Victoria W. Willard

Computerized Cognitive Training in Survivors of Childhood Cancer: A Pilot Study

The objective of the current study was to pilot a computerized cognitive training program, Captain’s Log, in a small sample of survivors of childhood cancer. A total of 9 survivors of acute lymphoblastic leukemia and brain tumors with attention and working memory deficits were enrolled in a home-based 12-week cognitive training program. Survivors returned for follow-up assessments postintervention and 3 months later. The intervention was associated with good feasibility and acceptability. Participants exhibited significant increases in working memory and decreases in parent-rated attention problems following the intervention. Findings indicate that home-based, computerized cognitive intervention is a promising intervention for survivors with cognitive late effects; however, further study is warranted with a larger sample.

Working memory training in survivors of pediatric cancer: a randomized pilot study

Survivors of pediatric brain tumors and acute lymphoblastic leukemia (ALL) are at increased risk for neurocognitive deficits, but few empirically supported treatment options exist. We examined the feasibility and preliminary efficacy of a home‐based, computerized working memory training program, CogmedRM, with survivors of childhood cancer.

Adjustment of caregivers of pediatric patients with brain tumors: a cross-sectional analysis.

Objective: The purpose of the study was to compare the psychological adjustment of caregivers of children with brain tumors who are on‐treatment with caregivers of children who are off‐treatment.

Social Functioning and Facial Expression Recognition in Survivors of Pediatric Brain Tumors

OBJECTIVE To assess social functioning and facial expression recognition skill in survivors of pediatric brain tumors (BT) as compared to children with juvenile rheumatoid arthritis (JRA). METHODS The social functioning of 51 survivors of BT and 31 children with JRA was assessed using a facial expression recognition task, questionnaire ratings of social functioning, and an IQ screener. RESULTS After controlling for estimated IQ, survivors of BT made significantly more errors interpreting adult facial expressions as compared to children with JRA. Additionally, history of therapy and diagnosis age predicted performance on the child portion of the facial recognition task. Finally, survivors of BT demonstrated significantly impaired social functioning across multiple measures when compared to children with JRA. CONCLUSIONS Survivors of pediatric BT showed significant deficits in social functioning as compared to an illness comparison group. Errors in facial expression recognition represent another method for evaluating deficits that contribute to social outcomes.

Hydrocephalus as a possible additional contributor to cognitive outcome in survivors of pediatric medulloblastoma

Objectives: The purpose of the study was to assess the relationship between shunted hydrocephalus and intellectual, memory and academic functioning in a group of survivors of pediatric medulloblastoma.

Psychosocial functioning in parents of adult survivors of childhood cancer.

Background Although significant progress has been made in identifying long-term sequelae for adult survivors of childhood cancer, comparatively little attention has been paid to the functioning of their parents. In a previous study, we observed that a majority of adult survivors are accompanied to clinic visits by at least 1 parent, suggesting ongoing concern for their childrens health. In the current study, we explore psychologic stressors that characterize this population and might account for this finding. Procedure Responses to measures of psychosocial functioning (ie, Brief Symptom Inventory, Impact on Family Scale, Impact of Events Scale, Parent Experience of Child Illness Scale) were compared between 27 parents of adult survivors (mean age=25.6 y) of pediatric cancer and 28 parents of current pediatric cancer patients (mean age=10.2 y) on, or within 1 year of, active treatment. Results Compared with parents of pediatric cancer patients on treatment, parents of adult survivors demonstrated few significant differences in overall psychologic functioning, posttraumatic stress symptoms, and adjustment to the disease experience. Indeed, the 2 groups differed only in their report of objective and family burden (eg, financial cost, time off from work, less time with family members), and in their levels of anger associated with the illness experience. Conclusions Results suggest that parents who continue to accompany their adult child to clinic may remain psychologically vulnerable many years after the end of treatment, and that the impact of having a child with a life-threatening illness may not diminish even years into the childs survivorship.

Cognitive Outcome After Pediatric Stem-Cell Transplantation: Impact of Age and Total-Body Irradiation

PURPOSE To examine the influence of age and conditioning with total-body irradiation (TBI) on the trajectory of cognitive functioning after treatment with pediatric hematopoietic stem-cell transplantation (SCT). PATIENTS AND METHODS Pediatric patients who were scheduled to undergo a SCT were eligible for the study, with 315 patients completing a baseline assessment. Of these, 183 patients (58.1%) were alive at 1 year after SCT and completed additional assessments at 1, 3, and 5 years after SCT. Half of the long-term sample (52.1%) received TBI during conditioning. Cognitive functioning was assessed via age-appropriate standardized measures. RESULTS At baseline, there were no differences in intelligence quotient (IQ) based on age. At 5 years after SCT, the youngest patients (< 3 years old at baseline) who received TBI demonstrated a significantly lower IQ than those who did not receive TBI (P = .05). Longitudinal analyses (piecewise linear mixed-effects models with a knot at 1 year after SCT) revealed a significant impact of age and TBI over time. The youngest patients evidenced declines in cognitive functioning during the first year; however, patients who did not receive TBI largely recovered their functioning in subsequent years. In contrast, young patients who received TBI failed to recover the losses experienced during the first year after SCT, demonstrating stability in their functioning, but at a lower level. CONCLUSION Our findings clarify the relationship between TBI and age on cognitive outcomes in pediatric SCT survivors. Young patients who receive TBI may benefit from early intervention efforts to minimize cognitive losses during the first year after SCT and to maximize potential recovery.

The impact of attention on social functioning in survivors of pediatric acute lymphoblastic leukemia and brain tumors

The cognitive late effects experienced by many survivors of pediatric acute lymphoblastic leukemia (ALL) and brain tumors are well‐established. The most commonly reported deficit is difficulty with attention. Problems with social functioning have also been identified, but their relationship with cognitive functioning is not well understood. This multi‐site, cross‐sectional study aimed to examine the impact of attention on social functioning.

Perceived social competency in children with brain tumors: Comparison between children on and off therapy

Children with brain tumors are at risk for a number of cognitive, academic, and social difficulties as a consequence of their illness and its treatment. Of these, the least is known about social functioning, particularly over the course of the illness. Thirty children with brain tumors were evaluated using neurocognitive and psychological measures, including a measure of perceived competency. Results indicated that off-therapy brain tumor patients reported more concerns about their social competence than both a normative sample and children on treatment. Findings highlight the need for more research aimed at helping survivors cope with long-term stressors associated with their illness.

Parents of Children With Cancer: At-Risk or Resilient?

OBJECTIVE To examine adjustment in parents of children with cancer using a design that minimizes focusing effects and allows for direct comparison with parents of healthy children. METHOD Parents of 305 children with cancer and a demographically similar sample of 231 parents of healthy children were evaluated using diagnostic interviews for posttraumatic stress disorder (PTSD), and questionnaire measures of posttraumatic stress symptoms (PTSS) and psychological growth (PG), as well as measures of global psychological functioning. RESULTS Rates of current and lifetime PTSD in parents of children with cancer were low, and did not differ from comparison parents. Likewise, levels of PTSS were not significantly different from comparison parents, but differed as a function of time since diagnosis, with parents of children who were ≥ 5 years from diagnosis reporting significantly lower PTSS than comparison parents. PG was higher in parents of children with cancer than in comparison parents regardless of time since diagnosis. CONCLUSION Parents of children with cancer demonstrate resilience to this challenge.