Psychological outcome in children treated for brain tumor

Barriers to employment for young adult central nervous system tumor survivors: The role of career readiness and core self-evaluations

BACKGROUND: Although the majority of childhood cancer survivors make successful transitions to adulthood, research suggests that a significant group experiences ongoing medical concerns, such as psychological distress, that significantly impact the achievement of crucial social roles including employment. OBJECTIVE: The purpose of this study was to examine the relationship between career decision making, core self-evaluations, and perceived internal and external barriers to employment in a sample of young adult central nervous system tumor survivors. METHOD: A sample of 110 young adult survivors of pediatric central nervous system tumors was surveyed. Mediation analysis with structural equational modeling was used to correlate a number of different measures (Career Decision Making [CTI], Perceived Employment Barriers [PEB], and Core-Self Evaluations [CSE]). RESULTS: The presence of both significant direct and indirect effects of career decision making on perceived employment barriers implied that there was a partial mediating effect of core self-evaluations on the association between career readiness and employment barriers. CONCLUSION: Career decision-making is a robust construct that can be applied to young adult central nervous system tumor survivors in effort to gain more insight into the vocational psychological factors that impact career development and employment in this group. Core self-evaluations was found to be a mediator between career decision making and perceived career barriers.

Effectiveness of internet-based behavioral activation on quality of life among young adult survivors of childhood brain tumor: a randomized controlled trial

PURPOSE

Diagnosis and treatment of childhood brain tumor have detrimental effects on physical, neurocognitive, psychological, and social functioning that lasts into adulthood and effects quality of life (QOL). To address diminished QOL, an Internet-based behavioral activation (BA) intervention was developed. Behavioral activation aims to increase activities and behaviors likely to improve thoughts, mood, and QOL.

METHODS

Participants included 127 young adult survivors of childhood brain tumor (SCBT) randomized into the experimental group (n= 64) or the waitlist control group (n= 63). The dependent variables included: life satisfaction, stress, and activation and were assessed with a two-way mixed analysis of variance (ANOVA).

RESULTS

Results revealed a significant interaction between the intervention and time on life satisfaction, F(1, 125)=4.793, p = 0.03. There were no significant main effects over time for perceived stress and activation.

CONCLUSIONS

Findings offer initial evidence that BA can be delivered over the internet and that Internet-delivered BA can have a positive effect on the QOL of young adult SCBT. Internet-based BA interventions can serve as a resource for young adult SCBT who desire to boost their mood and QOL.Implications for rehabilitationBehavioral activation (BA) is aimed at increasing positively reinforcing overt behaviors that are likely to promote improved thoughts, mood, and quality of life (QOL).Results indicated study participants in the experimental group demonstrated a significant gain in life satisfaction compared to the control group after receiving the Internet-based BA intervention; and provides support that the intervention was associated with positive changes across time.Findings offer initial evidence that BA can be delivered over the internet and that Internet-delivered BA can have a positive effect on the QOL of young adult survivors of childhood brain tumor (SCBT).Internet-based BA interventions can serve as a resource for young adult SCBT who desire to boost their mood and QOL.

Development of the perceived barriers scale: a new instrument identifying barriers to career development and employment for young adult survivors of pediatric CNS tumors

PURPOSE

Given the significant employment disparities for survivors of pediatric brain tumors, there is increased need to conduct vocational and career research with this group. The purpose of the present study was to construct an instrument, the Perceived Barriers Scale, that is psychometrically sound and has both clinical and research application related to career and employment issues of pediatric brain tumor survivors.

METHOD

The participants consisted of 110 young adult central nervous system survivors of childhood cancer aged between 18 and 30 years old (M = 23.05, SD = 3.36) who were identified by the DFCI Pediatric Brain Tumor Clinic. The 12-item Perceived Barriers Scale was developed from a comprehensive literature review, clinical interviews conducted with survivors of pediatric brain tumors, and feedback from multidisciplinary providers. Exploratory factor analysis and correlations were completed to examine the initial psychometric properties of the scale.

RESULTS

Exploratory factors analysis identified two factors that accounted for 57.92% with the two factors labeled as internal barriers and external barriers. All factors loaded significantly onto their respective factors (.48 to .88). The results of the correlational analysis found significant relationships between both internal barrier and external barrier subscales and CSE and WHODAS-2 providing initial support for the construct validity of the Perceived Barriers Scale.

CONCLUSIONS

Overall, the study findings indicate good psychometrics with the brevity of the scale increasing potential application and utilization in both research and clinical settings.

