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Updated: Jan 11, 2026
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Academic and cerebrovascular outcomes after neurodevelopmental screening in sickle cell disease: A longitudinal
Sarah E Bills1,2, Jeffrey Schatz2, Elizabeth Gillooly2
1Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
Insights
Ages and Stages Questionnaire (ASQ) screening in preschool children with sickle cell disease (SCD) effectively predicts academic issues and stroke risk. Early screening aids in identifying children needing support for better long-term outcomes.
Area of Science:
- Pediatric Neurology
- Neurodevelopmental Disorders
- Sickle Cell Disease
Background:
- Neurodevelopmental screening is crucial for children with sickle cell disease (SCD).
- The Ages and Stages Questionnaire (ASQ) is a common screening tool.
- Predictive validity of ASQ in SCD requires further investigation.
Purpose of the Study:
- To evaluate the predictive accuracy of ASQ screening in toddlers and preschool children with SCD.
- To determine if ASQ results predict academic problems and stroke risk.
- To compare predictive validity between toddlers and preschool-aged children.
Main Methods:
- Longitudinal cohort study design.
- ASQ screening administered to 2-year-old (toddlers) and 4-year-old (preschool) children with SCD.
- Medical records reviewed for academic outcomes (e.g., grade retention) and stroke risk (e.g., abnormal transcranial Doppler) over six years.
- Biopsychosocial variables analyzed as alternative predictors.
Main Results:
- Positive ASQ screenings were observed in 30% of toddlers and 34% of preschool children.
- For toddlers, ASQ predicted academic problems (p=0.009) but not stroke risk (p=0.938).
- For preschool children, ASQ predicted both academic problems (p<0.001) and increased stroke risk (p=0.018).
- ASQ independently predicted academic outcomes, while biomedical factors predicted stroke risk.
Conclusions:
- ASQ screening effectively stratifies neurodevelopmental risks in children with SCD.
- Screening preschool-aged children is particularly important due to evolving risk factors.
- ASQ is a valuable tool for identifying children with SCD who may need early intervention for academic and health outcomes.
Aim:
To assess the predictive validity of neurodevelopmental screening in toddlers and preschool children with sickle cell disease (SCD) using the Ages and Stages Questionnaire (ASQ). We expected screening in preschool children to predict academic problems in elementary school and future stroke risk.
Method:
Using a longitudinal cohort design, academic problems (e.g. grade retention, failing a subject) and increases in stroke risk (e.g. abnormal transcranial Doppler exam) were assessed for a 6-year period after neurodevelopmental screening in 2-year-olds ('toddlers') and 4-year-olds ('preschool children') using medical record review, which included annual information from parents about school functioning. Biopsychosocial variables were examined as alternate predictors.
Results:
In total, 30% of toddlers and 34% of preschool children had positive screenings. For toddlers (n = 111), positive screenings on the ASQ predicted academic problems (p = 0.009), but not increased stroke risk (p = 0.938). For preschool children (n = 110), positive screenings predicted academic problems (p < 0.001) and increased stroke risk (p = 0.018). The ASQ independently predicted academic outcomes across cohorts; baseline biomedical factors were unique predictors of stroke across cohorts.
Interpretation:
Screening with the ASQ allows for risk stratification for neurodevelopmental outcomes in SCD. Screening in preschool children is important because of changing risk factors with age.
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