The contribution of neurocognitive functions to academic and psychological outcomes in pediatric cancer: A latent profile analysis

This study aimed to identify the impact of neurocognitive functioning on academic and psychological domains using a novel person-centered latent profile analysis approach. We further examined the contribution of identified risk factors (e.g., age at diagnosis, treatment) on latent class membership. 101 pediatric oncology patients and survivors (M age = 11.2, 35.6% female; 47.5% African American; M time since diagnosis = 3.4 years) completed neuropsychological evaluations at a university medical center between February 2004 and June 2017. Neurocognitive, academic, and emotional-behavioral functioning were examined using validated measures. Discreet, homogenous neurocognitive subgroups (latent classes) were identified using latent profile analysis. Demographic and medical factors were evaluated as predictors of latent class. A 3-class model indicated excellent class separation (range: .00-.04) and homogeneity (range: .94-.99). Classes were distinguished by differential cognitive patterns. Class 2 (52%) and Class 3 (25%) displayed overall normative functioning; however, Class 3 displayed significantly poorer attention than the other two classes. Class 1 (23%) demonstrated Borderline neurocognitive, low average academic, and poorer emotional-behavioral and inhibition/executive control functioning. Class membership was predicted by race and whole brain radiation dose. Latent profile analysis identified discrete groups in neurocognitive functioning in this heterogeneous pediatric cancer population. Class membership was predicted by race, whole brain radiation dose, and referral source. Other medical variables (e.g., diagnosis, age at diagnosis) were not significant predictors of neurocognitive function in our sample.

Manualized and Modular Behavior Therapy for a Child With Tourette’s Disorder, Inattention, and Disruptive Behavior

Persistent tic disorders (PTDs), including Tourette’s Disorder (TD), involve motor and/or vocal tics and often cause significant impairment and distress for affected individuals and families. Functional impairment is typically greater among individuals with PTDs and comorbid disorders. The current gold standard behavioral intervention for tic disorders, Comprehensive Behavioral Intervention for Tics (CBIT), has demonstrated efficacy in randomized clinical trials. Complications introduced by comorbidities, however, potentially facilitate less optimal long-term outcomes using this treatment approach. This case study describes the implementation of CBIT and subsequent modularized parent training for an 8-year-old boy diagnosed with TD who also exhibited comorbid symptoms of inattention, hyperactivity, and oppositional behavior. Emphasis is placed on delineating treatment decisions, including the sequencing of specific techniques, in accord with algorithms for complicated PTD presentations discussed in the literature.

Treating Trichotillomania (Hair-Pulling Disorder) in a Child

Although cognitive behavioral treatments (CBTs) have been recommended as first-line interventions for trichotillomania (hair-pulling disorder [HPD]), research on CBT for young children with HPD is limited. We illustrate the use of family-based CBT for HPD in an 8-year-old boy. The client had a 5-year history of chronic HPD and several large bald spots on the crown of his head. Treatment primarily comprised habit reversal training (HRT) and function-based interventions. The child showed significant improvement in HPD severity and impairment after 8 weekly sessions, although complete abstinence was not achieved. The findings underscore the importance of parental involvement in the treatment and show that children as young as 8 years of age can successfully use strategies taught in HRT.

Anxiety and Psychosocial Concerns in Alopecia Areata

Alopecia areata (AA), or hair loss on the scalp and body, affects approximately 1 in 1,000 people. Psychological distress has been hypothesized as a determining factor of AA. Researchers evaluating psychological disorders in the development and course of AA have found equivocal results. Furthermore, few studies have evaluated parental distress in relation to childhood AA. Case studies have shown the benefit of behavioral techniques for adults with AA; however, no studies have examined the role of behavioral interventions on child and parent coping abilities in AA. This brief case report will discuss the treatment of child-reported and parent-reported psychological distress in a child with AA. Significant reductions in child anxiety and social concerns were found over the course of treatment. This case report provides support for the use of behavioral techniques for the treatment of psychological distress experienced secondary to a child's diagnosis of AA.

