Catherine C. Peterson

A meta-analysis of the neuropsychological sequelae of chemotherapy-only treatment for pediatric acute lymphoblastic leukemia

Mixed findings on the neuropsychological sequelae of chemotherapy‐only treatment for pediatric acute lymphoblastic leukemia (ALL), without radiation, indicate the need for a comprehensive meta‐analytic review. The purpose of the current study was to conduct a meta‐analysis assessing neuropsychological and academic functioning differences between children with ALL treated solely with chemotherapy and comparison groups.

Family impact of neurodevelopmental late effects in survivors of pediatric cancer: review of research, clinical evidence, and future directions.

Children and adolescents who have survived childhood cancer are vulnerable to late effects of their disease and treatment experience, including both physical and psychological sequelae. The neurodevelopmental (ND) sequelae (e.g., difficulties with attention, memory, information processing, and other executive functions) faced by children surviving central nervous system (CNS) cancers or CNS treatments can have a range of effects on their psychological adjustment and quality of life as they reintegrate into school and social settings. Survivors facing such difficulties may be influenced by their family environment, and these struggles may in turn impact the perceived burden of their parents and family system, suggesting a bidirectional framework for understanding the impact of ND late effects within the family. The current study summarizes the following: Findings of family outcomes in children with ND late effects of cancer treatment; evaluation of methodological and measurement issues; the importance of examining bidirectional family–child influences; and implications for future survivorship research and clinical care addressing the role of ND late effects from a systems perspective.

Age-Dependent Relationships Among Pain, Depressive Symptoms, and Functional Disability in Youth With Recurrent Headaches

Objective.—To assess age differences associated with depressive symptoms and functional disability in children and adolescents with recurrent headache.

Predicting family burden following childhood traumatic brain injury: a cumulative risk approach

ObjectiveTo examine the utility of a cumulative risk index (CRI) in predicting the family burden of injury (FBI) over time in families of children with traumatic brain injury (TBI). ParticipantsOne hundred eight children with severe or moderate TBI and their families participated in the study. MeasuresThe measures used in the study include the Socioeconomic Composite Index, Life Stressors and Social Resources Inventory-–Adult Form, Vineland Adaptive Behavior Scales, Child Behavior Checklist, Childrens Depression Inventory, McMaster Family Assessment Device, Brief Symptom Inventory, and Family Burden of Injury Interview. In addition, information on injury-related risk was obtained via medical charts. MethodsParticipants were assessed immediately, 6, and 12 months postinjury and at a 4-year extended follow-up. ResultsRisk variables were dichotomized (ie, high- or low-risk) and summed to create a CRI for each child. The CRI predicted the FBI at all assessments, even after accounting for autocorrelations across repeated assessments. Path coefficients between the outcome measures at each time point were significant, as were all path coefficients from the CRI to family burden at each time point. In addition, all fit indices were above the recommended guidelines, and the χ2 statistic indicated a good fit to the data. ConclusionsThe current study provides initial support for the utility of a CRI (ie, an index of accumulated risk factors) in predicting family outcomes over time for children with TBI. The time period immediately after injury best predicts the future levels of FBI; however, cumulative risk continues to influence the change across successive postinjury assessments. These results suggest that clinical interventions could be proactive or preventive by intervening with identified “at-risk” subgroups immediately following injury.

Discordant parent reports of family functioning following childhood neuroblastoma: A report from the children's oncology group

This study examined whether late effects and poor survivor quality of life (QOL) characterize discordant parent dyads and “unhealthy” family functioning in neuroblastoma survivors. Parents of 135 neuroblastoma survivors (78 two-parent dyads) completed measures of late effects and family functioning, and survivors completed the Pediatric Quality of Life Inventory 4.0 (PedsQL). Although average family functioning scores were “healthy,” parent concordance was lower for family functioning than late effects reports. Parent concordance did not differ by late effects or QOL. Family functioning scores were poorer when survivors had more late effects and low physical QOL scores. Parent data should be considered separately when examining child cancer outcomes.

