Adoption of a Multidimensional Approach to Assessing the Impact of Socioeconomic Status on Neurocognitive and Behavioral Outcomes in Pediatric Sickle Cell Disease

Broad neurocognitive deficits have been documented in children with sickle cell disease (SCD), even in the absence of stroke. These deficits pose significant consequences, as lower cognitive abilities are associated with lower academic achievement. However, there has been limited research examining the relationship between neurocognitive functioning and socioeconomic status (SES) in youth with SCD. Given that children with SCD experience socioeconomic disadvantage at higher than usual rates, SES has been posited as one explanation for the high prevalence of neurocognitive issues in SCD. In order to better understand the role of SES, we sought to evaluate the effects of multiple distinct measures of SES on neurocognitive outcomes in pediatric SCD. Fifty-nine children with sickle cell disease (SCD) ages 7-16 (M= 10.44, SD= 2.87, 42.37 % Male) enrolled in a larger study of the feasibility and efficacy of a computerized cognitive training program. As part of this study, a primary caregiver reported demographic information and rated child executive functioning difficulties on the Behavior Rating Inventory of Executive Function (BRIEF). Caregivers also reported on multiple measures of SES, including the patient’s health insurance type (i.e., public or private) and whether the participant received free-or-reduced lunch at school. Children and adolescents completed the Wechsler Intelligence Scale for Children, Fifth Edition (WISC-V). Multiple regression analyses were performed to examine the relationship between SES measures and performance-based and caregiver-reported neurocognitive and behavioral functioning. Controlling for age and gender, children having public health insurance significantly predicted lower Full Scale IQs on the WISC-V (R2 = 0.158, b = -8.609, p = 0.021) as well as impairments on the BRIEF working memory (R2 = 0.219, b = -9.556, p = 0.014) subscale. Whereas, having private health insurance significantly predicted higher Full Scale IQs (R2 = 0.187, b = 10.376, p = 0.007) and fewer problems on the BRIEF Working Memory (R2 = 0.101, b = 7.868, p = 0.046) subscale. In our study, SES significantly predicted performance-based and parent-reported neurocognitive functioning; however, each measure of SES appeared to account for a unique component of SES. Public insurance was a significant predictor of more caregiver-rated problems with working memory and executive function. Findings support the hypothesis that SES plays an important role in determining neurocognitive and behavioral outcomes. Researchers and clinicians should routinely assess SES using various measures to enhance detection of neurocognitive difficulties and assist in crafting tailored interventions to mitigate negative consequences of low SES in children with SCD