Your browser doesn't support javascript.
loading
Show: 20 | 50 | 100
Results 1 - 20 de 25
Filter
1.
J Fam Psychol ; 37(5): 635-646, 2023 Aug.
Article in English | MEDLINE | ID: mdl-36892923

ABSTRACT

Elevated child and caregiver psychopathology are observed in families of children with cancer, with a subset developing clinically significant symptoms. This study examines whether caregivers' resting respiratory sinus arrhythmia (RSA) and observed emotion regulation (ER) are protective against caregiver and child psychopathology during the first year of pediatric cancer treatment. Primary caregivers of children recently diagnosed with cancer (N = 159; child Mage = 5.6 years; children 48% male, 52% female) completed 12 monthly questionnaires. At Month 3, primary caregivers were interviewed about their experiences of emotions, and their resting RSA was measured. Data were analyzed using multilevel models. Observed ER was associated with lower caregiver anxiety, depression, and posttraumatic stress symptoms (PTSS) 1 year postdiagnosis but was not associated with children's symptoms. Resting RSA had a significant positive association with child depression/anxiety at the start of treatment and Month 12 child PTSS. Findings suggest that caregivers would benefit from interventions to manage their negative emotions at the start of cancer treatment. Additionally, caregivers who are more physiologically regulated may be more attuned to their children's negative emotions. Our findings highlight the importance of taking a multimethod approach to understanding how ER impacts functioning. (PsycInfo Database Record (c) 2023 APA, all rights reserved).


Subject(s)
Emotional Regulation , Mental Disorders , Neoplasms , Child , Humans , Male , Female , Child, Preschool , Caregivers/psychology , Emotions/physiology , Anxiety , Neoplasms/therapy
2.
Health Psychol ; 41(1): 43-52, 2022 Jan.
Article in English | MEDLINE | ID: mdl-34855417

ABSTRACT

OBJECTIVE: Previous work has examined family income and material hardship in pediatric cancer. However, few studies have focused on perceived financial strain (PFS), or the extent to which caregivers perceive financial stress and worry related to their child's cancer. The current study addresses this gap by a) describing the trajectory of perceived financial strain over the first year of pediatric cancer treatment; b) examining sociodemographic predictors of that trajectory; and c) examining associations between PFS and caregiver and child psychological adjustment. METHOD: Primary caregivers of children (Mage = 6.31) recently diagnosed with cancer provided 12 monthly reports of their own perceived financial strain and depression, anxiety, and posttraumatic stress symptoms, as well as their child's internalizing and externalizing symptoms. Data were analyzed using multilevel models. RESULTS: Caregiver PFS decreased over the first year of treatment. Nonmarried caregivers and those with lower income reported higher levels of PFS over time. Caregivers with higher PFS relative to other caregivers and relative to their own average PFS in a given month experienced psychological maladjustment. PFS was not associated with child adjustment. CONCLUSIONS: On average caregivers perceive less financial strain over the first year of treatment; however, nonmarried caregivers and those with lower income are at risk for higher PFS over time, and PFS may contribute to psychological maladjustment in caregivers. Caregivers may benefit from psychosocial support focused on managing financial strain. (PsycInfo Database Record (c) 2022 APA, all rights reserved).


Subject(s)
Caregivers , Neoplasms , Child , Emotional Adjustment , Family , Humans , Neoplasms/therapy , Stress, Psychological
3.
Health Psychol ; 40(5): 295-304, 2021 May.
Article in English | MEDLINE | ID: mdl-34152783

ABSTRACT

OBJECTIVE: To examine effects of stress on caregiver psychological adjustment during the first year of pediatric cancer. METHOD: Caregivers (N = 159) of children with cancer completed monthly questionnaires assessing domains of caregiver psychological adjustment (depression, anxiety, and posttraumatic stress symptoms) and stress (general life stress, treatment-related stress, caregiver perceptions of treatment intensity and life threat). Effects of stress were assessed at two levels to examine whether within-person changes in stress predicted concurrent changes in caregiver adjustment and whether average stress was associated with between-person differences in caregiver adjustment trajectories. RESULTS: Overall, higher levels of stress factors were associated with poorer caregiver adjustment at both the between- and within-person levels, with high average levels of treatment-related stress and general life stress emerging as leading predictors of worse adjustment. CONCLUSIONS: Both types of stressors, those directly related as well as unrelated to a child's cancer, contribute uniquely to caregiver distress. Caregiver distress is impacted by both overall levels of stress over time as well as month-to-month changes in stress. Implications for informing care for at-risk caregivers are discussed. (PsycInfo Database Record (c) 2021 APA, all rights reserved).


