Survival rates continue to rise for children living with once-fatal chronic pediatric health conditions. 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, Vanderbilt researchers documented how the brain is affected by leukemia, brain tumors, sickle cell disease, congenital heart disease, type 1 diabetes and traumatic brain injury in an effort to identify directions for future research and clinical care.
"What we have is a hidden epidemic," said lead investigator Bruce Compas, Patricia and Rodes Hart Professor of Psychology and Human Development at Vanderbilt'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. For the study, Compas and his colleagues measured the effects of three key factors that hinder brain function:
· 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).
Impact on IQ
The results, 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 research is shining a light on the magnitude of the problem, new interventions can be developed for before, during and after treatment.
Coping is Key
"When a child is diagnosed with a life-threatening condition, the parents' lives can go into chaos," said Compas, who also serves as professor of pediatrics and is an investigator 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, from depression to abuse to a cancer diagnosis. In longitudinal studies, he and his team have found that methods based in cognitive behavioral therapy (CBT) and computer-based cognitive remediation programs are effective in equalizing the debilitating impact of stress on the brain.
The Stress Factor
"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 said. "At the present time, we don't have solutions for all of the chronic health conditions impact learning and behavior. But as new collaborations are formed, we are making progress, and are coming up with better solutions than we could have in our individual siloes."