Tag Archive for: Steven Hardy

Clumps of sickle cell blocking a blood vessel

Neurocognitive and emotional factors predict hospital visits in children with SCD

 

Clumps of sickle cell blocking a blood vessel

Neurocognitive and emotional factors are predictors of visits children with SCD make to the hospital.

Many children with sickle cell disease (SCD) experience significant pain that often results in trips to the emergency department (ED) or hospitalization. Disease characteristics explain some – but not all – of the variability in pain-related healthcare utilization. In a new study published in Pediatric Blood & Cancer, experts examined the role of neurocognitive functioning and emotional factors in predicting future healthcare visits for pain up to three years later.

The big picture

In the 3-year study of 112 youth with SCD between ages 7-16, researchers found that poorer attentional control and greater emotional distress predicted more ED visits and hospitalizations for pain years later.

Past studies that have pointed to the importance of neurocognitive and emotional factors in the experience of pain have only looked at relationships at a single point in time.

“Those types of studies limit our ability to evaluate the directionality of relationships and consider the implications of neurocognitive functioning and emotional well-being for children’s health as they get older,” said lead author Steven Hardy, Ph.D., director of Psychology and Patient Care Services and psychologist in the Center for Cancer and Blood Disorders (CCBD) at Children’s  National Hospital.

Why it matters

This study advances the understanding of the effects of neurocognitive functioning and emotions on the course of pain and disease morbidity in pediatric SCD.

Additionally, the findings will benefit patients by shedding light on potential intervention targets to support effective pain management.

“It also helps to reframe the conversation around pain and healthcare utilization in SCD by broadening our understanding of the factors that precipitate pain to include neurocognitive functioning and mental health,” Dr. Hardy added.

What’s unique

This work demonstrates that factors beyond disease characteristics are important to consider in a comprehensive approach to managing pain and improving quality of life for children with SCD.

“It shows that we also need to be thinking about how neurocognitive functioning and mental health affect one’s ability to manage their disease in terms of taking medications, avoiding pain triggers, coping with pain, communicating about symptoms and advocating for needs,” Dr. Hardy said. “Future work will look to see if we can preserve neurocognitive functioning and support mental health as a way to reduce pain impairment and improve quality of life.”

Children’s National is conducting several studies focused on better understanding the course of neurocognitive functioning and pain in pediatric SCD. Psychologists in the CCBD are also exploring novel interventions to preserve neurocognitive functioning and promote the development of effective strategies for coping with pain in SCD.

father and son in playground

Using psychological treatments to help pediatric pain management

father and son in playground

Behavioral pain management can utilize approaches to address the experience of co-occurring acute and chronic pain.

There are different types of pain that people experience, such as short-term (acute) pain and longer term (chronic or persistent) pain. Just like there are different pharmacologic treatments depending on the type of pain, there are different psychological or behavioral therapies that seem more effective when tailored to a person’s type of pain. Furthermore, certain psychological treatments that are known to be helpful for managing acute pain may actually be unhelpful for a child dealing with chronic pain. A framework has not previously existed for the provision of psychological treatment when children are experiencing both acute and chronic pain.

In a new article, Megan Connolly, Ph.D., pediatric psychologist, and Steven Hardy, Ph.D., pediatric psychologist and director of Psychology and Patient Care Services for the Center for Cancer and Blood Disorders, both at Children’s National Hospital, outline recommendations for the psychological treatment of acute and chronic pain in children.

The hold-up in the field

Only recently have psychological therapies gained empirical support for their efficacy in treating pain conditions. Very little research, however, has been done on how to effectively tailor psychological treatments for groups experiencing both acute and chronic pain, likely because the pain conditions that involve both acute and chronic pain are rare.

In their new article, Dr. Connolly and Dr. Hardy draw attention to this issue by pulling together empirical evidence and clinical expertise to outline a framework for the psychological and behavioral management of co-occurring acute and chronic pain in children.