Future Directions for the Implementation and Dissemination of Statewide Developmental-Behavioral Pediatric Integrated Health Care

The integration of mental health and pediatric health care services has long been a goal for both research and practice. With the advent of federal policies developed to mandate clinical efficiency across the health care spectrum, this issue is becoming more salient. Applied literature on this topic is only recently emerging, however, and there are limited contextual examples to guide program development, research, and refinement. This article presents background information relevant to the development of such a program (the Center for Advancement of Youth). The cultural and organizational contexts for the project are discussed, with particular emphasis on models for cooperation among several institutions of varying size and scope. The implications for the future of tangible research in this area are also discussed, with attention to extending lessons learned to diverse settings motivated to integrate various aspects of health care service provision.

Quality of life among pediatric patients with cancer: Contributions of time since diagnosis and parental chronic stress

BACKGROUND

Pediatric cancer is associated with a host of negative psychosocial consequences; however, outcomes vary extensively suggesting a need to better understand this variation. Empirical research suggests a positive association between time since diagnosis (TSD) and Quality of Life (QoL). In addition to TSD, family stressors have been found to be particularly important in predicting QoL among children. The current study examined parental chronic stress beyond TSD in explanation of QoL functioning among a sample of pediatric patients with cancer.

PROCEDURE

Participants included 43 pediatric patients aged 5-18 years (M(age) = 10.2 ± 3.6) who were undergoing oncological treatment. Parents reported on TSD, child's QoL, and their own chronic stress.

RESULTS

TSD was associated with greater physical functioning (r = 0.30, P < 0.05). Parental chronic stress was associated with poorer emotional (r = -0.54, P < 0.01), physical (r = -0.41, P < 0.01), and social functioning (r = -0.44, P < 0.01). Further, hierarchal linear regression analyzes indicated parental chronic stress contributed incrementally beyond TSD in the explanation of physical (β = -0.37, t = -2.58, P < 0.01), emotional (β = -0.47, t = -3.51, P < 0.00), and social functioning (β = -0.38, t = -2.67, P < 0.01).

CONCLUSIONS

Parental chronic stress is associated with reduced levels of emotional, physical, and social functioning among pediatric patients. Future research is needed to further investigate the process by which chronic stress within the family interferes with adaptive coping among pediatric patients. In addition, clinical services may benefit from increased consideration of family factors, such as parental chronic stress, during oncological treatment.

Associations among emergency room visits, parenting styles, and psychopathology among pediatric patients with sickle cell

BACKGROUND

To examine associations between frequency of emergency room (ER) visits and various parenting styles, both conjointly and interactively, and psychopathological outcomes among pediatric patients with sickle cell disease (SCD).

PROCEDURES

Ninety-eight parents/caregivers of 6- to 18-year-old patients with SCD completed instruments assessing parenting style, child psychopathology, and reported on the frequency of ER visits during the previous year.

RESULTS

ER visits were found to significantly explain Withdrawn/Depressed problems and parenting styles were found to incrementally contribute to the explanation of all forms of psychopathology. Further, Permissive parenting was found to explain Rule Breaking Behavior for those patients with low ER visit frequency but not for those with high ER visit frequency.

CONCLUSIONS

Results of the current study confirm the importance of considering both the frequency of ER visits and parenting style in the explanation of psychopathology among pediatric patients with SCD. Results have important implications for both research and treatment.

Emotion: empirical contribution. Maternal borderline personality pathology and infant emotion regulation: examining the influence of maternal emotion-related difficulties and infant attachment

Evidence suggests that maternal borderline personality (BP) pathology increases offspring risk. This study examined the relations between maternal BP pathology and related emotional dysfunction (including emotion regulation [ER] difficulties and emotional intensity/reactivity) and infant ER difficulties. Specifically, we examined both self-focused and caregiver-focused ER behaviors and the modulation of emotional expressions (one indicator of ER in young children) in response to fear- and anger-eliciting stimuli among 101 infants (12 to 23 months old) of mothers with and without clinically relevant BP pathology. The authors also examined the moderating role of mother-infant attachment. Findings of a series of multiple regression mediation analyses revealed an indirect effect of maternal BP pathology on infant ER difficulties through maternal emotional dysfunction, with maternal ER difficulties facilitating an indirect effect of maternal BP pathology on expressivity-related indicators of infant ER difficulties and maternal emotional intensity/reactivity linking maternal BP pathology to lower self-focused ER for infants in insecure-resistant attachment relationships.

