T. David Elkin

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.

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.

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

Abstract: 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.

Handbook of Evidence-Based Therapies for Children and Adolescents

Section I: Establishing the Need and Criteria for Evidence-based Therapies.- Evidence-based Therapies for Children and Adolescents: Problems and Prospects.- Empirically Supported Treatments and Evidence-based Practice for Children and Adolescents.- Methodological Issues in the Evaluation of Therapies.- Evidence-based Therapies: Translating Research into Practice.- Section II: Evidence-based Therapies for Specific Disorders or Conditions.- Psychosocial Treatments for Phobic and Anxiety Disorders in Youth.- Panic Disorder in Adolescents.- Evidence-based Treatment of Pediatric Obsessive-Compulsive Disorder.- Interventions for Posttraumatic Stress in Children and Adolescents Following Natural Disasters and Acts of Terrorism.- Mood Disorders in Childhood.- Empirically Supported Psychotherapies for Adolescent Depression and Mood Disorders.- Evidence-based Therapies for Adolescent Suicidal Behavior.- Evidence-based Treatments for Attention-Deficit/Hyperactivity Disorder (ADHD).- Evidence-based Therapies for Oppositional Behavior in Young Children.- Treating Conduct Problems, Aggression, and Antisocial Behavior in Children and Adolescents: An Integrated View.- Components of Evidence-based Interventions for Bullying and Peer Victimization.- Pain and Pain Management.- Evidence-based Treatments for Children with Chronic Illnesses.- Evidence-based Therapies for Enuresis and Encopresis.- Evidence-based Therapies for Children and Adolescents with Eating Disorders.- Evidence-based Therapies for Pediatric Overweight.- Evidence-based Therapies for Autistic Disorder and Pervasive Developmental Disorders.- Evidence-based Treatment for Children with Serious Emotional Disturbance.- Evidence-based Approaches to Social Skills Training with Children and Adolescents.- Evidence-based Treatments for Adolescent Substance Use Disorders.- Section III: Implementation Issues.- Dissemination of Evidence-based Manualized Treatments for Children and Families in Practice Settings.- Client, Therapist, and Treatment Characteristics in EBTs for Children and Adolescents.- Implementing Evidence-based Treatments with Ethnically Diverse Clients.- Evidence-based Therapy and Ethical Practice.- Adoption of Evidence-based Treatments (EBTs) in Community Settings: Obstacles and Opportunities.- Evidence-based Assessment for Children and Adolescents.- Graduate Training in Evidence-based Practice in Psychology.- Emerging Issues in the Continuing Evolution of Evidence-based Practice.

Psychological distress, stressful life events, and religiosity in younger African American adults

Prior research has found that stressful life events relate to increased psychological distress as well as mental and physical morbidity, particularly in minority groups. However, there is limited understanding of factors that may influence this relationship. This paper examines psychological distress, stressful life events, and religiosity among younger African American adults between the ages of 18 and 43 (n = 215). Stressful life events and religiosity levels did not differ by gender, though females reported greater levels of each distress category. Female gender and stressful events were predictive of increased levels of distress. Dimensions of religiosity related in unique ways to individual categories of distress. This would suggest that the role of religion in reduced distress differs according to the type of religious experience. Intrinsic religiosity was found inversely related to both total distress and depression; organizational religiosity inversely related to somatization and obsessive-compulsiveness; finally, non-organizational religiosity was inversely related to interpersonal sensitivity. Further research is needed across additional sociodemographic and economic categories to further clarify the relationship of religiosity, stressful events, and distress in younger African American adults.

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.

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

ABSTRACT. 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 measures internal consistency was found to be high, Cronbachs 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 (Cronbachs 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, rc = .90-.91. The findings lend support to extending the PSCs clinical utility to tertiary care pediatric settings. Further research is recommended with a broader range of chronic illness groups to increase generalizability.

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.

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.