Social-environmental factors and cognitive and behavioral functioning in pediatric sickle cell disease

Area of Science:

• Pediatric Hematology
• Developmental Psychology
• Social Determinants of Health

Background:

• Sickle cell disease (SCD) is an inherited blood disorder disproportionately affecting individuals of African descent.
• Social-environmental factors, including inequities like financial hardship and discrimination, negatively impact cognitive and behavioral development in youth with SCD.
• Previous research often used limited socioeconomic status (SES) measures, failing to capture the full scope of social-environmental risk.

Purpose of the Study:

• To compare the unique and shared associations of SES and modifiable social-environmental factors (parent/family functioning) with cognitive and behavioral adjustment in pediatric SCD.
• To address limitations of traditional SES measures in understanding social-environmental risk in pediatric SCD.

Main Methods:

• Seventy children (ages 4-8) with SCD and their parents participated.
• Measures of social-environmental risk, including SES and parent/family functioning, were administered.
• Exploratory factor analysis and regression analyses were used to examine predictive relationships.

Main Results:

• Parent and family functioning were largely independent of SES.
• Parent and family functioning uniquely predicted phonological processing and ADHD symptoms, independent of SES.
• The impact of social-environmental risk on social functioning and math problem-solving varied by SCD genotype severity.

Conclusions:

• Modifiable parent and family functioning factors are crucial predictors of cognitive and behavioral outcomes in pediatric SCD, beyond SES.
• These findings highlight the need for interventions targeting family dynamics to improve adjustment in youth with SCD.
• Further research should explore specific models of modifiable social-environmental risks and their differential impact based on SCD genotype.