Neurocognitive and Academic Outcomes for Children With Sickle Cell Disease After Changes in Academic Instruction...

Sickle cell disease (SCD) is a monogenic blood disorder that places individuals at risk for poorer/lower neurocognitive function. In this population, the impact of changes in academic instruction related to the COVID-19 pandemic is unknown. We examined whether children who were assessed before schools closed showed higher academic and neurocognitive performance than did children who were assessed after schools reopened. Secondarily, we sought to evaluate whether these associations were moderated by age or socioeconomic status.

This retrospective study included 488 children with SCD (ages 7-18 years) who participated in a clinical cognitive surveillance program. Children assessed before school closures (March 1, 2020) and after re-openings (January 1, 2021) during the COVID-19 pandemic were matched on the following variables: age, sex, genotype, hydroxyurea treatment history, socioeconomic status, fetal hemoglobin, and oxygen saturation using propensity scores.

Children assessed before school closures displayed higher scores on measures of visuomotor integration (q = 0.006, estimate = -4.20), processing speed (q = 0.004, estimate = -0.96), math fluency (q = 0.05, estimate = -3.50), and basic reading (q = 0.006, estimate = -5.70) after controlling for confounding factors. These effects were moderated by age, such that the difference in outcomes between the groups was larger for younger patients.

Changes in academic instruction during the COVID-19 pandemic were associated with decreased neurocognitive and academic outcomes for children with SCD. The negative effect observed in this population is greater than that observed in the general population, suggesting that these students were particularly susceptible to learning loss.