IMPLICATIONS FOR CANCER SURVIVORS

Identification of employment barriers for brain tumor survivors provides opportunity for more targeted vocational intervention.

Social competence in pediatric brain tumor survivors: application of a model from social neuroscience and developmental psychology

Pediatric brain tumor (BT) survivors are at risk for psychosocial late effects across many domains of functioning, including neurocognitive and social. The literature on the social competence of pediatric BT survivors is still developing and future research is needed that integrates developmental and cognitive neuroscience research methodologies to identify predictors of survivor social adjustment and interventions to ameliorate problems. This review discusses the current literature on survivor social functioning through a model of social competence in childhood brain disorder and suggests future directions based on this model. Interventions pursuing change in survivor social adjustment should consider targeting social ecological factors.

Psychological and adjustment problems due to acquired brain lesions in pediatric patients: a comparison of vascular, infectious, and other origins

The aim of this study was to describe psychological, behavioral, and adjustment problems in children and adolescents with acquired brain lesions of different origins. Three groups of patients with acquired brain lesions (15 patients with infectious origin, 37 with vascular origin, and 15 with other origin), ranging in age from 4 to 18 years, received a psychological evaluation, including the Child Behavior Checklist for ages 4 to 18 and the Vineland Adaptive Behavior Scale. About half of the total sample (47.8%) showed psychological problems. Difficulties varied according to the cause of the brain lesions. The most problematic patients were children with brain lesions of infectious origin, whereas children with brain lesions of vascular origin scored lower on most of the Child Behavior Checklist scales. The authors conclude that psychological and behavioral difficulties are very common among school-aged children with acquired brain lesions, and their relevance and impact must necessarily be considered.

Psychological and adjustment problems due to acquired brain lesions in pre-school-aged patients

OBJECTIVE

To describe and compare psychological, behavioural and adjustment problems in pre-school patients with acquired brain lesions of different aetiology.

METHODS

Three groups of patients with acquired brain lesions (14 patients post-TBI, 18 brain tumour survivors and 23 patients with vascular or infectious brain lesions), ranging in age between 24-47 months, received a psychological evaluation, including the Child Behavior Checklist for Ages 2-3 (CBCL) and the Vineland Adaptive Behavior Scales (VABS).

RESULTS

About half of the total sample (47.2%) showed psychological and behavioural problems. Difficulties vary according to the aetiology of the brain lesions. Brain tumour survivors showed more marked internalizing problems, whereas children with vascular or infectious brain lesions scored higher on the CBCL externalizing scales. Children with traumatic brain injury reported intermediate scores on most of the CBCL scales.

CONCLUSIONS

Psychological and behavioural difficulties are very common, not only among school-aged children and adolescents, but also among pre-schoolers with acquired brain lesions. The relevance and the impact of these difficulties must necessarily be considered when developing psychological treatment and rehabilitation plans and planning for social re-entry.

Slower processing speed after treatment for pediatric brain tumor and acute lymphoblastic leukemia

BACKGROUND

Acute lymphoblastic leukemia (ALL) and brain tumor (BT) survivors are at risk for post-treatment IQ declines. The extent to which lower scores represent global cognitive decline versus domain-specific impairment remains unclear. This study examined discrepancies between processing speed and estimated IQ (EIQ) scores and identified clinical characteristics associated with score discrepancies in a sample of pediatric cancer survivors.

PROCEDURE

Survivors (50 ALL, 50 BT) ages 12-17 years completed cognitive testing. The Wechsler Abbreviated Scale of Intelligence provided an untimed measure of general reasoning ability (EIQ). The age-appropriate Wechsler Intelligence Scale provided a Processing Speed Index (PSI) score. Scores were examined and compared.

RESULTS

Survivors' PSI scores were lower than their EIQ scores (BT t(45) =6.3, p<0.001; ALL t(49) =6.9, p<0.001). For BT survivors, lower PSI scores were associated with history of craniospinal irradiation, t(44) =3.3, p<0.01. For ALL survivors, lower PSI scores were associated with male gender, grade retention, and time since diagnosis, F(3, 46) =10.1, p<0.001. Clinically significant EIQ-PSI score discrepancies were identified in 41.3% of BT and 14.0% of ALL survivors.

CONCLUSIONS

Many pediatric BT and ALL survivors exhibit slower processing speed than expected for age, whereas general reasoning ability remains largely intact. Risk factors associated with larger EIQ-PSI discrepancies include the following: BT diagnosis, craniospinal irradiation (BT only), male gender, and younger age at diagnosis (ALL only). Grade retention was frequent and associated with lower EIQ scores (both groups) and PSI scores (ALL only). Describing post-treatment cognitive declines using global measures of intellectual ability may underestimate dysfunction or fail to isolate specific underlying deficits contributing to impairment.

