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Updated: Apr 7, 2026
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Published on: October 17, 2025
Neurocognitive Predictors of Academic Outcomes Among Childhood Leukemia Survivors
Ida M Ki Moore1, Philip J Lupo, Kathleen Insel
1Author Affiliations: College of Nursing, University of Arizona, Tucson, Arizona (Drs Moore, Insel, and Pasvogel and Ms Koerner); Baylor College of Medicine, Houston, Texas (Drs Lupo and Harris and Mss Adkins and Taylor); and Duke School of Nursing, Durham, North Carolina (Dr Hockenberry).
Background:
Acute lymphoblastic leukemia is the most common pediatric cancer, and survival approaches 90%. Acute lymphoblastic leukemia survivors are more likely than healthy peers or siblings to experience academic underachievement, yet little is known about neurocognitive predictors of academic outcomes.
Objectives:
Objectives were to compare neurocognitive abilities to age-adjusted standardized norms, examine change over time in neurocognitive abilities, and establish neurocognitive predictors of academic outcomes.
Methods:
Seventy-one children were followed over the course of therapy. Cognitive abilities were assessed during induction when the child was in remission (baseline) and annually for 3 years (years 1, 2, and 3). Reading and mathematics abilities were assessed at year 3.
Results:
Fine motor dexterity was significantly below age-adjusted norms at all data points but showed improvement over time. Baseline visual-motor integration was within the reference range but significantly declined by year 3, and mean scores at years 2 and 3 were significantly below age-adjusted norms. Verbal short-term memory was significantly below age-adjusted norms at all assessments. Visual-motor integration predicted reading and mathematics abilities. Verbal short-term memory predicted reading abilities, and visual short-term memory predicted mathematics abilities.
Conclusions:
Central nervous system-directed therapy is associated with specific neurocognitive problems. Visual-spatial skills and verbal and visual short-term memory predict academic outcomes.
Implications For Practice:
Early assessment of visual-spatial perception and short-term memory can identify children at risk of academic problems. Children who are at risk of academic problems could benefit from a school-based individual educational program and/or educational intervention.
