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Neuropsychological Aspects of Pediatric Sickle Cell Disease
Abstract
Sickle cell disease (SCD), a class of genetic disorders characterized by abnormal, sickled red blood cells, is a chronic illness that results in progressive cerebrovascular disease. Neurocognitive sequelae of clinically apparent cerebrovascular accidents in children with SCD are characterized by pervasive impairments, including decrements in general intellectual functioning, language and verbal abilities, visual-motor and visual-spatial processing, memory, academic achievement, and processing of subtle prosodic information. In contrast, subtle neurocognitive deficits in the areas of attention and concentration, executive function, and visual-motor speed and coordination appear to be associated with silent infarcts that are not necessarily detected on physical examination. Investigation of the disease course and associated neurocognitive sequelae suggest a disease-specific model of neuropsychological impairment. Recommendations are made for clinical and research efforts in the field of pediatric neuropsychology.
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The literature links memory deficits and diverse pediatric conditions.
“the abundant literature linking memory deficits and diverse pediatric conditions (e.g., traumatic brain injury, Woodward & Donders, 1998;Yeates, Blumenstein, Patterson, & Dellis, 1995; sickle cell disease, Kral, Brown, & Hynd, 2001;epilepsy, Cohen, 1992;Seidenberg et al., 1997;acute lymphoblastic leukemia, Waber & Mullenix, 2000).”
From Validation of a Developmental Neuropsychological Assessment (NEPSY) through comparison of neurological, scholastic concerns, and control groups (2004) · cites this paper as Kral, Brown, & Hynd, 2001
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Smith, K. E., Patterson, C. A., Szabo, M. M., Tarazi, R. A., & Barakat, L. P. (2013) · Advances in School Mental Health Promotion · doi:10.1080/1754730x.2012.760919 · Cited by 47
Boivin, M. J., & Giordani, B. (2009) · Progress in brain research · doi:10.1016/s0079-6123(09)17808-1 · Cited by 57
SCHMITT, A. (2004) · Archives of Clinical Neuropsychology · doi:10.1016/j.acn.2004.02.002 · Cited by 50
Cognitive and academic problems associated with childhood cancers and sickle cell disease.
Daly, B. P., Kral, M. C., & Brown, R. T. (2008) · School Psychology Quarterly · doi:10.1037/1045-3830.23.2.230 · Cited by 38
Self-citationWhite Matter Integrity and Core Cognitive Function in Children Diagnosed With Sickle Cell Disease
Scantlebury, N., Mabbott, D., Janzen, L., Rockel, C., Widjaja, E., Jones, G., Kirby, M., & Odame, I. (2011) · Journal of pediatric hematology/oncology · doi:10.1097/mph.0b013e3182036f33 · Cited by 45
“Working memory, processing speed, and sustained visual attention are reported amongst the most frequently affected cognitive functions in the SCD population.(1,7,8) We report reduced performance on tasks, requiring working memory and efficient processing speed, in our patient population.”
BackgroundResultAcademic attainment findings in children with sickle cell disease.
Epping, A., Myrvik, M. P., Newby, R., Panepinto, J. A., Brandow, A., & Scott, J. (2013) · Journal of School Health · doi:10.1111/josh.12064 · Cited by 44
Daniel, L. C., Li, Y.-M., Smith, K. E., Tarazi, R. A., Robinson, M., Patterson, C. A., Smith-Whitley, K., Stuart, M. J., & Barakat, L. (2015) · Journal of Pediatric Psychology · doi:10.1093/jpepsy/jsv063 · Cited by 40
Psychosocial challenges of persons with sickle cell anemia: A narrative review
Essien, E., Winter-Eteng, B. F., Onukogu, C. U., Nkangha, D. D., & Daniel, F. (2023) · Medicine · doi:10.1097/md.0000000000036147 · Cited by 39
The Role of Neuropsychological Evaluation in Pediatric Sickle Cell Disease
Daly, B. P., Kral, M. C., & Tarazi, R. A. (2011) · The Clinical Neuropsychologist · doi:10.1080/13854046.2011.560190 · Cited by 30
“Stroke in pre-school and school-aged children with SCD is associated with broad and pervasive neuropsychological impairments, including deficits in general intelligence (IQ), attention and executive functions, memory (short- and long-term memory), language, visuomotor abilities, and academic achievement in reading, wr…”
BackgroundInfluentialSelf-citationAttention Deficits in Children with Sickle Cell Disease
Nabors, N., & Freymuth, A. K. (2002) · Perceptual and Motor Skills · doi:10.2466/pms.2002.95.1.57 · Cited by 34
Hardy, S., Bills, S. E., Wise, S. M., & Hardy, K. (2018) · Journal of Pediatric Psychology · doi:10.1093/jpepsy/jsy019 · Cited by 30
Assessment of Psycho-Educational Needs in a Clinical Sample of Children With Sickle Cell Disease
Peterson, C., Palermo, T., Swift, E. E., Beebe, A., & Drotar, D. (2005) · doi:10.1207/s15326888chc3402_4 · Cited by 29
Barakat, L. P., Daniel, L. C., Smith, K. E., Robinson, M. R., & Patterson, C. A. (2013) · Journal of Clinical Psychology in Medical Settings · doi:10.1007/s10880-013-9379-7 · Cited by 31
Distinct Clinical and Radiographic Phenotypes in Pediatric Patients With Moyamoya.