Developmental function in toddlers with sickle cell anemia

BACKGROUND

Neurocognitive impairment occurs in children and adults with sickle cell anemia, but little is known about neurodevelopment in very young children. We examined the neurodevelopmental status of infants participating in the Pediatric Hydroxyurea Phase III Clinical Trial (Baby Hug) to determine relationships with age, cerebral blood flow velocity, and hemoglobin concentration.

METHODS

Standardized measures of infant neurodevelopment were administered to 193 infants with hemoglobin SS or hemoglobin S-β(0) thalassemia between 7 and 18 months of age at the time of their baseline evaluation. Associations between neurodevelopmental scores and age, family income, parent education, hemoglobin concentration, and transcranial Doppler velocity were examined.

RESULTS

Mean functioning on the baseline neurodevelopment scales was in the average range. There were no mental development scores <70 (impaired); 22 children had scores in the clinically significant range, 11 with impaired psychomotor scores and 11 with problematic behavior rating scores. Significantly poorer performance was observed with older age at baseline. Behavior rating scores were an average of 2.82 percentile points lower per month of age, with similar patterns observed with parent report using adaptive behavior scales. Parent-reported functional abilities and hemoglobin were negatively associated with higher transcranial Doppler velocities.

CONCLUSIONS

Whereas overall functioning was in the normal range, behavioral and adaptive function was poorer with older age, even in this very young group of children. Explanatory mechanisms for this association between poorer developmental function and older age need to be identified.

Examination of risk and resiliency in a pediatric sickle cell disease population using the psychosocial assessment tool 2.0

OBJECTIVE

To evaluate the Psychosocial Assessment Tool 2.0 (PAT) as an appropriate screening measure of risk for patient and family psychological distress in pediatric sickle cell disease (SCD).

METHODS

219 caregivers completed the PAT during regular hematology clinic visits. Confirmatory factor analysis and tests of reliability were conducted. Multilevel modeling examined change and predictors of risk scores across four assessments.

RESULTS

Confirmatory factor analysis factor loadings ranged from .03 to .81, and reliability coefficients ranged from .43 to .83. Risk for patient and sibling emotional problems, family problems, and parent stress reaction decreased over time. Increased patient age, chronic blood transfusion, lower caregiver education, caregivers being divorced, fewer adults and more children in the home, and greater financial difficulties were independent predictors of psychosocial risk.

CONCLUSIONS

Results suggest that the PAT has utility in a pediatric sickle cell disease sample. Most caregivers reported low distress and high resiliency factors in this population.

Guidance for New Motivational Interviewing Trainers When Training Addiction Professionals: Findings from a Survey of Experienced Trainers

Evidence-based practices, such as motivational interviewing (MI), are not widely used in community alcohol and drug treatment settings. Successfully broadening the dissemination of MI will require numerous trainers and supervisors who are equipped to manage common barriers to technology transfer. The aims of the our survey of 36 MI trainers were: 1) to gather opinions about the optimal format, duration, and content for beginning level addiction-focused MI training conducted by novice trainers and 2) to identify the challenges most likely to be encountered during provision of beginning-level MI training and supervision, as well as the most highly recommended strategies for managing those challenges in addiction treatment sites. It is hoped that the findings of this survey will help beginning trainers equip themselves for successful training experiences.

The relationship between single-parent status and parenting capacities in mothers of youth with chronic health conditions: the mediating role of income

OBJECTIVE

To retrospectively examine the relationship of single-parent status to parenting capacity variables in mothers of youth with a chronic health condition.

