Enhanced Parenting Skills May Help Improve Cognitive Function in SCD Children, Study Suggests

Enhanced Parenting Skills May Help Improve Cognitive Function in SCD Children, Study Suggests

Enhanced parenting skills, including attentive listening and engaging in conversations, may help improve cognitive functioning in children with sickle cell disease (SCD), a study suggests.

Parent stress was related to lower parenting responsiveness, which also may lead to lower cognitive function in children, the researchers said.

The study, “Responsive Parenting Behaviors and Cognitive Function in Children With Sickle Cell Disease,” was published in the Journal of Pediatric Psychology.

It is well-described that, compared with healthy children, those with SCD experience deficits in cognition, including worse overall intellectual function, lower executive function — meaning poorer behavior and emotion control — and lesser school achievements.

While SCD is associated with brain tissue death (infarcts) and insufficient oxygen supply to the brain — which are directly linked to a decrease in cognition — researchers questioned whether children’s social environments also could play a role.

To address this, a team from Vanderbilt University studied the impact of parents’ behavior, also accounting for their social-economic and stress levels, on the cognitive performance of young SCD patients.

In total, they collected data from 48 children, ages 6 to 16, together with their respective caregivers. The 48 children — 56.8% boys — had been diagnosed with four subtypes of SCD, the majority with sickle cell anemia (HbSS, 70.8%).

To assess parenting behavior, the researchers developed a 10-minute task in which caregiver and child would together complete a series of 15-piece puzzles with increasing difficulty. This interaction was recorded by video to allow the team to evaluate how parent and child communicated to solve a problem together.

To quantify the behavior, the researchers used the Iowa Family Interaction Rating Scales (IFIRS), which measures verbal and non-verbal behaviors and emotions at a macro level. The IFIRS scores range from 1 to 9, in which a 1 reflects the absence of the behavior or emotion and a 9 indicates that the behavior or emotion is the main feature of the parent.

The children’s cognition was assessed using three measures: an IQ test called Full scale IQ or FSIQ; a working memory test known as the Working Memory Index or WMI; and a reading performance test — the Wide Range Achievement Test, Fourth Edition or WRAT4. The results of all three tests were significantly below the means estimated as the norm.

To evaluate stress levels on caregivers, the team used the Pediatric Inventory for Parents questionnaire and the 8-item Medical Care Difficulty scale.

Results suggest that there is a certain association between parents’ stress and their socioeconomic situation. However, their stress had no correlation with children’s disease severity.

The FSIQ and WMI cognition tests showed there was no significant correlation between the children’s functioning and the parents’ stress levels. But parent stress was found to significantly affect the children’s reading performance.

Children’s IQ, working memory, and reading were affected negatively when parents made less use of expansions — reflecting and building on what the child says. The researchers said one example of the use of expansions is when a child says “This way,” and the parent replies  “You want to turn it this way?”

Moreover, further analysis showed a signification correlation between socioeconomic status, disease risk factors, and stress. These were predictors of children’s working memory and reading performance.

“The elevated levels of stress experienced by parents of children with SCD are related to lower levels of responsive parenting that in turn, is related to more deficits in cognitive function,” the researchers said.

Overall, the findings suggest that cognitively stimulating parenting is a key factor in promoting cognitive development in this group of children, who are at risk due to their medical disorder.

“In summary, the findings from the present study highlight the potential impact of parent functioning on cognitive development in pediatric SCD” the researchers said.

These results “highlight the need to develop targeted interventions for parents of children with SCD to decrease levels of stress and enhance parenting skills, including attentive listening … with the aim [of] improving cognitive functioning in youth” with sickle cell disease, the study concluded.

Patricia holds her Ph.D. in Cell Biology from University Nova de Lisboa, and has served as an author on several research projects and fellowships, as well as major grant applications for European Agencies. She also served as a PhD student research assistant in the Laboratory of Doctor David A. Fidock, Department of Microbiology & Immunology, Columbia University, New York.
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Margarida graduated with a BS in Health Sciences from the University of Lisbon and a MSc in Biotechnology from Instituto Superior Técnico (IST-UL). She worked as a molecular biologist research associate at a Cambridge UK-based biotech company that discovers and develops therapeutic, fully human monoclonal antibodies.
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Patricia holds her Ph.D. in Cell Biology from University Nova de Lisboa, and has served as an author on several research projects and fellowships, as well as major grant applications for European Agencies. She also served as a PhD student research assistant in the Laboratory of Doctor David A. Fidock, Department of Microbiology & Immunology, Columbia University, New York.

One comment

  1. Rae Blaylark says:

    Thank you for your commitment to sharing sickle cell news from across the globe. It is trusted news sources like yours that keep both the medical and patient communities better-informed.

    With all due respect, I would like to once again suggest that further thought be given to the use of “ethnically white/European” graphics when connected to stories about sickle cell disease and it’s impact upon patients. While we certainly know that sickle cell disease is not a “black” disease, as it is often portrayed, it remains imperative that we remain thoughtful in the visual representation of this community.

    While the JPP article is relevant and makes several excellent points, it is my humble suggestion that the editor review with great sensitivity how the SCD community may perceive and be perceived in the way that this data is presented. While the last paragraph of this article provides a somewhat decent summation of the results, here lies an opportunity to thoughtfully present the data in such a way that families impacted by SCD do not feel that they or their children are perceived as “less than” simply because of parenting style, parenting skills or socioeconomic factors that are outside of their control.

    While I understand that these are delicate matters, it is my intent to offer both support and encouragement of on-going efforts to educate both the healthcare community as well as the patient community, we must not forget the fact that people of African ancestry have a long and painful history of racial bias and mistreatment in these spaces and using white families in articles such as this, continue to promote unconscious bias toward a white-centered model of healthcare and parenting.

    In my roles as both the founder and executive director of a sickle cell community-based organization as well as the Sickle Cell Patient Family Health Advocate at our local children’s hospital, I frequently share scholarly articles and websites such as yours with patients and families as trusted news sources. Sadly, I am unable to share this particular story because of the concerns mentioned above.

    Despite my on-going concerns, thank you again for all that you do and I look forward to continuing to like, share, and support your work as a trusted news source in the future.

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