Kaseka, M., Slim, M., Muthusami, P., Dirks, P., Westmacott, R., Kassner, A., Bhathal, I., Williams, S., Shroff, M., Logan, W., et al. (2021) · Pediatric Neurology · doi:10.1016/j.pediatrneurol.2021.03.002 · Cited by 23
Immune thrombotic thrombocytopenic purpura: Spotlight on long-term outcomes and survivorship
Selvakumar, S., Liu, A., & Chaturvedi, S. (2023) · Frontiers in Medicine · doi:10.3389/fmed.2023.1137019 · Cited by 21
“The pattern of cognitive impairments seen in iTTP is similar to that seen in patients with hypertension (71), sickle cell disease (72, 73), and other vascular disorders (74), suggesting that it could be due to acquired diffuse, subcortical microvascular lesions.”
ResultMartin, S. C., Roderick, M. C., Abel, C., Wolters, P. L., Toledo‐Tamula, M. A., Fitzhugh, C. D., Hsieh, M. M., & Tisdale, J. F. (2019) · Neuropsychological Rehabilitation · doi:10.1080/09602011.2019.1598876 · Cited by 21
Quimby, K. R., Hambleton, I. R., & Landis, R. C. (2015) · Medical Hypotheses · doi:10.1016/j.mehy.2015.06.023 · Cited by 16
“dactylitis and stroke, can occur in childhood with devastating sequelae [86–91].”
BackgroundSickle Cell anemia and hearing loss among children and youngsters: literature review
da Silva, L. P. A., Nova, C. V., & Lucena, R. (2015) · Brazilian Journal of Otorhinolaryngology · doi:10.1590/s1808-86942012000100020 · Cited by 19
Edwards, C., Raynor, R., Feliu, M., McDougald, C. S., Johnson, S. R., Schmechel, D., Wood, M., Bennett, G., Saurona, P., Bonner, M., et al. (2007) · Neuropsychiatric Disease and Treatment · doi:10.2147/ndt.s518 · Cited by 19
“…functioning, language and verbal abilities, visual-motor and visual-spatial processing, memory, academic achievement, and processing of subtle prosodic information in pediatric patients with a range of SCD severities and disease-related complicating issues (Kral et al 2001; Treadwell et al 2005).”
BackgroundChen, R., Krejza, J., Arkuszewski, M., Zimmerman, R., Herskovits, E., & Melhem, E. (2017) · Advances in Medical Sciences · doi:10.1016/j.advms.2016.09.002 · Cited by 15
“Children with sickle cell disease (SCD) are at high risk of cognitive impairment [1, 2].”
BackgroundExecutive functions in kindergarteners with high levels of disruptive behaviours
Monette, S., Bigras, M., & Guay, M. (2015) · British Journal of Developmental Psychology · doi:10.1111/bjdp.12105 · Cited by 22
Moving young people with sickle cell disease from paediatric to adult services.
Howard, J., Woodhead, T., Musumadi, L., Martell, A., & Inusa, B. (2010) · British journal of hospital medicine · doi:10.12968/hmed.2010.71.6.48435 · Cited by 14
Strum, D., Kapoor, E., Shim, T., Kim, S., Sabetrasekh, P., & Monfared, A. (2020) · The Laryngoscope · doi:10.1002/lary.29199 · Cited by 13
“cognitive delays, a more frequent and robust hearing screening protocol may be warranted in children with SCD.(12) Before the detailing of hearing screening proposals for children with SCD, more precise studies delineating audiometric data by age must be performed to determine at what age the prevalence of SNHL begins…”
BackgroundInfluentialArfé, B., Montanaro, M., Mottura, E., Scaltritti, M., Manara, R., Basso, G., Sainati, L., & Colombatti, R. (2018) · Journal of Pediatric Psychology · doi:10.1093/jpepsy/jsy005 · Cited by 13
Nunes, S., Argollo, N., Mota, M., Vieira, C., & de Sena, E. P. (2016) · Revista Brasileira de Hematologia e Hemoterapia · doi:10.1016/j.bjhh.2016.09.004 · Cited by 13
Amoran, O., Jimoh, A., Ojo, O., & Kuponiyi, T. (2017) · BMC Hematology · doi:10.1186/s12878-017-0077-9 · Cited by 9
“Such favorable family environment and appropriate prevention measures has been shown to be a good prognostic index [17, 18].”
