep disordered breathing/sleep apnea. However, social-environmental risk factors that may contribute additional risk for neurocognitive problems in children with SCD have received relatively little attention. The lone exceptions are two studies that have shown that low family socioeconomic status (SES) is related to poorer neurocognitive function in children with SCD. A growing body of research on children growing up in poverty has shown that environmental stress is a significant risk factor for cognitive impairment in children growing up poor and that disrupted/non-responsive parenting is a central mediator of the effects of poverty and stress on children's cognitive function and development. However, no studies to date have examined the potential role of parenting as a contributing factor in neurocognitive impairment in children with SCD. The goal of the proposed research is to test the feasibility, acceptability and initial proof of concept of social-environmental predictrs of cognitive function in children with SCD. We will (a) recruit a wide age range of children with SCD and their parents;(b) recruit a sibling control sample;(c) recruit a sample of healthy contro children from families without chronic illness;(d) administer cognitive tests to children with SCD their parents, and their siblings, as well as healthy control children and their parents;and (e) conduct direct observations of interactions of parents with children with SCD and interactions of parents with sibling controls and healthy controls and their parents.
This project examines biological and social-environmental predictors of cognitive impairment in children with SCD. This work will set the stage for later work to test interventions to reduce risk for adverse outcomes in this population. PUBLIC HEALTH RELEVANCE: This study will examine factors that are associated with increased risk for neurocognitive problems in children with sickle cell disease. Disease-related factors, such as history of stroke and anemia, will be examined along with the role of stress and parenting behaviors in children's cognitive development. Findings may be useful in developing ways to help parents of children with sickle cell disease to support stronger cognitive development in their children.