Intellectual and academic performance in children undergoing solid organ pretransplant evaluation

Abstract

Although prior research has shown lower intellectual functioning across pediatric solid organ transplant recipients relative to matched siblings or norm comparisons, few studies have assessed intellectual and academic performance prior to transplant across organ groups. The current data examine intellectual and academic functioning in children being evaluated for kidney, liver, or heart transplant. This investigation included intellectual and academic testing data from 195 children and adolescents between the ages of six and 19 yr evaluated for solid organ transplantation. Across organ groups, patients' intellectual functioning as estimated by the WASI/WASI-II at the time of pretransplant evaluation was within the average range, but lower compared to test norms. Patients demonstrated lower estimates of word reading, math computation, and spelling skills compared to the normal population, with the exception of heart patients' word reading and spelling skills and liver patients' spelling scores. Cognitive and academic impairments exist in children prior to transplantation. Findings emphasize the support that patients may require to manage the complicated medical regimen and succeed academically. Routine cognitive and academic assessment can inform healthcare providers regarding transplant patients' capacity to take on increasing medical responsibility and successfully reintegrate into the school environment.

A Randomized Trial of a Multicomponent Intervention to Promote Medication Adherence: The Teen Adherence in Kidney Transplant Effectiveness of Intervention Trial (TAKE-IT)

“…Forgetting and poor organization and planning were the most commonly identified adherence barriers in young kidney transplant recipients 7,8 . Neurocognitive dysfunction, particularly disturbances in executive function and memory 9–11 , is common among individuals who experienced chronic kidney disease in childhood; this may also impair medication management abilities.…”

Neurodevelopmental Outcome of Young Children with Biliary Atresia and Native Liver: Results from the ChiLDReN Study

“…Recent research initiatives have focused largely on neurocognitive outcomes in cohorts of pediatric LT recipients, comprised largely of BA participants and show that developmental delays are prominent at the time of listing and post-transplant 15, 16 . Only a handful of small, single-center studies have examined ND outcomes specifically in infants with BA and their native livers, with cognitive and motor delays most consistently reported in both pre-transplant 5, 6, 8, 17 as well as one-year post-LT patient populations 17 .…”

Long-Term Care of the Pediatric Kidney Transplant Recipient

“…Memory deficits, disturbances of executive function, and attention problems are common, but may go unrecognized (37)(38)(39). Formal assessment of cognitive assessment may reveal deficits in executive functions (e.g., planning, organization, problem solving) that may impair ability to engage in self-care behaviors such as medication adherence, whereas assessment of academic function may guide academic expectations and ensure appropriate provision of academic support (37). Recognition of such deficits will allow appropriate support structures to be put into place before adherence problems result in adverse outcomes.…”

“…However, compared with healthy children, a greater than expected proportion of pediatric transplant recipients are in the impaired, borderline, or low-average intelligence range, and academic performance is often poorer than in healthy peers (36,37). Memory deficits, disturbances of executive function, and attention problems are common, but may go unrecognized (37)(38)(39). Formal assessment of cognitive assessment may reveal deficits in executive functions (e.g., planning, organization, problem solving) that may impair ability to engage in self-care behaviors such as medication adherence, whereas assessment of academic function may guide academic expectations and ensure appropriate provision of academic support (37).…”