Does stroke impair academic achievement in children? The role of metacognition in math and spelling outcomes following pediatric stroke

ABSTRACT

Introduction: Current research suggests that pediatric stroke is associated with a reduction in intellectual functioning. However, less is known about academic achievement and the contribution of specific executive functions to math and literacy in this population. The current study investigates behavioral ratings of executive functioning and their relationship to math and spelling performance in children with a history of unilateral arterial ischemic stroke.

Method: Thirty-two pediatric patients with stroke (M_age = 9.5 ± 2.7 years) and 32 demographically equivalent, healthy controls were tested on standardized measures of arithmetic, spelling, and intelligence. Executive functioning data were collected via standardized parent questionnaire.

Results: Relative to controls, stroke participants demonstrated significantly poorer functioning in math, spelling, metacognition, and behavioral-regulation. Pencil and paper arithmetic was particularly challenging for the stroke group, with 40% of patients reaching levels of clinical impairment. Hierarchical regression in stroke participants further revealed that metacognition was a robust predictor of academic deficits. Stroke occurring in later childhood and affecting cortical and subcortical brain regions also presented as potential clinical risk factors.

Conclusions: Children with stroke were especially vulnerable to math achievement deficits. Metacognition made a substantial contribution to academic achievement abilities among stroke patients, and results underscore the importance of early metacognitive skills in the completion of schoolwork. Results also emphasize that pediatric stroke patients are a heterogeneous group with regard to functioning and that there is value in examining standard score distributions of clinical participant samples.

KEYWORDS:

• Academic achievement
• children
• executive functioning
• math
• metacognition
• pediatric
• stroke

Acknowledgments

The authors thank the children and families who generously contributed their time to this research.

Disclosure statement

The authors report no conflicts of interest. They have no vested financial interest in the current study and will not personally benefit from any applications that arise from this research. The funding sources had no role in study design, data collection, interpretation, or analysis, in the writing of the report, or in the decision to submit for publication. None of the investigators receive personal salary support from the study sponsor.

Additional information

Funding

This work was supported by the Canadian Institutes of Health Research (CIHR): Institute of Neurosciences, Mental Health and Addiction [funding reference number 201510GSD-368152-221047]; and York University, Faculty of Health [grant number 400 496085].