Long-term Psychological and Cognitive Evaluation of Children Treated With Allogeneic Hematopoietic Stem Cell Transplantation for Immunodeficiency

Assessment of global intellectual functioning using the Wechsler Preschool and Primary Scale of Intelligence, Fourth Edition (WPPSI-IV) or the Wechsler Intelligence Scale for Children, Fifth Edition (WISC-V), according to the participant's age.

The Full-Scale IQ is derived from five cognitive indices:

• Verbal Comprehension Index (VCI)
• Visual Spatial Index (VSI)
• Fluid Reasoning Index (FRI)
• Working Memory Index (WMI)
• Processing Speed Index (PSI) Each index is standardized with a mean of 100 and a standard deviation (SD) of 15. Individual subtests have a mean score of 10 (SD 3).

Higher scores indicate better cognitive performance.

Interpretation of IQ scores:

• <70: Extremely low (clinically impaired)
• 70-79: Borderline
• 80-89: Low average
• 90-109: Average
• 110-119: High average
• 120-129: Superior
• ≥130: Very superior

For subtest scaled scores:

• 15-19: Very high
• 12-14: High average
• 9-11: Average
• 7-8: Low average
• 6: Borderline
• 1-5: Impaired

Assessment of sustained attention, selective attention and executive attention using the Test of Everyday Attention for Children (TEA-Ch).

The assessment includes the following subtests:

• Sky Search
• Score!
• Creature Counting
• Dual Task ("Score Dual Task") Raw performances are converted into age-adjusted percentile ranks. Higher percentile scores indicate better attentional performance.

Interpretation:

• ≤5th percentile: Impaired
• 6th-10th percentile: Very low
• 11th-25th percentile: Borderline
• 26th-50th percentile: Low average
• 51st-75th percentile: High average
• >75th percentile: Superior

Assessment of visuospatial construction and visual memory using the Rey-Osterrieth Complex Figure Test.

The following measures are analyzed:

• Copy condition (visuoconstructive abilities)
• Delayed recall after 20 minutes (visual memory) Results are expressed as age-adjusted Z-scores. Higher scores indicate better performance. A Z-score ≤ -1.645 is considered clinically impaired.

Reading abilities are assessed using the Alouette-R Reading Test.

Outcome measures include:

Alouette-R

• Number of correctly read words
• Reading speed Results are expressed as age-adjusted Z-scores. Higher scores indicate better performance. A Z-score ≤ -1.645 is considered clinically impaired.

Assessment of anxiety using the Revised Children's Manifest Anxiety Scale (R-CMAS).

The questionnaire evaluates:

• Physiological Anxiety
• Worry/Oversensitivity
• Social Concerns/Concentration Results include subscale scores and an overall standardized T-score. Higher scores indicate greater anxiety symptoms.

Interpretation:

• Raw subscale score >13: Clinically significant
• Overall T-score ≥70: Clinical range

Assessment of behavioral functioning using the Conners 3rd Edition (Conners-3).

The questionnaire evaluates:

• Inattention
• Hyperactivity/Impulsivity
• Learning Problems
• Executive Functioning
• Aggression
• Peer Relations
• Conduct Disorder
• Oppositional Defiant Disorder Results are expressed as standardized T-scores. Higher scores indicate greater symptom severity.

Interpretation:

• T-score <65: Within normal limits
• T-score 65-69: Borderline
• T-score ≥70: Clinically significant

Assessment of adaptive functioning using the Vineland Adaptive Behavior Scales, Second Edition (Vineland-II).

The assessment evaluates adaptive functioning across three domains:

• Communication (Receptive, Expressive, Written)
• Daily Living Skills (Personal, Domestic, Community)
• Socialization (Interpersonal Relationships, Play and Leisure, Coping Skills) Domain scores are derived from subdomain v-scale scores.

Interpretation of v-scale scores:

• 1-9: Low
• 10-12: Moderately low
• 13-17: Adequate
• 18-20: Moderately high
• 21-24: High Higher scores indicate better adaptive functioning.

Assessment of socio-emotional competencies using the Social Skills Improvement System, Social-Emotional Learning Edition (SSIS-SEL).

The assessment evaluates five core domains:

• Self-awareness
• Self-management
• Social awareness
• Relationship skills

Qualitative analysis of the semi-structured interview with the child and then with the family, focused on the experience of the illness and the transplant and on the current psychological state.

Assessment of emotional and behavioral functioning using the Child Behavior Checklist (CBCL).

The following syndrome scales and composite scores are evaluated:

• Anxiety/Depression
• Withdrawn/Depressed
• Somatic Complaints
• Social Problems
• Thought Problems
• Attention Problems
• Rule-Breaking Behavior
• Aggressive Behavior
• Internalizing Problems
• Externalizing Problems
• Total Problems Score

Results are expressed as standardized T-scores. Higher T-scores indicate greater emotional or behavioral difficulties.

Interpretation:

• T-score <65: Normal
• T-score 65-69: Borderline clinical range
• T-score ≥70: Clinical range

Handwriting abilities are assessed using the BHK Handwriting Test.

Outcome measures include:

• Handwriting speed Results are expressed as age-adjusted Z-scores. Higher scores indicate better performance. A Z-score ≤ -1.645 is considered clinically impaired.