METHODS

Parental overprotection, perceived vulnerability, and parenting stress were assessed in 383 mothers (308 married and 75 single parents) of youth with one of six chronic health conditions (i.e., type 1 diabetes, asthma, cancer, cystic fibrosis, hemophilia, or sickle cell disease).

RESULTS

Single mothers evidenced higher levels of both perceived vulnerability and parenting stress, but not overprotection, than married parents. These differences disappeared in the presence of income as a predictor.

CONCLUSIONS

Single parents appear to evidence differences in parenting capacity; however, low income appears to account in large part for the higher level of risk associated with single-parent status.

Gender Differences in Incidence Rates of Childhood B-Precursor Acute Lymphocytic Leukemia in Mississippi

The authors studied pediatric patients with B-precursor acute lymphocytic leukemia (ALL) to determine whether Mississippi’s gender incidences correlate with national statistics. Furthermore, data on gender incidences in each of the risk categories of low, standard, and high were collected. A retrospective chart review was performed of pediatric B-precursor ALL patients diagnosed at the Children’s Cancer Clinic at the University of Mississippi Medical Center from 1995 to 2005. The gender incidences in Mississippi were found to be comparable with the national average for ALL (1.34:1 vs 1.3:1) overall. However, the national average includes T-cell ALL, which is known to be significantly more prevalent in boys. Of greater significance, boys were noted to present with high-risk B-precursor ALL 4 times more than girls, suggesting the need for further investigation into possible causes of this phenomenon.

Parenting children with food allergy: preliminary development of a measure assessing child-rearing behaviors in the context of pediatric food allergy

BACKGROUND

Food allergy affects up to 8% of children and is increasingly common. Although adult caregivers initially assume the primary role in children's daily allergy management activities, as children approach school age they assume greater responsibility for the prevention of allergic exposures. The ways that parents prepare children for this transition are likely to influence children's subsequent risk for allergic exposures, yet few studies have examined parent behaviors in the context of pediatric food allergy.

OBJECTIVE

To develop a brief measure to evaluate specific parenting practices related to caring for a child with food allergy.

METHODS

A total of 292 primary caregivers of food-allergic children completed an Internet-based survey that included the Parenting Children with Food Allergy (PCFA) questionnaire.

RESULTS

Factor analysis of the PCFA items suggested 3 factors that accounted for 98% of the variance: autonomy support, protection/monitoring, and emergency education. Internal consistencies for the 3 scales were acceptable (alpha = .79, .73, and .82, respectively). Child age and medical variables (history of emergency epinephrine use, perceived severity of worst allergic reaction, and number of different food allergies) were associated with parenting practices.

CONCLUSION

Although additional psychometric data for the PCFA are needed, preliminary findings suggest that this measure may be useful in evaluating parenting within the context of pediatric food allergy.

Behavioral Inhibition and Its Relation to Anxiety and Depression Symptoms in Adolescents With Sickle Cell Disease: A Preliminary Study

Several investigations have found support for the role of behavioral inhibition in the etiology of childhood anxiety and depression disorders. However, nothing is known about how this relation extends to children with a chronic, life-threatening illness. The purpose of the current study was to examine behavioral inhibition and its relation to anxiety and depression symptoms among 30 adolescents with sickle cell disease (SCD). Adolescents with SCD and their primary caregivers completed instruments assessing demographic information, behavioral inhibition, and anxiety and depression symptoms. A majority of adolescents with SCD classified themselves as middle or low on behavioral inhibition. Adolescents with SCD who classified themselves as high on behavioral inhibition displayed higher levels of anxiety and depression than adolescents with SCD who classified themselves as low on behavioral inhibition; adolescents with SCD endorsing the middle behavioral inhibition category generally scored in between. These data extend previous work with healthy children and adolescents and suggest that early and continued assessment of behavioral inhibition may be important in preventing adverse psychological outcomes among a group that is already at risk for internalizing disorders.

Predictors of health-harming and health-protective behaviors in adolescents with cancer

BACKGROUND

Given adolescent cancer survivors' increased susceptibility to late effects, it is imperative that we understand factors that influence their engagement in healthy and unhealthy behaviors. The purpose of this exploratory study was to identify significant predictors of health-harming and health-protective behaviors in adolescent cancer patients.

