WISC-R Verbal/Performance Discrepancies in Pediatric Cancer Patients

Intelligence testing was completed on 38 newly diagnosed pediatriconcology patients and 29 hemophilia patients between 6 and I7years of age. A low Verbal/high Performance intelligence testpattern was displayed by 39% of the oncology patients as comparedto an expected frequency of 12/14% in the hemophilia controls.Increased amounts of prednisone, vincristine, and number ofdays between diagnosis and intelligence testing correlated withthe Verbal-Performance (V-P) discrepancy scores in the oncologypatients. These findings and previous studies suggest the needfor monitoring the intellectual, emotional, linguistic, andneuropsychological status of pediatric oncology patients beginningat the time of diagnosis.     

Declining immune function in children and adolescents with hemophilia and HIV infection: effects on neuropsychological performance. Hemophilia Growth and Development Study

OBJECTIVE: To determine whether declines in immune functioning are associated with changes in neuropsychological performance in children and adolescents with hemophilia who are infected with the human immunodeficiency virus (HIV). METHODS: Participants were 333 males with hemophilia, ages 6-19 years at entry. A baseline and four annual neuropsychological evaluations were given. A longitudinal growth curves analysis of data was performed to detect changes associated with declining immune function. The cohort was stratified into four groups: (1) HIV- (n = 126); (2) HIV+, average of first two and last two CD4 counts > or = 200, (n = 106; High CD4 group); (3) HIV+, average first two counts > or = 200, average last two counts < 200 (n = 41; CD4 Drop group); and (4) HIV+, average first two and last two counts < 200 (n = 60; Low CD4 group). RESULTS: There were significant differences among the four groups over time in nonverbal intelligence, perceptual/performance skills, nonverbal memory, academic achievement, and language. The Low CD4 group consistently showed the greatest decrement in performance. On measures showing a practice effect for repeated measurements, the Low CD4 group participants' scores remained stable over time, suggesting opposing effects of practice and HIV-related declines. Lowered academic performance relative to IQ was found in all groups. CONCLUSIONS: Declines in neuropsychological functioning are directly related to declines in immune functioning in HIV+ children, adolescents, and young adults with hemophilia. Hemophilia itself may be a risk factor for academic underachievement.