An Exploratory Study Examining Current Assessment Supervisory Practices in Professional Psychology

ABSTRACT The extant literature reveals a considerable amount of research examining course work or technical training in psychological assessment, but a dearth of empirical research on assessment supervision. This study examined perspectives on current assessment supervisory practices in professional psychology through an online survey. Descriptive and qualitative data were collected from 125 survey respondents who were members of assessment-focused professional organizations and who had at least 1 year of supervision experience. Responses indicated a general recognition of the need for formal training in assessment supervision, ongoing training opportunities, and adherence to supervision competencies. Responses indicated more common use of developmental and skill-based models, although most did not regard any one model of assessment supervision as superior. Despite the recommended use of a supervision contract, only 65.6% (n = 80) of respondents use one. Discussion, directed readings, modeling, role-play, and case presentations were the most common supervisory interventions. Although conclusions are constrained by low survey response rate, results yielded rich data that might guide future examination of multiple perspectives on assessment supervision and ultimately contribute to curriculum advances and the development of supervision “best practices.”

Childhood cancer incidence and survival in Thailand: A comprehensive population-based registry analysis, 1990-2011

Southeast Asia is undergoing a transition from infectious to chronic diseases, including a dramatic increase in adult cancers. Childhood cancer research in Thailand has focused predominantly on leukemias and lymphomas or only examined children for a short period of time. This comprehensive multisite study examined childhood cancer incidence and survival rates in Thailand across all International Classification of Childhood Cancer (ICCC) groups over a 20‐year period.

Medical care experiences of children with autism and their parents: A scoping review

Children with autism spectrum disorder (ASD) and their families may benefit from the provision of additional supports in health care settings, particularly when preparing for and attending medical appointments. This review examined literature that describes experiences in medical care settings from the perspective of patients under age 18 with ASD and their caregivers. A scoping review was conducted to examine the experiences of children with ASD and their families in medical care settings. Twenty-nine studies meeting inclusion criteria were identified and reviewed. The review indicated a number of challenges (e.g., parent-reported problems in parent-provider communication and overwhelming environments) as well as factors that facilitate positive experiences (e.g., providing positive reinforcement and explaining exam steps) during medical appointments. Children with ASD and their families are faced with many challenges while receiving care in medical settings. The present review identified many challenges families face, as well as facilitators of positive experiences. Understanding the unique experiences of patients with ASD and their parents will help to improve experiences in medical care settings for children, caregivers, and health care providers.

Development of a brief assessment of activity limitations in children with food allergy