PROCEDURE

Forty-two adolescents (ages 12-19 years) currently on-treatment for cancer and their parents were recruited from outpatient pediatric cancer clinics. Adolescents completed a battery of questionnaires that assessed their health-behaviors, quality of life, and psychological distress, while parents completed a demographic questionnaire.

RESULTS

Regression analyses indicated that specific demographic, illness, and psychosocial variables significantly predicted health-harming and health-protective behaviors. Older adolescent age and unmarried parent status emerged as the best predictors of adolescent health-harming behaviors, whereas married parent status, increased adolescent time since diagnosis, increased adolescent-rated quality of life, and increased distress emerged as the best predictors of health-protective behaviors.

CONCLUSIONS

Demographic, illness, and psychosocial variables may help inform the development of interventions designed to promote the initiation and/or maintenance of good health practices among adolescents on-treatment for cancer. Interventions are needed that target health behaviors while adolescents are approaching treatment completion, in order to help facilitate the practice of good health practices in survivorship.

Religiosity and coping in mothers of children diagnosed with cancer: an exploratory analysis

Although several factors related to coping in parents of children diagnosed with cancer have been explored, little is known about their religious beliefs and behavior and its relationship to coping. The purpose of this study was to provide preliminary data on the religious beliefs and behaviors of mothers of children with cancer and the relation to their psychological adjustment. Twenty-seven mothers of children diagnosed with cancer completed several measures of religious beliefs and behaviors as well as the Beck Depression Inventory-II. The sample was highly religious and specifically Christian. Thirty percent of the mothers reported elevated levels of depressive symptoms, and these mothers reported lower levels of religious belief and behavior than the mothers who denied depressive symptoms. These data suggest a relationship between religiosity and positive coping behavior that should continue to be explored.

Single parents of children with chronic illness: an understudied phenomenon

OBJECTIVE

To examine the chronic illness literature and evaluate the impact on single parenting and children and adolescents with chronic illness.

METHODS

We conducted literature reviews of relevant research pertaining to single-parent families on PubMed, Medline, and PsychINFO and also surveyed pertinent book chapters and all of the articles from the Journal of Pediatric Psychology since 1987 for articles, specifically examining the potential associations of single (lone) parenting versus two-parent households on children's psychosocial functioning and the impact of the child's illness on caregiver functioning.

RESULTS

While the literature has examined and discussed the stressors associated with parenting a child with an illness, including the impact of illness on finances, family roles, and caregiver burden, few studies have examined single parents of children and adolescents with chronic illnesses and related stressors stemming from being a lone caregiver.

CONCLUSIONS

There is a dearth of studies examining the association between lone parenting and psychosocial functioning among children and adolescents with chronic illnesses. Specific questions necessitating future investigation are summarized and recommendations are made for future research in this important area of inquiry.

Dietary essential fatty acids and gender-specific behavioral responses in cranially irradiated rats

Specific memory deficits, reduced intellectual processing speed, and a variety of social and behavioral problems have been implicated as long-term effects of cranial radiation therapy (CRT). These deficits are thought to be related to changes in brain cytology and structure associated with microvascular aberrations. N-3 fatty acids may serve as protectants in pediatric patients who receive CRT for brain tumors. Timed-pregnant rat dams were fed one of four diets that were identical in all respects, except for their essential fatty acid content. The dams were placed on these diets at the beginning of the third trimester of gestation and their pups remained on them throughout the study. The rats' behavioral response as judged by acoustic startle response (ASR) and neurocognitive response (performance in a radial maze, RM) were evaluated in relation to diet, gender, and CRT. The following hypotheses were tested: (1) female rats will show greater CRT-induced neurocognitive and behavioral deficits; (2) dietary n-3 fatty acids will diminish CRT-induced neurocognitive and behavioral deficits; (3) gender-specific differences would be dampened by n-3 fatty acids in the diet. All three hypotheses were partially supported. These findings are discussed in light of the potential neuroprotective effects of n-3 fatty acids.

