In recent years, researchers have observed selective neuropsychological impairment associated with insulin-dependent diabetes mellitus in childhood. At increased risk are children who develop diabetes before the age of 5, who experience severe hypo- and hyperglycemia, or who have frequent episodes of mild to moderate hypoglycemia. This article explores the existing literature to establish frequency and consistency of general and specific neurocognitive deficits in this pediatric patient population, as well as the impact of these deficits on school achievement and learning disabilities. Studies are integrated to identify contributing diabetes and nondiabetes factors. This is followed by a reanalysis of the data from two studies of diabetic children to determine the learning disability characteristics of this population and the factors contributing to dysfunctional school performance. Findings are discussed in terms of the impact of different factors reflecting adequacy of diabetes control on specific psychoe-ducational abilities.
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References
1.
Ack, M., Miller, I., & Weil, W.B. (1961). Intelligence of children with diabetes mellitus. Pediatrics, 25, 764–799.
2.
Anderson, B.J., Hagen, J., Barclay, C., Goldstein, G., Kandt, R., & Bacon, G. (1984). Cognitive and school performance in diabetic children. Diabetes Supplement, 33, 21.
3.
Bale, R.N. (1973). Brain damage in diabetes mellitus. British Journal of Psychiatry, 122, 337–341.
4.
Banting, F.G. (1929). The history of insulin. Edinburgh Medical Journal, 36, 1–18.
5.
Bennett-Johnson, S. (1980). Psychosocial factors in juvenile diabetes: A review. Journal of Behavioural Medicine, 3, 93–116.
6.
Breslau, N. (1983). The psychological study of chronically ill and disabled children: Are healthy siblings appropriate controls?Journal of Abnormal Child Psychology, 11, 379–391.
7.
Brown, G.D. (1938). The development of diabetic children, with special reference to mental and personality comparisons. Child Development, 9, 175–184.
8.
Cahill, G.F., Etzwiler, D.D., & Freinkel, N. (1976). “Control” and diabetes. New England Journal of Medicine, 294, 1004–1005.
9.
DCCT Research Group. (1991). Epidemiology of severe hypoglycemia in the Diabetes Control and Complications Trial. American Journal of Medicine, 90, 450–459.
10.
Eeg-Olofsson, O., & Petersen, I. (1966). Childhood diabetic neuropathy: A clinical and neuropsychological study. Acta Pediatrica Scandinavica, 55, 163–176.
11.
Fowler, M.G., Johnson, M.P., & Atkinson, S.S. (1985). School achievement and absence in children with chronic health conditions. Journal of Pediatrics, 106, 683–687.
12.
Franceschi, M., Ceccetto, R., Minicucci, F., Smizne, S., Baio, G., & Canal, N. (1984). Cognitive processes in insulin-dependent diabetes. Diabetes Care, 7, 228–231.
13.
Gath, A., Smith, A., & Baum, J.D. (1980). Emotional, behavioral, and educational disorders in diabetic children. Archives of Diseases in Childhood, 55, 371–375.
14.
Golden, M.P., Ingersoll, G.M., Brack, C.J., Russell, B.A., Wright, J.C., & Huberty, T.J. (1989). Longitudinal relationship of asymptomatic hypoglycemia to cognitive function in IDDM. Diabetes Care, 12, 89–93.
15.
Grishaw, W.H., West, H.F., & Smith, B. (1939). Juvenile diabetes mellitus. Archives of Internal Medicine, 64, 787–799.
16.
Hagen, J.W., Barclay, C.R., Anderson, B.J., Feeman, D.J., Segal, S.S., Bacon, G., & Goldstein, G.W. (1990). Intellective functioning and strategy use in children with insulin-dependent diabetes mellitus. Child Development, 61, 1714–1727.
17.
Hansen, O., Nerup, J., & Holbek, B. (1986). A common genetic origin of specific dyslexia and insulin-dependent diabetes mellitus?Hereditas, 105, 165–167.
18.
Haumont, D., Dorchy, H., & Pelc, S. (1979). EEG abnormalities in diabetic children: Influence of hypoglycemia and muscular complications. Clinical Pediatrics, 18, 750–753.
19.
Holmes, C.S., Hayford, J.T., Gonzalez, J.L., & Weydert, J.A. (1983). A survey of cognitive functioning at different glucose levels in diabetic persons. Diabetes Care, 6, 180–185.
20.
Holmes, C.S., & Richman, L.C. (1985). Cognitive profiles of children with insulin-dependent diabetes. Developmental and Behavioral Pediatrics, 6, 323–326.
21.
Ingram, T.T.S., Stark, G.D., & Blackburn, I. (1967). Ataxia and other neurological disorders as sequels of severe hypoglycemia in childhood. Brain, 90, 851–862.
22.
Kwentus, J.A., Achilles, J.T., & Goyer, P.F. (1982). Hypoglycemia: Etiology and psychosomatic aspects of diagnosis. Post-graduate Medicine, 71, 99–104.
23.
Lovett, M.W., Hinchley, J.W., & Benson, N.J. (1991). Assessing the remedial gains of disabled learners: Conceptual, measurement, and statistical considerations in the evaluation of remedial outcome. Manuscript submitted for publication.
24.
Luse, S., Gerritsen, G., & Dulin, W. (1970). Cerebral abnormalities in diabetes mellitus: An ultrastructural study of the brain in early onset diabetes mellitus in the Chinese hamster. Diabetologia, 6, 192.