Comparison of intelligence quotient in children surviving leukemia who received different prophylactic central nervous system treatments

Background:

Neurocognitive deficits and decrease in intelligence quotient (IQ) is one of the complication of prophylactic central nervous system (CNS) treatment in acute lymphoblastic leukemia (ALL) patients. In this study, we compare the IQ in survivors of ALL that were treated with different prophylactic CNS treatments.

Materials and Methods:

We compared 43 long-term survivors of ALL: 21 survivors with intrathecal methotrexate (IT MTX) as CNS prophylaxis, 22 with IT MTX+1800-2400 rads cranial irradiation and 20 healthy controls. The IQ was measured using the Raven's test in these patients.

Results:

Raven's test revealed significant differences in IQ between the survivors of ALL that were treated with IT MTX, IT MTX plus cranial irradiation and control group. There was no significant difference in the IQ with respect to sex, age and irradiation dose.

Conclusion:

We can that reveal that CNS prophylaxis treatment, especially the combined treatment, is associated with IQ score decline in ALL survivors. Therefore,a baseline and an annual assessment of their educational progress are suggested.

Parent-child communication and psychological adjustment in children with a brain tumor

BACKGROUND

Internalizing problems, anxiety, depression, withdrawal, and consequent social problems are frequently observed in children with brain tumors. The objective of this work is to describe the relationship between these psychological problems and the type of parent-child communication established about the disease.

PROCEDURES

A group of 64 children surviving a brain tumor (aged 4-18 years) underwent psychological assessment by means of parent reports on the Child Behavior Checklist (CBCL) and the Vineland Adaptive Behavior Scales (VABS). A semi-structured interview with each child and their parents enabled us to classify the method of communication regarding the disease as "avoidance," "ineffective," and "effective." Demographic, clinical, and functional data relating to the disease were also collected.

RESULTS

A significant relationship between the onset of Internalizing problems, withdrawal, anxiety-depression, and social problems and the presence of avoidance or ineffective communication about the disease was observed (P = 0.001, P = 0.001, P = 0.001, and P = 0.01, respectively). These psychological problems did not prove to be associated to demographic or clinical variables; however, they were found to be related to the children's residual functional problems. By contrast, the method of communication proved to be unrelated to clinical or functional variables, but it was associated to demographic variables such as sex and age at assessment.

CONCLUSIONS

Effective (complete, truthful, consistent, comprehensible, gradual and continuous, and tailored) communication to the child about his/her condition proved to be associated with a better psychological outcome.

Are the psychological needs of adolescent survivors of pediatric cancer adequately identified and treated?

OBJECTIVES

To describe the psychological needs of adolescent survivors of acute lymphoblastic leukemia (ALL) or brain tumor (BT), we examined the following: (i) the occurrence of cognitive, behavioral, and emotional concerns identified during a comprehensive psychological evaluation and (ii) the frequency of referrals for psychological follow-up services to address identified concerns.

METHODS

Psychological concerns were identified on measures according to predetermined criteria for 100 adolescent survivors. Referrals for psychological follow-up services were made for concerns previously unidentified in formal assessment or not adequately addressed by current services.

RESULTS

Most survivors (82%) exhibited at least one concern across domains: behavioral (76%), cognitive (47%), and emotional (19%). Behavioral concerns emerged most often on scales associated with executive dysfunction, inattention, learning, and peer difficulties. Cranial radiation therapy was associated with cognitive concerns, χ(2) (1, N = 100) = 5.63, p < 0.05. Lower income was associated with more cognitive concerns for ALL survivors, t(47) = 3.28, p < 0.01, and more behavioral concerns for BT survivors, t(48) = 2.93, p < 0.01. Of the survivors with concerns, 38% were referred for psychological follow-up services. Lower-income ALL survivors received more referrals for follow-up, χ(2) (1, N = 41) = 8.05, p < 0.01. Referred survivors had more concerns across domains than non-referred survivors, ALL: t(39) = 2.96, p < 0.01; BT: t(39) = 3.52, p < 0.01. Trends suggest ALL survivors may be at risk for experiencing unaddressed cognitive needs.

CONCLUSIONS

Many adolescent survivors of cancer experience psychological difficulties that are not adequately managed by current services, underscoring the need for long-term surveillance. In addition to prescribing regular psychological evaluations, clinicians should closely monitor whether current support services appropriately meet survivors' needs, particularly for lower-income survivors and those treated with cranial radiation therapy.