Longitudinal neurocognitive outcome in an adolescent with Hurler-Scheie syndrome

An adolescent with Hurler-Scheie syndrome is reported. This now 15 year-old-young woman was initially diagnosed at age 4. She was assessed for neurocognitive functioning at ages 5, 13, and 15 years. Results show a significant decline in intellectual functioning from the superior range to the average range from age 5 to age 13, and then no change from age 13 to age 15. The relationship between Hurler-Scheie syndrome, premorbid intellectual functioning, and cognitive-behavioral interventions are discussed in light of the longitudinal neurocognitive effects of this disease.

Insurance barriers for childhood survivors of pediatric brain tumors: the case for neurocognitive evaluations

OBJECTIVE

The purpose of the present study was to provide empirical evidence of system-based barriers to psychological services for pediatric brain tumor patients when they are medically indicated.

METHOD

Insurance claims data covering 263,866 insured lives during the 1996 fiscal year were pooled from a cross-sectional national sample of adults and their families insured by private insurance companies or self-insured firms. Based on inclusion criteria, records for 209 pediatric brain tumor patients aged 18 and under were extracted and analyzed. Claims data including total amount of payments made on behalf of a member, total length of hospital stays, and total number of unique admissions were recorded for all patients, and current procedural terminology (CPT) codes were analyzed to determine frequency of payment for routinely billed psychological procedures. Results were then compared to the frequency of payment for routinely billed psychological procedures for children with other medical conditions.

RESULTS

Results indicate that two of the CPT codes commonly associated with neurocognitive evaluations were reimbursed by these third-party payers for pediatric brain tumor patients during the 1996 fiscal year. Additionally, seven of the CPT codes commonly associated with psychological therapy were also reimbursed.

CONCLUSIONS

The present findings provide empirical evidence of system-based obstacles (i.e., lack of third-party reimbursement) for medically indicated psychological services in pediatric brain tumor patients.

Nocturnal enuresis and psychosocial problems in pediatric sickle cell disease and sibling controls

To evaluate current and lifetime prevalence rates of nocturnal enuresis and psychosocial problems among children with sickle cell disease (SCD) in comparison with sibling controls, a structured interview and the Pediatric Symptom Checklist were administered to primary caretakers regarding 126 of their children aged 5 to 17 with SCD and 47 sibling controls. Lifetime rates of enuresis among children with SCD were comparable to similar studies, and exceeded population prevalence and sibling control rates. In addition, enuretic children had higher levels of total psychosocial problems on the Pediatric Symptom Checklist regardless of group status, although patterns of subscale differences varied by group and enuresis history after controlling for child age. These findings replicate and extend previous findings and provide further evidence to support a need for monitoring of hydration levels and screening for psychosocial problems among children with SCD and enuresis, as well as evaluation of the psychometric properties of psychosocial screening measures and identification of efficacious treatments for enuresis in children with SCD.

Factor analysis of the Pediatric Symptom Checklist with a chronically ill pediatric population

The psychometric properties and factor structure of a widely used screening measure for behavioral and emotional dysfunction, the Pediatric Symptom Checklist (PSC), was extended to a population of chronically ill children. Parents of 404 children ranging from 6 to 17 years of age and diagnosed with either insulin-dependent diabetes mellitus (IDDM) or sickle cell disease (SCD) completed the PSC while waiting for a routine medical appointment. The measure's internal consistency was found to be high, Cronbach's alpha = .89, and test-retest reliability across 4 months was observed to be acceptable, r = .77. A principal components analysis with an oblique (promax) rotation yielded a four-factor solution with factors that included items representative of internalizing, externalizing, attention, and chronic illness-related problems, respectively. Cronbach alpha estimates ranged from .78 to .83 for the first three factors but was lower for the chronic illness-related problems factor (Cronbach's alpha = .60). A three-factor solution and reliability estimates were recomputed without the chronic illness items that yielded the same reliability estimates for each of the three factors and for the full scale. The three-factor solution was also found to be similar to a published factor structure obtained with a primary care sample, r(c) = .90-.91. The findings lend support to extending the PSC's clinical utility to tertiary care pediatric settings. Further research is recommended with a broader range of chronic illness groups to increase generalizability.

