Very ill children live longer, but struggle to learn

Children who have once-fatal conditions are living longer but at a cost: many deal with long-term brain deficits. "What we have is a hidden epidemic."

Children living with several once-fatal chronic pediatric health conditions are living longer, but their survival comes at a cost: many experience long-term neurocognitive deficits.

In a first-of-its-kind review of meta-analytic results across conditions, researchers documented how the brain is affected by six conditions in an effort to identify directions for future research and clinical care. They are:

  • leukemia
  • brain tumors
  • sickle cell disease
  • congenital heart disease
  • type 1 diabetes
  • traumatic brain injury

“What we have is a hidden epidemic,” says lead investigator Bruce Compas, professor of psychology and human development at Vanderbilt University’s Peabody College.

“For the four million children with these conditions, the functioning of the prefrontal cortex is disrupted significantly, affecting learning, memory, and decision-making. We found that an alarming number are performing academically below 80 percent of their peers, and have lost three to 12 IQ points.”

During their medical journey, children may face multiple short- and long-term disruptions to the functioning of their prefrontal cortex, which impact their learning and behavior, sometimes for life.

Researchers measured the effects of the chronic health condition itself, the treatments for the condition (such as surgery, medications, chemotherapy, and radiation therapy), and the prolonged stress associated with having a chronic health condition (which can be compounded for children who are also growing up in poverty).

The findings, published in American Psychologist, confirm a troubling trend. Pediatric brain tumor survivors placed academically below 80 percent of their peers, with a loss of 12 IQ points. Survivors of severe traumatic brain injury, as well as acute lymphocytic leukemia and certain types of congenital heart disease, also were found to have large neurocognitive side effects, including impact on full-scale IQ.

Children with sickle cell disease experienced medium to large impact on brain function, while those with type-1 diabetes experienced small but significant deficits.

Now that the findings have shed a light on the magnitude of the problem, new interventions can be developed for before, during, and after treatment, researchers say.

“When a child is diagnosed with a life-threatening condition, the parents’ lives can go into chaos,” says Compas, who is also a professor of pediatrics at the Vanderbilt Kennedy Center. “They are only focused on if their child is going to survive.

“In our work, we often meet with families within hours of the diagnosis. We evaluate the child’s cognitive ability and work with the surgical and medical teams to come up with treatment and interventions that offer the best cognitive outcome. It’s a remarkable partnership.”

Compas directs a team of researchers at the Vanderbilt Stress and Coping Research Lab who work with children and families struggling with a broad range of difficulties that can interfere with cognitive function, including depression, abuse, and cancer.

Longitudinal studies show that methods based in cognitive behavioral therapy and computer-based cognitive remediation programs are effective in equalizing the debilitating impact of stress on the brain.

“Stress is the common thread among all of the conditions we study, and stress piles on to the neurocognitive deficits children are already experiencing,” Compas says.

The National Science Foundation supported the work.

Source: Vanderbilt University

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