“This framework will help to guide the development of novel clinical interventions for individuals who experience co-occurring acute and chronic pain,” Dr. Connolly said.

Why we’re excited

The authors reviewed how behavioral pain management strategies can utilize complementary approaches to address the experience of co-occurring acute and chronic pain.

“It’s challenging that there are not many psychological treatments that were developed with the populations we see in mind,” Dr. Connolly added. “And it’s exciting there is now a more coherent framework for treating patients that have acute and chronic pain.”

Children’s National Hospital leads the way

Many clinicians see the unique challenges of treating co-occurring acute and chronic pain. However, this is the first article to propose a clinical framework for the psychological treatment of patients experiencing both types of pain.

The authors said they hope that their article helps to enhance the current dialogue around pain perception and pain burden to address the needs of co-occurring acute and chronic pain presentations.

You can read the full study, Clinical Considerations for Behavioral Pain Management in Co-occurring Acute and Chronic Pain Presentations, in the journal Clinical Practice in Pediatric Psychology.

Sickle-Cell-Blood-Cells

Treating neurocognitive difficulties in children with sickle cell disease

Sickle-Cell-Blood-Cells

An adaptive cognitive training program could help treat attention and working memory difficulties in children with sickle cell disease (SCD), a new study published in the of Journal of Pediatric Psychology shows.

An adaptive cognitive training program could help treat attention and working memory difficulties in children with sickle cell disease (SCD), a new study published in the of Journal of Pediatric Psychology shows.

These neurocognitive difficulties have practical implications for the 100,000 individuals in the U.S. with SCD, as 20-40% of youth with SCD repeat a grade in school and fewer than half of adults with SCD are employed. Interventions to prevent and treat neurocognitive difficulties caused by SCD have the potential to significantly improve academic outcomes, vocational attainment and quality of life.

The study, led by Steven Hardy, Ph.D., director of Psychology and Patient Care Services at the Center for Cancer and Blood Disorders at Children’s National Hospital, examined a promising approach using an adaptive cognitive training program (known as Cogmed Working Memory Training) that patients complete at home on an iPad.

Using a randomized controlled trial design, children were asked to complete Cogmed training sessions 3 to 5 times per week for about 30 minutes at a time until they completed 25 sessions. The Cogmed program involves game-like working memory exercises that adapt to the user’s performance, gradually becoming more challenging over time as performance improves. The team found that patients with sickle cell disease (SCD) who completed the cognitive training intervention showed significant improvement in visual working memory compared to a waitlist group that used Cogmed after the waiting period. Treatment effects were especially notable for patients who completed a training “dose” of 10 sessions.

“Patients who completed at least 10 cognitive training sessions showed improved visual working memory, verbal short-term memory and math fluency,” Dr. Hardy said.

SCD increases risk for neurocognitive difficulties because of cerebrovascular complications (such as overt strokes and silent cerebral infarcts) and underlying disease characteristics (such as chronic anemia). Neurocognitive effects of SCD most commonly involve problems with attention, working memory and other executive functions.

“This study demonstrates that digital working memory training is an effective approach to treating neurocognitive deficits in youth with sickle cell disease,” Dr. Hardy added. “We also found that benefits of the training extend to tasks that involve short-term verbal memory and math performance when patients are able to stick with the program and complete at least 10 training sessions. These benefits could have a real impact on daily living, making it easier to remember and follow directions in school and at home, organize tasks or solve math problems that require remembering information for short periods of time.”

To date, there have been few efforts to test interventions that address the neurocognitive issues experienced by many individuals with SCD. These findings show that abilities are modifiable and that a non-pharmacological treatment exists.

The Comprehensive Sickle Cell Disease Program at Children’s National is a leader in pediatric SCD research and clinical innovation. This study was funded by a grant from the Doris Duke Charitable Foundation, which was the only Innovations in Clinical Research Award ever awarded to a psychologist (out of 31 grants totaling over $15 million), since the award established a focus on sickle cell disease in 2009.