Adaptive Functioning in Pediatric Brain Tumor Survivors: The Role of Neurocognitive Risk Factors and Social...

Pediatric brain tumor (PBT) survivors are at risk for impaired executive functioning (EF) and downstream disruption of adaptive functioning (AF), impacting the transition to adulthood. We aimed to examine variables related to AF among PBT survivors to identify targets for intervention supporting the transition to adulthood. We hypothesized that intelligence, EF, and social determinants of health (SDOH) would be associated with AF, and that the relationship between EF and AF would be stronger at lower SDOH.

Retrospective neuropsychological data were extracted for 78 clinically referred PBT survivors (8-24 years). Assessments included performance-based measures of intelligence and EF, and parent-proxy reported EF and AF. The Childhood Opportunity Index 2.0 (COI) measured SDOH. Statistics included correlations, t-tests, and regressions.

Participants (56.4% male, mean age 14.03 [4.09]) had an average intelligence of 87.18 (impairment rate of 43.6%) and an average AF composite of 84.86 (impairment rate 50%). Parent proxy EF and a performance-based measure of cognitive flexibility, but not working memory, was associated with overall AF and practical and conceptual subdomains of AF. Cognitive regulation, specifically initiation and working memory, was more associated with AF than behavioral and emotional regulation. COI was associated with intelligence, AF, and working memory.

Executive functioning is significantly associated with AF in PBT survivors, even more so than intelligence or medical factors. Initiation, working memory, and cognitive flexibility are important intervention targets to facilitate independent skill development and support the transition to adulthood, particularly for those with fewer neighborhood resources.