Given the increasing prevalence of food allergies (FA), affecting approximately 8% of children in the United States,1 and the increasing rates of anaphylaxis due to FA,2 parents of children with FA have lowered quality of life (QOL).3,4 Many parents report their family QOL is associated with social limitations due to FA,3 and some parents worry so much about allergen avoidance that they significantly restrict their child’s school and social activities.4 Children’s day-today social functioning is important for maintaining an acceptable QOL and coping with FA. Thus, engagement in social activities with peers (eg, playdates, sports, summer camp) provides an important developmental context for normative social and emotional development in children.5 Because no measure exists to assess social activities in children with FA, we have developed the Social Activity Limitations Inventory (SALI), a 20-item checklist to assess activity limitation due to FA. The SALI was developed based on review of the relevant FA literature and input from parents of children with FA. Activities included common childhood settings (eg, school) and activities (eg, sports). Parents rated the perceived likelihood of allowing their child to participate in each activity on a 4-point scale, ranging from 0 (“Almost always likely” to allow their child to participate) to 4 (“Never”). Higher scores indicate greater activity limitation. We recruited, via social media, a sample of 293 parents of children with FA to complete an online survey including demographic and allergy information, measures of parent worry6 and burden,7 and activity limitations on the newly developed SALI. An exploratory factor analysis measure allows authors to examine whether items intercorrelate in theoretically logical or predicted patterns and to determine the structure of a new measure (ie, number of subscales). Using SPSS version 21 (IBM SPSS, Inc, Armonk, New York) software, an exploratory factor analysis of the SALI indicated that the measure was best characterized in a 2-factor structure, including all 20 items. Table 1 presents all 20 items and their factor loadings, all of which were >0.4 and thus retained. Factor 1 included 11 activities in which the parent may perceive less control over the environment (eg, “How likely are you to allow your child to eat from self-serve food stations?” or “How likely are you to allow your child to participate in activities supervised by other adults?”). Based on the limited opportunity to monitor the child in these activities, this was labeled “Limited Monitoring.” Factor 2 included 9 activities in which parents may perceive relatively greater opportunity for closer supervision or monitoring (eg, going on vacation, playing with friends at own house) and thus was labeled “Trusted Monitoring.” Both subscales demonstrated strong internal consistency (Limited Monitoring, α = .90; Trusted Monitoring, α = .89), suggesting that subscale items are related to one another, an indicator of reliable measurement. The subscales were only moderately correlated (r = 0.41) with one another, suggesting discrete constructs, and thus presented 2 distinct areas to assess in FA-affected families. The SALI was examined for associations with measures of parent worry6 and burden7 to explore utility as a screening tool in clinical settings. SALI total was weakly associated with parent worry (r = 0.170, P = .016) and moderately associated with parent burden (r = 0.333, P < .001), suggesting the SALI captures unique content other measures do not. The Trusted Monitoring subscale was associated with parent worry (r = 0.201, P = .004) and burden (r = 0.296, P < .001). These associations indicate that parents who are more worried and burdened by their child’s FA were more likely to limit their child’s activities, even in situations of increased ability to monitor their child. The Limited Monitoring subscale was associated with parent burden (r = 0.289, P < .001), indicating that limitation may pose a burden on the family’s QOL. The Limited Monitoring subscale was not significantly associated with worry; parents may be intermittently worried as a function of their activity limitation, depending on ability to monitorsafety. Correlation coefficients between SALI subscales and allergy characteristics revealed associations between Limited Monitoring and number of FA (r = 0.160, P = .019), time to symptom onset (r = −0.176, P = .010), number of FA-related emergency visits in the last 6 months (r = −0.191, P = .005), number of FA-related hospitalizations in the last 6 months (r = −0.236, P < .001), use of injectable epinephrine in the last 6 months (r = −0.179, P = .009), and anaphylaxis events in the last 6 months (r = −0.237, P < .001). The Trusted Monitoring subscale was associated with number of emergency department visits in the last 6 months (r = 0.199, P = .004). These associations suggest that the SALI captures the heightened limitation of social activity associated with several markers of increased allergy severity. The SALI was developed to assess limitation of developmentally appropriate social experiences, which may be an important component of decreased QOL3 for children with FA and their families. SALI is an efficient, reliable screener of parental limitation of children’s developmentally appropriate social activities, both in situations where the parent can monitor the safety of the child and in those where monitoring is limited. Total activity limitations were associated with parent worry and burden, such that these concerns were associated with greater limitation of the child’s activities, as might be expected in clinical practice with anxious families. Limited Monitoring was not significantly associated with worry, which may reflect a nonlinear association between these constructs, or a bidirectional association over time. Parents may be less Disclosures: Authors have nothing to disclose. Funding Sources: This project was supported by an Eastern Michigan University New Faculty Award to Dr Peterson.

Educational Issues: The Impact of Cancer in the Classroom

Both during and after treatment, children with cancer can have specific educational needs, related to physical, social-emotional, and cognitive factors. While in treatment, the focus is often on ways to support a child’s ongoing attendance or involvement in school, whereas after treatment, there is an increased focus on management of specific learning or cognitive issues, which can be direct sequelae of treatment and may emerge over time. Children treated for cancer, particularly those with a central nervous system malignancy or those treated with cranial radiation, are at highest risk for educational difficulties. Families of survivors with educational problems are typically distressed by the particular pattern and timing of deficits, but they may have different needs about when and how to discuss those issues. In addition to supporting children and their families, clinicians also need to inform and educate school personnel. Teachers and school psychologists often have limited training or knowledge about educational issues specifically related to childhood cancer, and parents may not be aware of the school-based services or how to access them. According to federal law, children with a health issue that significantly impacts their success at school can be eligible for special education services, accommodations, and supports within the school. Intervention may include instructional approaches, cognitive remediation, psychopharmacological treatments, and ongoing advocacy. This chapter aims to provide background and guidance for clinicians working with children with cancer to help support their academic success and promote optimal educational outcomes during and after cancer treatment.