Perception of difficulty and glucose control:Effects on academic performance in youth with type Ⅰ diabetes

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 comorbid 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.Hb A1 c 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 associatedwith 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.