While epilepsy and cerebral palsy get far more attention as noted outcomes from HIE, the prevalence of learning, attention and behavioral challenges, especially for those who have experienced a more mild outcome from HIE, are a significant burden that need more attention and follow-up care. 

October is Learning Disabilities Awareness Month. Hope for HIE is working with several clinicians and researchers, in different projects, and as a part of our Medical Advisory Board, to bring more awareness, education and support to the prevalence of these challenges for our population that may get early sign off by clinicians, but need more in-depth follow up and identification around school age (ages 5-8). In addition, many times learning difficulties can exacerbate behavioral challenges, and lead to the development of anxiety, depression and other conditions.

Like early intervention, early identification of learning, attention and behavioral challenges and disabilities is important for family, school and life success.

Researchers from the Infant Centre of Ireland are trailblazing with the development of apps that may be able to identify earlier cognitive challenges for the HIE community, such as the Babyscreen app.

One of the most valuable resources for families as they suspect a learning difference or disability in HIE is a comprehensive neuropsychological evaluation around school age. The resulting neuropsychological report will give key insights to how a child learns best, what areas of strength and difficulties they are experiencing and therefore can provide helpful insight for not only the family, but the child's educational team.

There is hope with these differences and difficulties as well. Many children learn strategies to work around their differences and important skills such as self-advocacy, and there are many different accommodations that can be written into educational plans to help students adapt.

Learning, Attention & Behavioral Resources:

• Understood.org
• Child Mind Institute
• National Center for Learning Disabilities
• CHADD - Children and Adults with ADD
• ADDitude Magazine

Key Research Reviews on the Prevalence of Learning, Attention & Behavioral Challenges from HIE:

• Neuropsychological and educational problems at school age associated with neonatal encephalopathy
• Long-term cognitive and behavioral consequences of neonatal encephalopathy following perinatal asphyxia: a review
• Systematic review: long‐term cognitive and behavioural outcomes of neonatal hypoxic–ischaemic encephalopathy in children without cerebral palsy
• "More than meets the eye": when the neonatal course may impact several years out
• ADHD linked to oxygen deprivation before birth
• Cognitive and behavioural outcomes: are they impaired in children without cerebral palsy following neonatal hypoxic‐ischaemic encephalopathy?
• Early EEG Grade and Outcome at 5 Years After Mild Neonatal Hypoxic Ischemic Encephalopathy
• Perinatal hypoxia as a risk factor for psychopathology later in life: the role of dopamine and neurotrophins
• Behavioral Outcome in Children with a History of Neonatal Encephalopathy following Perinatal Asphyxia
• Late Diagnosis of Hypoxic-Ischemic Encephalopathy in a Child with Normal Apgar Scores
• Follow-up of the term infant after hypoxic-ischemic encephalopathy
• The long‐term health, social, and financial burden of hypoxic–ischaemic encephalopathy