ADHD and secondary ADHD criteria fail to identify many at-risk survivors of pediatric ALL and brain tumor

BACKGROUND

Post-treatment attention problems experienced by pediatric cancer survivors have been described as similar to symptoms of Attention-Deficit/Hyperactivity Disorder (ADHD) experienced in physically healthy children. Accordingly, the objectives of this study were to: (a) estimate the rate of occurrence of ADHD and secondary ADHD (SADHD) in a sample of pediatric cancer survivors, (b) compare the rate of ADHD/SADHD among survivors to the prevalence of ADHD in the general population, and (c) examine clinical correlates of ADHD/SADHD in this sample.

PROCEDURE

Survivors of pediatric ALL or brain tumor (n = 100) participated in an assessment of attention including a Computerized Performance Measure [Conners' Continuous Performance test-II (CPT-II)], parent and self-report measures (Conners 3), and a structured diagnostic interview for ADHD and other psychological disorders [Diagnostic Interview for Children and Adolescents-IV (DICA-IV)].

RESULTS

Binomial tests revealed that the rate of ADHD/SADHD in our sample (9%) was significantly greater than the lower limits of ADHD prevalence among children in the US (3%; P < 0.001), while no difference was identified compared to the upper limits of ADHD prevalence (7%; P > 0.05). Many additional survivors (>25% of the sample) obtained clinical elevations on Conners 3 scales but did not meet ADHD/SADHD criteria.

CONCLUSIONS

Attentional deficits experienced by pediatric cancer survivors do not appear to resemble the clinical presentation of ADHD or SADHD. Many survivors with cognitive and behavioral difficulties related to attention were not identified using this diagnostic approach. Findings offer needed clarification to guide researchers and clinicians in conceptualizing, assessing, and intervening on attentional late effects.

Adaptive functioning in children in the first six months after surgery for brain tumours

PURPOSE

To examine the adaptive functioning of children who underwent surgery for brain tumours with a view to analyse the related acute impairments and to describe their short-term outcome.

METHOD

We investigated adaptive functioning in 25 children (ranging from 2 to 18 years of age) for 40 days and again 3 and 6 months after they underwent surgery for various brain tumours. The Vineland Adaptive Behaviour Scales (VABS) were used to assess their adaptive functioning, considering the four main domains and all the subdomains.

RESULTS

The results remained stable over the follow-up period considered. The domain in which the scores were most severely affected was Daily Living, followed by the Socialisation and Communication domains. Within the Communication domain, the abilities investigated in the Receptive subdomain revealed the worst impairments. Within the Daily Living domain, impairments were most evident in the children's capacity to take care of themselves and handle domestic activities. In the Socialisation domain, Play and Leisure Time, and Interpersonal Relationships were the subdomains most severely impaired.

CONCLUSIONS

These findings are relevant because identifying children's adaptive functioning difficulties sooner could help their rehabilitation to be tailored and thus have a positive fallout on their long-term outcome.

Adolescent cancer survivors' smoking intentions are associated with aggression, attention, and smoking history

INTRODUCTION

The present study examines behavioral and psychosocial factors associated with smoking intentions and experimentation among adolescent survivors of pediatric cancer.

METHODS

Adolescent survivors of brain tumor and acute lymphoblastic leukemia (n  =  99) provided information about their smoking histories and their intentions to smoke in the future. Behavior rating scales were completed by survivors, parents, and teachers.

RESULTS

Past experimentation with smoking and higher levels of self-reported aggression were associated with intentions to smoke in the future (OR  =  4.18, 95% CI 1.02-17.04, and OR  =  1.08, 95% CI 1.01-1.15, respectively), while teacher-ratings of inattention in the classroom were negatively associated with intentions to smoke (OR  =  0.94, 95% CI.88-.99), all p  < .05. Experimentation with smoking was more likely among older survivors (OR  =  1.76, 95% CI 1.16-2.66, p  < .01) and those whose parents had divorced (OR  =  4.40, 95% CI 1.21-16.06, p  < .05).

DISCUSSION

A concerning minority of adolescent survivors have clear intentions to smoke, a behavior that adds to their overall health risk. Smoking intentions and experimentation are important precursors to regular smoking. Prevention efforts are needed to interrupt the progression from intentions and experimentation to established smoking and nicotine dependence in this medically vulnerable population.

