Neurocognitive deficits affect school performance in pediatric bipolar disorder


22 November 2006

Researchers have found that neuropsychological deficits in attention, working memory, and organization/problem solving skills may explain why children with bipolar disorder experience academic difficulties.

"Identifying the domains of cognitive dysfunction that underlie the academic difficulties is the first step toward educational remediation," note Mani Pavuluri and colleagues from the University of Illinois at Chicago, USA.

"Intervention strategies can then be targeted to reduce neurocognitive dysfunction or circumvent them by teaching compensatory strategies, thereby enhancing the learning potential of individuals with pediatric bipolar disorder during their years of formal education."

The researchers used a computerized neurocognitive battery and standard neuropsychological tests to determine the impact of neurocognitive function on academic difficulties in 55 children and adolescents aged between 7 and 17 years with bipolar disorder.

Information on school and academic performance was gathered from structured questionnaires completed by the children's parents.

Reading difficulties were noted in 46% of children, while math difficulties were reported in 29%. Of those with reading difficulties, 52% also had trouble with math, and of those with math difficulties, 81% also had reading difficulties.

Analysis showed that scores for executive function, attention, working memory, and verbal memory were significantly worse among children with reading and writing difficulties than among those without problems, while deficits in attentional dysfunction predicted math difficulties.

Given their findings, Pavuluri and co-workers suggest the need for clinical neuropsychological evaluations in pediatric patients with bipolar disorder to identify those at risk of school performance problems, and for clinicians caring for such patients to be aware of the effects of functional impairment on school performance.

Moreover, the results identify cognitive deficits as a treatment target, they add, recommending the incorporation of cognitive remediation measures for these children in their educational plans.

"One approach is to plan for specific additional support and individualizing currently available curriculum. A second, long-term aim would be to develop and validate innovative cognitive remediation programs targeting the 'rate limiting neurocognitive deficits,'" say the researchers.

"A third strategy would be to provide pharmacological intervention with the aim of enhancing cognition, perhaps especially with regard to attentional difficulties."





Source: Biol Psychiatry 2006; 60: 951–956