Risk of Posttraumatic Stress Symptoms: A Comparison of Child Survivors of Pediatric Cancer and Parental Bereavement

OBJECTIVE

To compare the risk of posttraumatic stress (PTS) symptoms and the mediating effect of perceived future threat on the risk of PTS symptoms among survivors of pediatric cancer and children who had a parent die.

METHODS

Seventy-eight children (39 survivors of cancer, 39 bereaved) completed self-report measures of PTS symptoms, depression, anxiety, and perceived risk of future threat for the event they experienced.

RESULTS

The children who lost a parent reported significantly more PTS symptoms than the survivors of cancer. The effect of group status (survivor of cancer vs. bereaved) on PTS symptomatology was partly mediated by the children's perceived risk of future threat.

CONCLUSIONS

The rate of PTS symptoms was found to be higher among children who had lost a parent than among survivors of pediatric cancer. This difference may partly be explained by their perceived risk of a future threat. Clinical implications are discussed.

Predictors of Children’s and Adolescents’ Risk Perception

OBJECTIVE

To test cognitive-developmental, social-cognitive, motivational, and cognitive hypotheses about the psychological mechanisms underlying children's risk perception.

METHOD

Youth (N = 1315) ranging from 9 to 17 years of age completed measures assessing adolescent egocentrism, personal experience with four negative health events, how much they worried about the health events, and their perceived skill for event-related activities. The measures were completed twice, 12 months apart.

RESULTS

Lacking personal experience with and worrying less about health threats were significant predictors of more optimistically biased risk perception a year later.

CONCLUSIONS

The lack of experience with and not worrying about serious health consequences may desensitize children to potential health risks. Clinical applications for health education programs are discussed.

Academic outcomes in children with congenital heart disease

Congenital heart disease (CHD) is often associated with intellectual, developmental, and academic late effects related to the diagnosis itself and treatment. This literature review examines what is currently understood about these intellectual and academic deficits. It appears that children with CHD, and particularly those with cyanotic CHD, are at risk for significant impairments in visual spatial skills, visual motor skills, and overall processing speed. Early neurocognitive interventions, especially with younger children, may prove beneficial for remediating some of these deficits.

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.

Non-adherence in pediatric transplantation: a review of the existing literature

The degree of medical adherence in pediatric solid-organ transplant recipients frequently correlates with the degree of psychological distress, family functioning, and the physiological side-effects of immunosuppressant medications. This article examines the current literature regarding each of these factors and proposes recommendations for increasing the medical compliance among childhood transplant recipients.

Neurocognitive deficits in medulloblastoma survivors and white matter loss

Although previous studies have documented a significant risk of intellectual loss after treatment for childhood medulloblastoma (MED), the pathophysiology underlying this process is poorly understood. The purpose of this study was to test the hypotheses that (1) patients treated for MED in childhood have reduced volumes of normal white matter (NWM) related to their treatment with craniospinal irradiation with or without chemotherapy, and (2) deficits in NWM among patients surviving MED can at least partially explain deficits in their intellectual performance. Eighteen pediatric patients previously treated for MED were matched on the basis of age at the time of evaluation to 18 patients previously treated for low-grade posterior fossa tumors with surgery alone (mean difference, 3.7 months). Evaluations were conducted with age-appropriate neurocognitive testing and quantitative magnetic resonance imaging by using a novel automated segmentation and classification algorithm constructed from a hybrid neural network. Patients treated for MED had significantly less NWM (p < 0.01) and significantly lower Full-Scale IQ values than those treated for low-grade tumors (mean, 82.1 vs 92.9). In addition, NWM had a positive and statistically significant association with Full-Scale IQ among the patients treated for MED. We conclude that irradiation- or chemotherapy-induced destruction of NWM can at least partially explain intellectual and academic achievement deficits among MED survivors.