IMPLICATIONS FOR CANCER SURVIVORS

Assessment of an adolescent's history of parental divorce, past experimentation with smoking, and aggressive behavior will identify those survivors who are likely to consider smoking in the future. Screening for these characteristics will allow clinicians to be more vigilant in health promotion.

Behaviour profiles after tuberculous meningitis

The purpose of the study was to investigate child behaviour in children who recovered from tuberculous meningitis (TBM) and to compare behaviour profiles of stage II and stage III patients. The mean age of the cohort of 74 children at the time of evaluation was 10 years and 7 months. At follow-up all patients underwent a thorough neurological examination and a psychometric test battery, which included intellectual assessment and evaluation of behaviour by means of the CBCL/6-18. Results indicated elevated mean scores (T > 60) on CBCL/6-18 scales which measure problems with anxiety, depression, attention, social relationships, disruptive and rule-breaking behaviour. Mean CBCL scores of stage III patients were significantly higher than the mean scores of stage II patients on scales which measure social problems, disruptive and rule-breaking behaviour. In addition, problems with conduct, attention, attention-deficit/hyperactivity problems, affective problems as well as the total problem scores were more pronounced in the patients with stage III TBM. We conclude that general behavioural disinhibitions as well as internalized emotional disorder probably are long-term complications in more than 10% of the survivors of TBM.

Attentional and executive dysfunction as predictors of smoking within the Childhood Cancer Survivor Study cohort

INTRODUCTION

Previous research has suggested that childhood cancer survivors initiate smoking at rates approaching those of healthy individuals, even though smoking presents unique risks to survivors. The present study explores whether the attentional and executive functioning (EF) deficits associated with cancer and treatment place survivors of childhood cancer at increased risk for smoking.

METHODS

Data from the Childhood Cancer Survivor Study were examined to identify concurrent and longitudinal correlates of tobacco use. We explored whether childhood attention problems and adulthood executive dysfunction were associated with smoking among adult survivors of childhood cancer.

RESULTS

Childhood attention problems emerged as a striking predictor of adult smoking nearly a decade later on average. Nearly half (40.4%) of survivors who experienced attention problems in childhood reported a history of smoking, a significantly higher rate of ever smoking, than reported by those without childhood attention problems (relative risk [RR] = 1.53, 95% CI = 1.31-1.79). Furthermore, they were nearly twice as likely to be current smokers in adulthood compared with those without childhood attention problems (RR = 1.71, 95% CI = 1.38-2.11). Similar associations were found between components of adult executive dysfunction and adult smoking.

DISCUSSION

Childhood cancer and treatment are associated with subsequent deficits in attention and EF. Early detection of these deficits will allow clinicians to identify patients who are at increased risk for smoking, an important step in promoting and maintaining health in this medically vulnerable population.

Health-related quality of life in long-term survivors of childhood brain tumors

BACKGROUND

To identify predictors for health-related quality of life (HRQOL) in survivors of childhood brain tumors and its relationship to cognitive function.

PROCEDURE

One hundred twenty-six consecutive Danish childhood brain tumor patients treated 1970-1997 and being 7.9-40.4 years at follow-up were assessed for general intelligence (IQ) and administered the Minneapolis-Manchester Quality of Life (MMQL) questionnaire.

RESULTS

In multivariate linear regression treatment with RT was the most important risk factor for reduced HRQOL. Lower scores for physical functioning and energy, social functioning, cognitive functioning, body image, outlook of life, and intimate relations were significantly related to RT. Tumor location in the posterior fossa was associated with lower scores for physical functioning and energy, and tumor site in the third ventricle region was associated with lower scores for body image. Younger age at diagnosis was associated with lower scores for social functioning and intimate relations, and younger age at follow-up was associated with more physical symptoms. When IQ was included as a covariate, RT only remained significant for social functioning and intimate relations while tumor location in the third ventricle region remained significant for body image, younger age at diagnosis for social functioning and intimate relations, and younger age at follow-up for physical symptoms. In contrasts, neither gender nor presence of hydrocephalus requiring shunt inserted predicted significantly reduced HRQOL in the multivariate analyses.

CONCLUSION

RT is an important predictor of HRQOL primarily due to its effect on general intelligence, which suggests that IQ is a strong determinant of HRQOL.

Predicting behavioral problems in craniopharyngioma survivors after conformal radiation therapy

BACKGROUND

Although radiation therapy is a primary treatment for craniopharyngioma, it can exacerbate existing problems related to the tumor and pre-irradiation management. Survival is often marked by neurologic deficits, panhypopituitarism, diabetes insipidus, cognitive deficiencies, and behavioral and social problems.

