Published online Apr 15, 2015. doi: 10.4239/wjd.v6.i3.527
Peer-review started: August 6, 2014
First decision: August 28, 2014
Revised: October 7, 2014
Accepted: February 4, 2015
Article in press: February 9, 2015
Published online: April 15, 2015
Processing time: 257 Days and 5 Hours
AIM: To investigate whether perceptions of task difficulty on neuropsychological tests predicted academic achievement after controlling for glucose levels and depression.
METHODS: Participants were type 1 diabetic adolescents, with a mean age = 12.5 years (23 females and 16 males), seen at a northwest suburban Chicago hospital. The sample population was free of co-morbid clinical health conditions. Subjects completed a three-part neuropsychological battery including the Digit Symbol Task, Trail Making Test, and Controlled Oral Word Association test. Following each task, individuals rated task difficulty and then completed a depression inventory. Performance on these three tests is reflective of neuropsychological status in relation to glucose control. Blood glucose levels were measured immediately prior to and after completing the neuropsychological battery using a glucose meter. HbA1c levels were obtained from medical records. Academic performance was based on self-reported grades in Math, Science, and English. Data was analyzed using multiple regression models to evaluate the associations between academic performance, perception of task difficulty, and glucose control.
RESULTS: Perceptions of difficulty on a neuropsychological battery significantly predicted academic performance after accounting for glucose control and depression. Perceptions of difficulty on the neuropsychological tests were inversely correlated with academic performance (r = -0.48), while acute (blood glucose) and long-term glucose levels increased along with perceptions of task difficulty (r = 0.47). Additionally, higher depression scores were associated with poorer academic performance (r = -0.43). With the first regression analysis, perception of difficulty on the neuropsychological tasks contributed to 8% of the variance in academic performance after controlling for peripheral blood glucose and depression. In the second regression analysis, perception of difficulty accounted for 11% of the variance after accounting for academic performance and depression. The final regression analysis indicated that perception of difficulty increased with peripheral blood glucose, contributing to 22% of the variance. Most importantly, after controlling for perceptions of task difficulty, academic performance no longer predicted glucose levels. Finally, subjects who found the cognitive battery difficult were likely to have poor academic grades.
CONCLUSION: Perceptions of difficulty on neurological tests exhibited a significant association with academic achievement, indicating that deficits in this skill may lead to academic disadvantage in diabetic patients.
Core tip: The objective of the current study was to investigate the association between perceptions of difficulty and academic performance in adolescents with type 1 diabetes. Perceptions of difficulty are reflected in executing cognitive activities as well as in the task of glucose regulation. Glucose control needs to be understood, not so much from a biological perspective but as an effortful process that is also reflected in academic challenges. The problem of anergia observed generally in patients with diabetes seems to broadly affect a variety of tasks and challenges. Thus, the novelty of the study is in showing that the regulation of glucose in diabetic patients is another example of the broad challenges confronted in the life of patients with diabetes.