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Predicting changes in adaptive functioning and behavioral adjustment following treatment for a pediatric brain tumor:
Kristen R Hoskinson1,2, Kelly R Wolfe3, Keith Owen Yeates4,5
1Center for Biobehavioral Health, Research Institute at Nationwide Children's Hospital, Columbus, OH, USA.
Insights
Pediatric brain tumor survivors may experience reduced adaptive functioning, particularly in practical skills. Premorbid behavior problems and tumor size are key predictors of posttreatment adaptive outcomes.
Area of Science:
- Pediatric Oncology
- Neuropsychology
- Child Psychology
Background:
- Children treated for brain tumors face risks of behavioral and adaptive challenges.
- Identifying predictors of posttreatment functioning is crucial for intervention.
Purpose of the Study:
- To determine which variables (familial/demographic, developmental, diagnostic, treatment-related) best predict behavioral and adaptive functioning after pediatric brain tumor treatment.
Main Methods:
- 40 children treated for pediatric brain tumors participated.
- Parent-reported data on behavior, adaptive functioning, demographics, and development were collected.
- Medical records provided diagnostic and treatment information.
Main Results:
- Adaptive functioning was generally in the average range 2 years postdiagnosis, but practical skills showed higher impairment rates.
- Premorbid behavior problems and tumor size predicted posttreatment adaptive functioning.
- Premorbid behavior problems predicted declines in adaptive functioning, even after accounting for initial adjustment.
Conclusions:
- Children with brain tumors may have vulnerable adaptive functioning, especially practical skills, post-treatment.
- Assessing prediagnosis functioning and tumor characteristics aids in predicting risk for adaptive difficulties.
- These factors may be less effective for predicting behavioral difficulties, highlighting the need for targeted screening and long-term follow-up.
Background:
Children are at risk for behavioral and adaptive difficulties following pediatric brain tumor. This study explored whether familial/demographic, developmental, diagnostic, or treatment-related variables best predict posttreatment behavioral and adaptive functioning.
Methods:
Participants included 40 children (mean age = 12.76 years, SD = 4.01) posttreatment (mean time since diagnosis = 1.99 years, SD = 0.21) for pediatric brain tumor. Parents rated children's behavioral adjustment and adaptive functioning and provided demographic and developmental histories. Diagnostic and treatment-related information was abstracted from medical records.
Results:
Ratings of adaptive and behavioral functioning approximately 2 years postdiagnosis were within the average range, although the percentage of children exceeding clinical cutoffs for impairment in adaptive skills exceeded expectation, particularly practical skills. Premorbid behavior problems and tumor size predicted posttreatment adaptive functioning. After accounting for adaptive functioning near diagnosis, premorbid behavior problems predicted declines in adaptive functioning 2 years postdiagnosis. After accounting for adjustment near diagnosis, no variables predicted declines in behavioral adjustment.
Conclusions:
Children may be vulnerable to reduced adaptive functioning following pediatric brain tumor treatment, especially in practical skills. Assessing prediagnosis functioning and diagnostic and treatment-related variables may improve our ability to predict those at greatest risk, although those factors may be less helpful in identifying children likely to develop behavioral difficulties. Screening of these factors in tertiary care and long-term follow-up settings may improve identification of those at greatest need for support services.
