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.