title: 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.
abstract: OBJECTIVE
  To longitudinally assess the relationship of behavioral problems, intellectual functioning, and family functioning in children with sickle cell disease (SCD).
  
  
  METHODS
  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.
authors.affiliation: Duke University, 114 Allen Building, Box 90042, Durham, NC 27708-0042, USA. bobt@asdean.duke.edu
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Thompson
authors.forename: F Daniel
authors.initials: FD
authors.lastname: Armstrong
authors.forename: Carol L
authors.initials: CL
authors.lastname: Link
authors.forename: Charles H
authors.initials: CH
authors.lastname: Pegelow
authors.forename: Franklin
authors.initials: F
authors.lastname: Moser
authors.forename: Winfred C
authors.initials: WC
authors.lastname: Wang
mesh_terms: D000223:Adaptation, Psychological; D000293:Adolescent; D000294:Adolescent Behavior; D000328:Adult; D000755:Anemia, Sickle Cell / Q000150:complications / Q000523:psychology*; D002648:Child; D002652:Child Behavior; D002675:Child, Preschool; D003072:Cognition Disorders / Q000175:diagnosis / Q000209:etiology; D005190:Family / Q000523:psychology*; D005260:Female; D006801:Humans; D007361:Intelligence Tests; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D011446:Prospective Studies; D012494:Sampling Studies