Subject(s)
Caregivers/psychology , Emotional Adjustment , Neoplasms/psychology , Parents/psychology , Stress, Psychological/psychology , Adolescent , Adult , Caregivers/statistics & numerical data , Child , Child, Preschool , Female , Humans , Male , Neoplasms/therapy , Surveys and Questionnaires
4.
Psychooncology ; 30(6): 928-935, 2021 06.
Article in English | MEDLINE | ID: mdl-33724595

ABSTRACT

OBJECTIVE: After diagnosis, caregivers of children with cancer, particularly mothers or primary caregivers (PCs), often show elevated depressive symptoms which may negatively impact family functioning. We tested PC and secondary caregiver (SC) depressive symptoms as predictors of family, co-parenting, and marital functioning and whether having a non-depressed SC buffers against potential negative effects of PC depressive symptoms. METHODS: Families (N = 137) were recruited from two major children's hospitals following a diagnosis of pediatric cancer. Caregivers completed self-report measures of depressive symptoms (Center for Epidemiological Studies-Depression Scale; Depression, Anxiety, and Stress Scale) and marital functioning (Dyadic Adjustment Scale) at 1-month post-diagnosis. A subset of families (n = 75) completed videotaped interaction tasks at approximately 3-months post-diagnosis that were coded for family and co-parenting interactions. RESULTS: Higher PC depressive symptoms at 1-month post-diagnosis was associated with higher adaptability and lower conflict in family functioning. PC depressive symptoms were also associated lower dyadic consensus and lower dyadic satisfaction. SC depressive symptoms were not significantly associated with any family/co-parenting/marital functioning variables. Significant interaction analyses suggested that SC depressive symptoms moderated the effect of PC depressive symptoms on family cohesion, withdrawn parenting, and affective expression in the marriage, such that the relationship between PC depressive symptoms and poorer functioning was attenuated when SC depressive symptoms were at low or average levels. CONCLUSIONS: Having a nondepressed SC buffered against negative effects of PC depressive symptoms on certain domains of family, coparenting, and marital functioning. SCs may play a protective role for families of children with cancer.


Subject(s)
Caregivers , Neoplasms , Anxiety , Child , Depression/diagnosis , Female , Humans , Parenting
6.
J Atten Disord ; 24(11): 1547-1556, 2020 09.
Article in English | MEDLINE | ID: mdl-27231214

ABSTRACT

Objective: Common methods for clinical diagnosis include clinical interview, behavioral questionnaires, and neuropsychological assessment. These methods rely on clinical interpretation and have variable reliability, sensitivity, and specificity. The goal of this study was to evaluate the utility of machine learning in the prediction and classification of children with ADHD-Combined presentation (ADHD-C) using brief neuropsychological measures (d2 Test of Attention, Children with ADHD-C and typically developing control children completed semi-structured clinical interviews and measures of attention/concentration and parents completed symptom severity questionnaires. Method: We used a forward feature selection method to identify the most informative neuropsychological features for support vector machine (SVM) classification and a decision tree model to derive a rule-based model. Results: The SVM model yielded excellent classification accuracy (100%) of individual children with and without ADHD (1.0). Decision tree algorithms identified individuals with and without ADHD-C with 100% sensitivity and specificity. Conclusion:This study observed highly accurate statistical diagnostic classification, at the individual level, in a sample of children with ADHD-C. The findings suggest data-driven behavioral algorithms based on brief neuropsychological data may present an efficient and accurate diagnostic tool for clinicians.


Subject(s)
Attention Deficit Disorder with Hyperactivity , Support Vector Machine , Attention Deficit Disorder with Hyperactivity/diagnosis , Child , Humans , Machine Learning , Neuropsychological Tests , Reproducibility of Results
7.
Neuro Oncol ; 21(10): 1310-1318, 2019 10 09.
Article in English | MEDLINE | ID: mdl-31123753

ABSTRACT

BACKGROUND: Female and male trajectories of cerebellar and lobar brain structures are sexually dimorphic, making sex a potential candidate moderator of neurocognitive late effects from radiation treatment. We sought to evaluate longitudinal neurocognitive functioning in male versus female children treated for posterior fossa brain tumors. METHODS: Fifty-one female and 63 male survivors of posterior fossa tumors completed neuropsychological testing at 2 timepoints. We included patients treated with surgical resection, chemotherapy, and radiation therapy. Multilevel mixed modeling was used to predict IQ score as a function of patient sex following treatment (~2 or ~4 years post treatment). Effect sizes were used as a measure of clinical significance. RESULTS: Multilevel models resulted in a significant sex by time interaction (F = 6.69, P = 0.011). Females' cognitive scores were considerably higher compared with males at 4 years posttreatment. Females demonstrated an average improvement of 7.61 standard score IQ points compared with a decline of 2.97 points for males at 4 years follow-up. Effect sizes for female IQ compared with male IQ at 4 years posttreatment were between 0.8 and 0.9. CONCLUSION: Trajectories of neurocognitive functioning following posterior fossa tumor treatment differed between female and male children. Sexual dimorphism in radiation late effects may alter treatment decisions in children. Research into sex-specific neuroprotective mechanisms underlying neurocognitive development following pediatric brain tumor treatments is warranted.


