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Cognitive Predictors of Academic Achievement in Children with Neurofibromatosis Type 1 and Plexiform Neurofibromas

Wed, April 7, 4:30 to 5:30pm EDT (4:30 to 5:30pm EDT), Virtual

Abstract

Neurofibromatosis type 1 (NF1) is a rare disease affecting approximately 1:3500 individuals worldwide and is characterized by a wide range of tumor and non-tumor manifestations that can negatively impact individuals’ quality of life (Gutmann et al., 2017; McClatchey, 2007). Cognitive impairments and academic difficulties, which are present in over 80% of individuals with NF1, are common non-tumor manifestations of the disease ( Lehtonen et al., 2015; Vogel et al., 2017). Cognitive functioning is important for various life outcomes including academic achievement (Diamond, 2013). However, we know little about what cognitive factors lead to academic difficulties in children with NF1, with inconsistent findings from only a few existing cross-sectional studies (Klein-Tasman et al., 2014; Martin et al., 2012). No known studies have looked at how cognitive skills impact academic development over time in the NF1 population. To address this gap, the current study aims to examine how cognitive skills (i.e., executive functioning, attention) predict academic development in math, reading, and writing over time among children with NF1 and plexiform neurofibromas (PNs, a physical manifestation of NF1).

Participants included 88 children with NF1 and PNs (ages 6-18 years old, M = 12.05, SD = 3.62, 57% male) on a natural history study at National Cancer Institute. Neuropsychological assessments were administered three times over six years, each approximately 3 years apart (see Table 1 for measures). Multilevel growth modeling examined how baseline performance-based (PB) and parent-rated (PR) measures of executive functioning (inhibitory control, working memory, cognitive flexibility) and PB attention relate to academic development over six years. Parental educational level and NF1 status were included as covariates because they were related to academic development (Hou et al., 2020).

Working memory (PB and PR), cognitive flexibility (PB and PR), and attention were positively associated with initial levels of math achievement (β=.18 to .47, p<.05); inhibitory control (PR), and cognitive flexibility (PB and PR) were related to change of math scores over time (β=.03 to .04, p<.05), suggesting that children with lower initial levels of inhibitory control or cognitive flexibility were more likely to experience decline in math scores as they got older. For reading performance, working memory (PB), cognitive flexibility (PB), and attention were positively associated with its initial levels (β=.25 to .62, p< .01); inhibitory control (PR) were related to its change (β=.03, p=.02), suggesting that children with lower initial levels of inhibitory control were more likely to experience decline of reading performance across time. For writing performance, working memory (PB and PR), cognitive flexibility (PB), and attention were positively associated with its initial levels (β=.24 to .71, p<.05); no cognitive variables were related to its change.

The current findings indicate that inhibitory control, working memory, cognitive flexibility, and attention are important predictors of academic development in children with NF1 and PNs. Results vary across specific domains of academic achievement and types of cognitive measures (PB vs PR). A better understanding of cognitive factors contributing to academic development will enable us to develop appropriate interventions to support students with NF1 in the classroom.

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