25.
McGavin, A.P., Schultz, E., Peden, G.W., & Bowen, B.D. (1940). The physical growth, the degree of intelligence, and the personality adjustment of a group of diabetic children. The New England Journal of Medicine, 223, 119–127.
26.
Petrauskas, R.J., & Rourke, B.P. (1979). Identification of subtypes of retarded readers: A neuropsychological multivaried approach. Journal of Clinical Neuropsychology, 1, 17–37.
27.
Reich, J.N., Kaspar, J.C., Puczynski, M.S., Puczynski, S., cleland, J.W., Dell'Anagela, K., & Emanuele, M.A. (1990). Hypoglycemic episode on neuropsychological functioning in diabetic children. Journal of Clinical and Experimental Neuropsychology, 12, 613–627.
28.
Reske-Neilsen, E., Lunbaek, K., & Rafaelsen, O.J. (1965). Pathologic changes in central and peripheral nervous systems of young long-term diabetics. Diabetologia, 1, 233–241.
29.
Rourke, B.P., & Finlayson, M.A.J. (1978). Neuropsychological significance of variations in patterns of academic performance: Verbal and visual-spatial abilities. Journal of Abnormal Child Psychology, 6, 121–133.
30.
Rourke, B.P., & Strang, J.D. (1983). Subtypes of reading and arithmetical disabilities: A neuropsychological analysis. In M. Rutter (Ed.), Developmental neuropsychiatry (pp. 473–488). New York: Guilford.
31.
Rovet, J.F. (1989, June). Effects of diabetes on neuropsychological functioning in children: A three-year prospective study. Paper presented at the annual meeting of the American Diabetes Association, Detroit.
32.
Rovet, J.F., & Ehrlich, R.M. (1988). Effect of temperament on metabolic control in children with diabetes mellitus. Diabetes Care, 11, 77–82.
33.
Rovet, J.F., Ehrlich, R.M., & Czuchta, D. (1990). Intellectual characteristics of diabetic children at diagnosis and one year later. Journal of Pediatric Psychology, 15, 775–788.
34.
Rovet, J.F., Ehrlich, R.M., & Hoppe, M. (1987). Intellectual deficits associated with early onset of insulin-dependent diabetes mellitus in children. Diabetes Care, 10, 510–515.
35.
Rovet, J.F., Ehrlich, R.M., & Hoppe, M. (1988). Specific intellectual deficits in children with early-onset diabetes mellitus. Child Development, 59, 226–234.
36.
Ryan, C.M. (1990). Neuropsychological consequences and correlates of diabetes in childhood. In C.S. Holmes (Ed.) Neuropsychological and behavioural aspects of diabetes (pp. 58–84). New York: Springer-Verlag.
37.
Ryan, C.M., Atchinson, J., Puczynski, S., Puczynski, M., Arslanian, S., & Becker, D. (1990). Mild hypoglycemia associated with deterioration of mental efficiency in children with insulin-dependent diabetes mellitus. Journal of Pediatrics, 117, 32–38.
38.
Ryan, C., Longstreet, C., & Morrow, L. (1985). The effects of diabetes mellitus on the school attendance and school achievement of adolescents. Child: Care, Health and Development, 11, 229–240.
39.
Ryan, C., Vega, A., & Drash, A. (1981). Cognitive deficits in adolescents who developed diabetes before age 3. Diabetes, 39 (Suppl. 1), 59.
40.
Ryan, C., Vega, A., & Drash, A. (1985). Cognitive deficits in adolescents who develop diabetes early in life. Pediatrics, 75, 921–927.
41.
Ryan, C., Vega, A., Longstreet, C., & Drash, A. (1984). Neuropsychological changes in adolescents with insulin-dependent diabetes. Journal of Consulting and Clinical Psychology, 52, 335–342.
42.
Shirley, H.F., & Greer, I.M. (1940). Environmental and personality problems in the treatment of diabetic children. Journal of Pediatrics, 16, 775–781.
43.
Siegel, L. (1989). IQ is irrelevant to the definition of learning disabilities. Journal of Learning Disabilities, 22, 469–486.
44.
Siegel, L.S., & Heaven, R.K. (1986). Categorization of learning disabilities. In S.J. Ceci (Ed.), Handbook of cognitive, social and neuropsychological aspects of learning disabilities (Vol. 1, pp. 95–121). Hillsdale, NJ: Erlbaum.
45.
Skenazy, J.A., & Bigler, E.D. (1984). Psychological and neuropsychological performance in diabetic patients. Journal of Clinical Psychology, 41, 391–396.
46.
Skyler, J.S. (1989). Intensive insulin therapy: A personal and historical perspective. The Diabetes Educator, 15, 33–39.
47.
Traisman, H.S. (1980). Management of juvenile diabetes (3rd ed.). St. Louis, MO: Mosby.
48.
Vlassara, H., Brownlee, M., & Cerami, A. (1983). Excessive nonenzymatic glycosylation of peripheral and central nervous system myelin components in diabetic rats. Diabetes, 32, 670–674.
49.
Weil, W.B., & Ack, M. (1964). School achievement in juvenile diabetes mellitus. Diabetes, 13, 303–306.
50.
Yakovlev, P.I., & Lecours, A. (1967). The myelogenetic cycles of regional maturation of the brain. In A. Minkowski (Ed.), Regional development of the brain in early life (pp. 3–64). Oxford, England: Blackwell.