PROCEDURE

The Achenbach Child Behavior Checklist (CBCL) was used to evaluate behavioral and social problems during the first 5 years of follow-up in 27 patients with craniopharyngioma treated with conformal radiation therapy.

RESULTS

All group averages for the CBCL scales were within the age-typical range at pre-irradiation baseline. Extent of surgical resection was implicated in baseline differences for the internalizing, externalizing, behavior problem and social scores. Significant longitudinal changes were found in internalizing, externalizing, behavior problem and school scores that correlated with tumor and treatment-related factors.

CONCLUSIONS

The most common variables implicated in post-irradiation behavioral and social problems were CSF shunting, presence of an Ommaya reservoir, diabetes insipidus, and low pre-irradiation growth hormone levels.

Almost normal cognitive function in patients during therapy for childhood acute lymphoblastic leukemia without cranial irradiation according to ALL-BFM 95 and COALL 06-97 protocols: results of an Austrian-German multicenter longitudinal study and implications for follow-up

In a multicenter study the authors prospectively investigated neurocognitive function in childhood ALL patients. Sixty-six patients (mean age at diagnosis 7.9 +/- 3.6 years, 34 female), treated with repeated intrathecal and systemical methotrexate administrations without cranial irradiation, underwent psychometric testing for intelligence, concentration, and visual-motor integration postdiagnosis and after reinduction therapy. Although there was a statistically significant decline of intellectual function after reinduction therapy for younger patients and girls (IQ scores still within normative data range), there were no differences in visual-motor performance and concentration over the time of induction therapy. Thus, neurocognitive examination should focus on younger ALL patients and girls.

School experiences after treatment for a brain tumour

BACKGROUND

Children surviving a brain tumour face major difficulties including learning problems, lengthy school absences and psychosocial problems, all of which can impact on school functioning. Our aims were to provide information for parents and teachers about the skills and resources of this group. Specifically, we aimed to: describe the special educational needs of these children; document the impact of diagnosis and treatment on school attendance; compare parent and teacher assessments of social, emotional and behavioural difficulties.

METHODS

Forty families agreed to participate (response rate = 58.82%). The children (19 males and 21 females) were aged from 6 to 16 years and had completed treatment at least 2 years previously (range = 2 years-12 years 5 months). Questionnaires (Strengths and Difficulties and school experience) were completed by mothers and teachers.

RESULTS

Survivors were experiencing a wide range of physical, learning and interpersonal difficulties, according to parent and teacher reports. Almost half the children (n = 19) had ongoing neurological problems that were significant enough to require special help at school. Literacy and numeracy were the most common learning difficulties. Parents also rated brain tumour survivors as having more behavioural and emotional problems than would be expected from population norms. For example, survivors were rated as having more Total Difficulties (t = 6.86, P < 0.001), Emotional Symptoms (t = 8.82, P < 0.001), Hyperactivity (t = 2.25, P = 0.03), Peer Relationship Problems (t = 7.58, P < 0.001) and poorer Pro-social Behaviour (t = -3.34, P = 0.002) than would be expected from population norms. These problems were also seen to be having a significant impact on the child's functioning (t = 3.95, P < 0.001). Teachers rated these problems as less serious than parents.

CONCLUSION

These children experience significant problems in school some time after diagnosis and when they are considered medically cured. Closer school-hospital liaison is essential to maximize integration and achievement in these children.

Psychological and adjustment problems due to acquired brain lesions in childhood: a comparison between post-traumatic patients and brain tumour survivors

OBJECTIVE

To define and differentiate psychological and adjustment problems due to brain injury or brain tumour in children and adolescents.

METHODS

Two groups of patients with acquired brain lesions (24 post-traumatic patients and 22 brain tumour survivors), ranging in age between 8-15 years, received a psychological evaluation, including the Child Behaviour Checklist for Ages 4-18 (CBCL) and the Vineland Behaviour Adaptive Scales (VABS).

RESULTS

Both groups showed psychological and social adjustment problems. Post-traumatic patients were more impaired than brain tumour survivors. Social adjustment problems were associated to externalizing problems in post-traumatic patients and internalizing problems in brain tumour surviving patients.

CONCLUSIONS

These differences in psychological and behavioural disorders between the two groups must necessarily be considered when developing psychological treatment, rehabilitation plan and social re-entry.