BackgroundEvent-Based Prospective Memory in Children with Sickle Cell Disease: Effect of Cue Distinctiveness
McCauley, S. R., & Pedroza, C. (2010) · Child Neuropsychology · doi:10.1080/09297041003601470 · Cited by 12
Gondhi, J. P., Dombkowski, K. J., Scott, E. L., & Reeves, S. L. (2020) · The Journal of Pediatrics · doi:10.1016/j.jpeds.2020.05.027 · Cited by 9
Jones, K., Jacobson, L., & Tarazi, R. A. (2017) · Rehabilitation Psychology · doi:10.1037/rep0000158 · Cited by 7
The Relationship Between Sickle Cell Disease and Sudden Onset Sensorineural Deafness
Abdelmahmuod, E. A., Yassin, M., Ahmed, M. A., & Ali, E. (2020) · Cureus · doi:10.7759/cureus.9413 · Cited by 6
“The tendency of cochlear to develop ischemia is very high, so specialized care and attention must be achieved to prevent hearing disability [9].”
BackgroundReferral Outcomes From a Neurocognitive Screening Program for Pediatric Sickle Cell Disease
Karst, J. S., Miller, M., Heffelfinger, A., Newby, R., & Scott, J. (2022) · Clinical Practice in Pediatric Psychology · doi:10.1037/cpp0000431 · Cited by 5
“…demonstrate de fi cits in intellectual functioning, verbal abilities, visual-motor and visual-spatial skills, attention and executive functioning including working memory, and processing speed (Acquazzino et al., 2017; Kral et al., 2001; Noll et al., 2001; Schatz et al., 2004; Steen et al., 2005).”
School performance of children with sickle cell disease in Basra, Iraq
Abid, F., Hassan, M., & Ahmed, B. (2019) · Iraqi Journal of Hematology · doi:10.4103/ijh.ijh_21_18 · Cited by 5
“The cognitive impairments in children with SCD are characterized by a reduction in general intellectual functioning, language and verbal abilities, visual-motor and visual-locational processing, memory, and school performance.[14]”
BackgroundSocial adjustment in children diagnosed with sickle cell disease: A retrospective study
Zwicker, H., Fay-McClymont, T. B., Hou, S. H. J., Cho, S., McDonald, K., Guilcher, G., Yeates, K., Brooks, B. L., & Schulte, F. S. M. (2023) · Pediatric Blood & Cancer · doi:10.1002/pbc.30807 · Cited by 4
“11,46,47 Impaired executive functioning is understood to have a negative influence on children’s ability to perceive and interpret social situations, and often leads to atypical social interaction behaviors.”
BackgroundMachado, C., Rodríguez-Rojas, R., & Leisman, G. (2020) · BMJ Case Reports · doi:10.1136/bcr-2019-233737 · Cited by 4
Neuropsychological Disorders of Children
Gouvier, W. D., Baumeister, A. L., & Ijaola, K. (2008) · Springer eBooks · doi:10.1007/978-0-387-09528-8_6 · Cited by 3
An Analysis of Risk Factors for Sensorineural Hearing Loss in Children With Sickle Cell Disease.
Youner, E. R., Haupt, T. L., Shatanofy, M. E., Strum, D., Moncada, P. X., Tunkel, A. E., Kallik, C., Sabetrasekh, P., Rodriguez, D., Rana, M., et al. (2025) · Otology and Neurotology · doi:10.1097/mao.0000000000004674 · Cited by 2
Hyacinth, H., & Adams, R. (2017) · doi:10.1007/978-1-4939-2462-2_26 · Cited by 2
Alghasi, A., Hassanpour, Z., Bahadoram, M., Ashrafi, S., & Nourbakhsh, S. M. K. (2020) · Journal of Preventive Epidemiology · doi:10.34172/jpe.2020.13 · Cited by 2
“The most common complications of SCD in the nervous system are neurological complications, and neurological complications are the most important consequences of the disease, with one-third of the patients with the disease experiencing neurological complications (12-14).”
