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Journal of Pediatric Psychology, Vol. 28, No. 1, 2003, pp. 59-65
© 2003 Society of Pediatric Psychology

A Prospective Study of the Relationship Over Time of Behavior Problems, Intellectual Functioning, and Family Functioning in Children With Sickle Cell Disease: A Report From the Cooperative Study of Sickle Cell Disease

Robert J. Thompson, Jr., PhD1, F. Daniel Armstrong, PhD2, Carol L. Link, PhD3, Charles H. Pegelow, MD2, Franklin Moser, MD4 and Winfred C. Wang, MD5

1 Duke University, 2 University of Miami School of Medicine, 3 New England Research Institute, 4 Cedar Sinai Hospital, Los Angeles, 5 St. Jude Children's Research Hospital

All correspondence should be sent to Robert J. Thompson, Jr., Duke University, 114 Allen Building, Box 90042, Durham, North Carolina 27708-0042. E-mail: bobt{at}asdean.duke.edu.

Objective To longitudinally assess the relationship of behavioral problems, intellectual functioning, and family functioning in children with sickle cell disease (SCD). Method The study sample included 222 children enrolled in the Cooperative Study of Sickle Cell Disease (CSSCD). The study protocol included intellectual evaluation and brain magnetic resonance imaging (MRI) of the children, and mothers completed the Child Behavior Checklist and Family Environment Scale. At least two complete sets of measures were obtained across four assessment points over the study period of 9 years. Results Intellectual functioning declined, but family functioning and behavior problem scores did not change significantly. Consistent behavior problems were reported by mothers for 9% of the children. The risk of consistent behavior problems was not related to MRI classification, gender, education level of mother, or age of the child but significantly increased with higher baseline levels of family conflict and decreased with higher baseline full-scale IQ. An increase in behavior problems was associated with an increase in family conflict. Conclusions Maternal appraisal of family conflict is a risk factor for the small subgroup of children with SCD with consistent mother-reported behavior problems and a salient intervention target for fostering adaptation.

Key words: family functioning; intellectual functioning; behavior problems; sickle cell disease.


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