Brain tumors in children and adolescents: cognitive and psychological disorders at different ages

Cognitive and psychological disorders are among the most frequently observed sequelae in brain tumor survivors. The goal of this work was to verify the presence of these disorders in a group of children and adolescents diagnosed with brain tumor before age 18 years, differentiate these disorders according to age of assessment, identify correlations between the two types of impairments and define possible associations between these impairments and clinical variables. The study involved 76 patients diagnosed with brain tumor before age 18 years. Three age groups were formed, and all the patients received a standardized battery of age-matched cognitive and psychological tests. According to our findings, all three groups present with cognitive and psychological-behavioral disorders. Their frequency varies according to age of onset and is strongly associated to time since diagnosis. The performance intelligence quotient (PIQ) was more impaired than the verbal intelligence quotient (VIQ). Internalizing problems, withdrawal and social problems were the most frequent psychological disorders. Correlations were found between cognitive impairment and the onset of the main psychological and behavioral disorders. These findings are relevant as they point out the long-term outcome of brain tumor survivors. Hence, the recommendation to diversify psychological interventions and rehabilitation plans according to the patients' age.

Factor Analysis and Validity of the Conners Parent and Teacher Rating Scales in Childhood Cancer Survivors

OBJECTIVE

To examine the factor structure of the Conners Parent Rating Scale-Revised: Short Form (CPRS-R:S) and the Conners Teacher Rating Scale-Revised: Short Form (CTRS-R:S) in children who are long-term survivors of acute lymphocytic leukemia (ALL) or brain tumors (BT)and who have received central nervous system directed treatment.

METHOD

Parents and teachers of 150 long-term survivors completed the CPRS-R:S or CTRS-R:S as part of a screening battery. The data were submitted to a maximum likelihood confirmatory factor analysis to test the construct validity of the scales and the forms were compared. The CPRS-R:S was also compared to selected subscales of the Achenbach Child Behavior Checklist (CBCL) for further validation.

RESULTS

The analyses demonstrated an adequate fit of the original three-factor structure of the CTRS-R:S [oppositional, cognitive problems/inattention, hyperactivity]. The analyses of the CPRS-R:S suggested a less adequate fit of the original three-factor structure but principal components factor analysis yielded a three-factor solution with factors similar to those of Conners' original factor structure. Significant correlations were found between the CPRS-R:S and the selected subscales of the CBCL.

CONCLUSIONS

These findings support the similar construct validity of the original CTRS-R:S and CPRS-R:S. Although significantly correlated, the CPRS-R:S and CTRS-R:S are not interchangeable in the assessment of survivors of childhood cancer.

Online exclusive: behavioral adjustment of children and adolescents with cancer: teacher, parent, and self-report

PURPOSE/OBJECTIVES

To describe behavioral adjustment in children and adolescents with acute lymphoblastic leukemia (ALL) and to determine whether behavioral adjustment is correlated with cognitive and academic abilities.

DESIGN

Descriptive, cross-sectional design.

SETTING

Two pediatric oncology treatment centers.

SAMPLE

47 children and adolescents who had been receiving ALL therapy for at least one year or who were off therapy for no more than three years and their parents and teachers. Wechsler Intelligence Scale for Children-Revised (WISC-R) and Wide Range Achievement Test-Revised (WRAT-R) data were available on a subset of 17 subjects.

METHODS

Parent, teacher, and self-report Behavioral Assessment System for Children (BASC) ratings were used to measure behavioral adjustment. WISC-R measured cognitive abilities, and WRAT-R measured academic abilities. Demographic, family, and treatment-related data also were collected.

MAIN RESEARCH VARIABLES

Behavioral adjustment and cognitive and academic abilities.

FINDINGS

At least 20% of teacher ratings for somatization, learning problems, leadership, and study skills; parent ratings for somatization, adaptability, attention problems, withdrawal, anxiety, social skills, and depression; and self-report ratings for anxiety and attitude to school were in the at-risk range (i.e., presence of significant problems that require treatment). The majority of teacher BASC ratings were correlated significantly with WISC-R and WRAT-R scores. Self-report depression and social stress ratings were correlated significantly with some WISC-R and WRAT-R scores. Treatment-related experiences such as body image alterations and mental and emotional problems were associated with problematic behaviors, including depression, somatization, withdrawal, and social stress.

CONCLUSIONS

Youth with ALL are at risk for some behavioral adjustment problems, particularly anxiety, somatization, adaptability, attention, and withdrawal. Cognitive and academic abilities are associated with some dimensions of behavioral adjustment.