BackgroundQuimby, K. R., & Hambleton, I. R. (2013) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd010300 · Cited by 2
Neurological Manifestations of Hematological Disease
Weksler, B. (2007) · doi:10.1016/b978-012088592-3/50061-x · Cited by 1
A Conversation Starter: Surveying Sexual Health Concerns for Adults Living With Sickle Cell Disease
Massa, L. A., Tally, Z., Bauer, L., Martino, J., Mlay, A., Shelby, R., & Crawford, R. (2026) · Journal of Women's & Pelvic Health Physical Therapy · doi:10.1097/jwh.0000000000000375
Zerdan, M. B., Watfa, A., Kfoury, B., Hoballah, J., El‐Hachem, R., Ruggieri, L., Bonifazi, F., Abboud, M. R., & Yazbeck, S. (2025) · Pediatric Blood & Cancer · doi:10.1002/pbc.31994 · Cited by 2
Neurocognitive passport: A novel feedback tool for pediatric patients with sickle cell disease
Karst, J. S., Miller, M., Simpson, P., Hoag, J. A., & Bingen, K. (2025) · Journal of Child Health Care · doi:10.1177/13674935251326787
“…sequela such as vaso-occlusive pain crises, acute chest syndrome, and risk of stroke (Meier and Miller, 2012), SCD is associated with de fi cits in intellectual, academic, and executive functioning (Acquazzino et al., 2017; Kral et al., 2001; Noll, 2001; Schatz et al., 2001; Steen et al., 2005).”
A study about effect of hydroxyurea on scholastic performance of children with sickle cell anemia
Joshi, N., Jain, N. J., & Jain, P. R. (2021) · Indian Journal of Child Health · doi:10.32677/ijch.2021.v08.i03.002 · Cited by 1
“Other researchers have studied the effect on specific domain and inferred that SCA affects language, visual, motor, and memory, while another study reported that poor school performance associated with concentration and attention abilities of children [3-5].”
BackgroundDesenvolvimento de uma metodologia rápida e de baixo custo para diagnóstico da Anemia Falciforme
dos Santos, E. G. (2014) · doi:10.11606/t.85.2014.tde-23072015-140021
“Os métodos de diagnóstico da anemia falciforme vão desde eletroforese de hemoglobina (EHG) ([14]), focalização isoelétrica (IEF) [15,16] e até cromatografia líquida de alta eficiência (HPLC) ([17]).”
BackgroundCognitief functioneren bij jongvolwassen patiënten met sikkelcelziekte
Raterink, M., van der Land, V., Fijnvandraat, K., & Schmand, B. A. (2014) · Tijdschrift voor kindergeneeskunde · doi:10.1007/s12456-014-0013-x
Cissé, O., Mbaye, K. A., Guène, A., Diop-Sène, M., Diagne, R., Sow, P. S., Soumaré, A., Ba, E., & Ndiaye, M. (2025) · Neuroscience & Medicine · doi:10.4236/nm.2025.164019
Executive Abilities and Academic Achievement in Children with Sickle Cell Disease
Wesonga, E. (2019) · Open Scholarship Institutional Repository (Washington University in St. Louis) · doi:10.7936/xbsp-ys46
“However, neuroimaging studies have indicated that most CVAs in children with SCD are not accompanied by overt neurological symptoms, a phenomenon that has been termed “silent stroke” (Kral et al., 2001).”
BackgroundInfluentialPediatric Case of Sickle Cell Disease
Gerstle, M., Baum, K. T., Quinn, C., & Beebe, D. (2019) · Physician's Field Guide to Neuropsychology · doi:10.1007/978-1-4939-8722-1_5
Special Population: Children and Adolescents
McEachern, M. A., & Page, C. P. (2018) · Springer eBooks · doi:10.1007/978-3-319-71812-5_24
Metadata
- Authors
- Kral, M. C., Brown, R. T., & Hynd, G. W.
- Affiliations
- Medical University of South Carolina (US)
- University of Georgia (US)
- Corresponding author
- Kral, Mary C.
- Venue
- Neuropsychology Review
- Published
- 2001-12
- Volume
- 11
- Issue
- 4
- Pages
- 179-196
- ISSN
- 1040-7308 (ISSN-L)
- 1573-6660
- OpenAlex
- W1502367468
- Cited by
- 86
- References
- 0
- Citations by year
- 2026: 1 · 2025: 6 · 2023: 7 · 2022: 2 · 2021: 3 · 2020: 7 · 2019: 5 · 2018: 3 · 2017: 4 · 2016: 2 · 2015: 4 · 2014: 4 · 2013: 7 · 2012: 5
- FWCI
- 0.52
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- Locations
- Neuropsychology Review (publishedVersion)
- PubMed (publishedVersion)
- Digital Scholarship - UNLV (University of Nevada Reno) (submittedVersion)
- Topics
- Health Sciences › Medicine › Genetics (clinical) › Hemoglobinopathies and Related Disorders
- Social Sciences › Psychology › Neuropsychology and Physiological Psychology › Developmental and Educational Neuropsychology
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Neonatal Health and Biochemistry
- Keywords
- sickle cell disease, pediatric sickle cell disease, neurocognitive impairment, cerebrovascular disease, silent cerebral infarction, intellectual functioning, memory, academic performance, prosodic processing, attention and concentration, executive function, visual motor speed, neuropsychological assessment
- MeSH terms
- Anemia, Sickle Cell, Brain, Brain Damage, Chronic, Cerebral Infarction, Child, Diagnostic Imaging, Humans, Neuropsychological Tests
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