Utility of caregiver signaling questions to detect neurocognitive impairment in children with sickle cell disease

Christina M Dandar ¹, Lakia Kearson ¹, Jennifer N Longoria ¹

⁰Department of Psychology and Biobehavioral Sciences, St. Jude Children's Research Hospital, Memphis, TN.

Blood Advances +

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November 13, 2024

View abstract on PubMed

Summary

Caregiver questions can help identify neurocognitive impairment in children with sickle cell disease (SCD). A history of learning difficulties was the most effective question for detecting impairment, improving screening efforts.

Area Of Science

Neuroscience
Pediatrics
Hematology

Background

Sickle cell disease (SCD) management guidelines recommend screening for neurocognitive difficulties using signaling questions.
The clinical utility of these caregiver-reported signaling questions for identifying neurocognitive impairment in pediatric SCD patients remains under-established.

Purpose Of The Study

To assess the clinical utility of caregiver signaling questions in detecting significant neurocognitive impairment and domain-specific impairment in children and adolescents with SCD.
To evaluate the predictive value of caregiver reports, including specific signaling questions, for neurocognitive deficits.

Main Methods

A total of 421 caregivers of children (aged 8–17) with SCD completed 7 signaling questions.
Children underwent performance-based neurocognitive and academic assessments.
Statistical analyses examined the association between signaling questions, demographic/clinical factors, and neurocognitive outcomes.

Main Results

Children with a history of grade repetition, lower academic performance, or reported learning difficulties were more likely to have significant neurocognitive impairment.
A history of learning difficulties demonstrated the highest sensitivity (0.64) and specificity (0.77) for detecting significant neurocognitive impairment.
Cumulative caregiver reports enhanced the prediction of neurocognitive impairment beyond demographic and clinical variables alone.

Conclusions

While performance-based screening is optimal, caregiver signaling questions offer a brief, low-cost method to improve the detection of neurocognitive and academic impairment in pediatric SCD patients.
History of learning difficulties is a particularly effective signaling question for identifying children with SCD who may require support.