IMPLICATIONS FOR NURSING

Findings suggest the need for ongoing assessment of behavioral adjustment and cognitive and academic abilities of children with ALL. Behavioral interventions that target at-risk mannerisms, such as somatization, depression, anxiety, and social stress, are needed. Central nervous system treatment may contribute to behavioral adjustment problems, as well as to cognitive and academic problems. Strategies to improve academic abilities also may have a positive effect on behavioral adjustment.

Psychosocial and behavioral functioning among pediatric brain tumor survivors

OBJECTIVE

To describe the psychosocial and behavioral functioning, as described by patient, parent and teacher, of a cohort of adolescents who have been previously treated for a brain tumor.

METHODS

A cohort of 32 patients, 12-18 years old, were evaluated between 1 and 5 years post-treatment for brain tumor during the patient's regularly scheduled follow-up clinic appointment at the Dana-Farber Cancer Institute. The Self-Report questionnaire and the Parent-Report of the Behavioral Assessment System for Children (BASC) were administered to the patient and to one of the patient's parents, respectively. In addition, the BASC Teacher-Report was completed by the patient's teacher. Descriptive statistics were generated; binomial distribution analyses were carried out to assess whether the proportion of individuals with impaired performance on each measure exceeded normative expectations.

RESULTS

Comparison of the proportion of patients with elevated scores to normative expectations indicated no excess of elevated scores on any of the BASC scales of the Self-Report. However, parents endorsed items in the areas of attention problems and leadership; teachers endorsed items concerning learning problems; and both parents and teachers endorsed items indicative of somatization behaviors.

CONCLUSIONS

Parent and teacher feedback indicate some level of psychosocial and behavioral morbidity for adolescents treated for a brain tumor; this finding contrasts with adolescent Self-Report indicating no difficulties in behavioral and psychosocial functioning. The extent to which these vulnerabilities impact quality of life and the discrepancy between reporters should be assessed in follow-up studies with a larger cohort of patients.

Survivors of childhood brain tumors: behavioral, emotional, and social adjustment

This paper reviews the literature on the psychological adjustment and quality of life in children who survive brain tumors. A total of 31 studies were reviewed. Findings are discussed in terms of the rates of general psychological adjustment, internalizing behavior problems, externalizing behavior problems, social competence, correlates or predictors of adjustment, and quality of life among survivors. Although these survivors appear to be at risk for compromised social competence and long-term quality of life, reports in the literature on rates of psychological adjustment in this population vary widely. Limitations in the current literature are discussed including inadequate assessment techniques, lack of appropriate comparison groups, and small sample sizes. Directions for future research are offered.

Eine Übersicht über kognitiv, behaviorale und psychosoziale Langzeitfolgen nach pädiatrischen Hirntumoren

Zusammenfassung. In diesem Beitrag wird ein Überblick über die kognitiven, behavioralen und psychosozialen Langzeitfolgen bei Kindern und Jugendlichen mit Hirntumoren gegeben. In der Übersicht wird deutlich, daß die kognitiven Leistungen der pädiatrischen Hirntumor-Patienten (insb. nach Radiatio) deutlich stärker beeinträchtigt sind als bei Kindern mit Leukämieerkrankung nach ZNS-Bestrahlung. Verbunden damit, aber auch aufgrund der großen Häufigkeit von Verhaltensauffälligkeiten, wird die schulische Reintegration als schwierig beschrieben. Die massiven kognitiven Beeinträchtigungen und Verhaltensauffälligkeiten der Hirntumor-Kinder machen die Notwendigkeit der Konzeption und Evaluation von Rehabilitations- und Beratungsmaßnahmen für die betroffenen Kinder und ihre Eltern deutlich.

Review of research studies that evaluated the impact of treatment for childhood cancers on neurocognition and behavioral and social competence: nursing implications

ISSUES AND PURPOSE

Given the increasing incidence of childhood cancer, increasing survivor rates, and documented incidence of sequelae, nurses need evidence on which to base interventions for families at risk. The authors review and critique research studies that evaluated the impact of treatment for childhood cancers. Implications for nursing practice are discussed.

CONCLUSIONS

Research to evaluate the effects of treatment on neurocognition and behavioral and social competency of children with cancer has produced conflicting results. Most studies found deleterious effects on all three areas associated with childhood cancer treatment. Some studies, however, found no differences between childhood cancer survivors and children on therapy compared to normative data or healthy controls.

PRACTICE IMPLICATIONS

Knowledge of the short- and long-term impact of treatment for childhood cancer on neurocognition and behavioral and social competence allows nurses to design interventions that mitigate neurocognitive effects, decrease behavioral problems, and improve social competence.