A hybrid neural network analysis of subtle brain volume differences in children surviving brain tumors

In the treatment of children with brain tumors, balancing the efficacy of treatment against commonly observed side effects is difficult because of a lack of quantitative measures of brain damage that can be correlated with the intensity of treatment. We quantitatively assessed volumes of brain parenchyma on magnetic resonance (MR) images using a hybrid combination of the Kohonen self-organizing map for segmentation and a multilayer backpropagation neural network for tissue classification. Initially, we analyzed the relationship between volumetric differences and radiologists' grading of atrophy in 80 subjects. This investigation revealed that brain parenchyma and white matter volumes significantly decreased as atrophy increased, whereas gray matter volumes had no relationship with atrophy. Next, we compared 37 medulloblastoma patients treated with surgery, irradiation, and chemotherapy to 19 patients treated with surgery and irradiation alone. This study demonstrated that, in these patients, chemotherapy had no significant effect on brain parenchyma, white matter, or gray matter volumes. We then investigated volumetric differences due to cranial irradiation in 15 medulloblastoma patients treated with surgery and radiation therapy, and compared these with a group of 15 age-matched patients with low-grade astrocytoma treated with surgery alone. With a minimum follow-up of one year after irradiation, all radiation-treated patients demonstrated significantly reduced white matter volumes, whereas gray matter volumes were relatively unchanged compared with those of age-matched patients treated with surgery alone. These results indicate that reductions in cerebral white matter: 1) are correlated significantly with atrophy; 2) are not related to chemotherapy; and 3) are correlated significantly with irradiation. This hybrid neural network analysis of subtle brain volume differences with magnetic resonance may constitute a direct measure of treatment-induced brain damage.

The effect of Achievement orientation on response to success and failure in pediatric cancer patients

OBJECTIVE

To assess the effects of different cognitive orientations focused on social comparison or self-comparison, followed by success or failure feedback, on mood, task persistence, and task difficulty choice in children with cancer.

METHOD

Children with cancer (N = 79) and a group of age-matched controls (N = 72 were randomly assigned in a 2 (Achievement Orientation) x 2 (Feedback) between-subjects design.

RESULTS

Between-group differences revealed that children with cancer chose more difficult tasks for the future than those in the comparison group, while the comparison subjects chose to persist longer with the problems than did children with cancer, with no significant differences on measures of mood.

CONCLUSIONS

The beneficial effects of achievement orientation as a clinical manipulation may not be as robust as expected with a medically ill population, due to the apparent stability of achievement orientations.

Psychological functioning of adolescent and young adult survivors of pediatric malignancy

OBJECTIVE

To assess the psychological functioning of adolescent and young adult survivors of pediatric malignancy, and identify risk factors for maladjustment.

DESIGN

Patients age > or = 14.5 years (N = 161) receiving surveillance follow-up at a major pediatric cancer center completed the SCL-90-R, a self-report measure of psychological symptomatology. Comparisons were made with the normative standardization sample, and the relationship of selected demographic and medical variables with psychological distress was explored using logistic regression analyses.

RESULTS

Survivors mean scores on all SCL-90-R subscales were lower than those of the standardization sample, and the distribution of scores on the Anxiety, Psychoticism, Global severity Index, and Positive Symptom Total scales were significantly below normative values. No SCL-90-R subscale displayed an excessive frequency of clinically elevated scores. For patients who displayed clinical elevations on the SCL-90-R, three factors were identified which were associated with increased risk of maladjustment; older patient age at follow-up, more frequent disease relapse, and more severe functional impairment.

CONCLUSIONS

This cohort of childhood cancer survivors is characterized by very low levels of psychological distress and significantly better psychological health than would be expected according to normative data. These findings contrast with those of another study from the same institution in which a fourfold increase in social and behavioral problems was found amongst younger survivors, in the age range 7-15. The use of self-report vs. parent-report, and the potential influence of repressive adaptation on the self-reports of pediatric cancer survivors, are raised as possible explanations for these findings.