Executive Functioning and Transition to Adult Care among Youth with Sickle Cell Disease

Rates of mortality and morbidity increase during adulthood among those with sickle cell disease (SCD) and successful transition from pediatric to adult health care is considered a major factor in the health outcomes among this population. However, little is understood about the predictors of successful transition for these individuals. Executive functioning (EF) has been linked to successful adaptation and transition to adult care among youth with some chronic illnesses; however, the relationship between attention, EF, and successful transition to adult care among youth with SCD has received no attention. Exploratory structural equation modeling (ESEM) was used to examine the relationship between attention, EF, and transition from pediatric to adult health care in a longitudinal sample of youth with SCD. Neuropsychology tests were administered to 58 patients aged 16 - 18 years when receiving care at a mid-south Childrens Hospital. All patients also completed a structured transition to adult care program at the same hospital. Successful transition was defined as (1) time to first clinic attendance and (2) first clinic attendance within 6 months of last pediatric appointment. An exploratory factor analysis suggested that a two-factor solution was most useful, with factor loadings reflecting (1) Attention and (2) Speed. However, the two latent factors did not predict transition to adult care. A post hoc multivariate regression analysis indicated that Omission errors from the Conners Continuous Performance Test-II (CPT-II) successfully predicted attendance of the first adult health care visit within 6 months of the last pediatric health care appointment. As Omission errors scores increased, patients were less likely to attend the adult clinic within 6 months. Our findings suggest important relationships between inattention (as measured by Omission errors from the CPT-II) and transition to adult care. These findings highlight the need for further research on the role of attention dysfunction in the successful adaptation and transition to adult care among youth with SCD and other chronic illnesses. These results also support the need for effective interventions, such as computer-based interventions for inattention or stimulant medications, for youth with SCD