Subject(s)
Brain/radiation effects , Infratentorial Neoplasms/radiotherapy , Intelligence/radiation effects , Radiation Injuries/complications , Sex Characteristics , Child , Cognition Disorders/etiology , Cranial Irradiation/adverse effects , Female , Humans , Male , Retrospective Studies , Wechsler Scales
8.
Health Psychol ; 37(8): 725-735, 2018 08.
Article in English | MEDLINE | ID: mdl-30024229

ABSTRACT

OBJECTIVE: To describe the trajectory of patient and caregiver mental health from diagnosis through the first year of treatment for pediatric cancer and assess whether rates of clinically relevant symptoms were elevated compared with norms. We examined mean levels of internalizing and externalizing symptoms and posttraumatic stress symptoms (PTSS) in children with cancer, and depression, anxiety, and PTSS in caregivers during the first year of treatment; the proportion of patients and caregivers that scored in the clinical range at each time point; and the typical trajectory of symptoms in patients and caregivers and whether trajectories differed between individuals. METHOD: Families (N = 159) of children newly diagnosed with cancer (Mage = 5.6 years; range = 2-18 years) participated in a short-term prospective study. Primary caregivers provided monthly reports of their own and their children's psychological adjustment. RESULTS: On average, children were well-adjusted. However, compared with norms, there was a higher than expected proportion of children with clinically relevant internalizing symptoms around the time of diagnosis. On average children's symptoms declined over time, though variability was observed. Caregivers were less well-adjusted on average, with a high proportion reporting clinically relevant symptoms over time for depression and anxiety. Caregiver symptoms also declined over time, though considerable variability was observed. CONCLUSION: Although most children remain well-adjusted during the first year of treatment, many caregivers experience clinically relevant symptoms of psychological distress. Implications for development of interventions targeting at-risk patients and caregivers are discussed. Identifying processes that predict between-family variability in trajectories of psychopathology is an important next step. (PsycINFO Database Record


Subject(s)
Caregivers/psychology , Emotional Adjustment/physiology , Family/psychology , Neoplasms/psychology , Stress, Psychological/psychology , Adolescent , Child , Child, Preschool , Female , Humans , Male
9.
Health Psychol ; 37(8): 736-745, 2018 08.
Article in English | MEDLINE | ID: mdl-29809021

ABSTRACT

OBJECTIVE: The stress of having a child with cancer can impact the quality of relationships within the family. The current study describes the longitudinal trajectory of marital, parent-child, and sibling conflict beginning around the time of diagnosis through the first year of treatment. We examined the average level of marital, parent-child, and sibling conflict at each monthly time point in the first year of treatment; the proportion of families that fall into the distressed range of marital, parent-child, and sibling conflict at each time point; the typical trajectory of conflict during the first year of treatment and whether there are differences in trajectories across families. METHOD: A total of 160 families of children newly diagnosed with cancer (Mage = 5.6 years; range = 2-18 years) participated in a short-term prospective longitudinal study. Primary caregivers provided monthly reports of marital, parent-child, and sibling conflict. RESULTS: Using multilevel modeling (MLM), most families showed stability in quality of family relationships, although considerable between-family variability was observed. For married couples, 25-36% of couples were in the distressed range at one time point over the first year of treatment. For married couples, more distress occurred at earlier months, particularly month 3. For parent-child and sibling dyads, the most difficult time periods were during later months. CONCLUSION: Implications for development of interventions that target at-risk family relationships are discussed. Identifying processes that predict between-family variability in trajectories of family relationships is an important next step, particularly for the marital relationship. (PsycINFO Database Record


Subject(s)
Family Relations/psychology , Marriage/psychology , Neoplasms/psychology , Parent-Child Relations , Parents/psychology , Siblings/psychology , Adolescent , Adult , Child , Child, Preschool , Female , Humans , Longitudinal Studies , Male , Neoplasms/pathology , Prospective Studies
10.
J Pediatr Psychol ; 43(7): 769-778, 2018 08 01.
Article in English | MEDLINE | ID: mdl-29562288

ABSTRACT

Objective: When a child is diagnosed with cancer, problems may arise in family relationships and negatively affect child adjustment. The current study examined patterns of spillover between marital and parent-child relationships to identify targets for intervention aimed at ameliorating family conflict. Method: Families (N = 117) were recruited from two US children's hospitals within 2-week postdiagnosis to participate in a short-term prospective longitudinal study. Children with cancer were 2-10 years old (M = 5.42 years, SD = 2.59). Primary caregivers provided reports of marital and parent-child conflict at 1-, 6-, and 12-month postdiagnosis. Results: Results indicated that a unidirectional model of spillover from the marital to the parent-child relationship best explained the data. In terms of specific temporal patterns, lower marital adjustment soon after diagnosis was associated with an increase in parent-child conflict 6 months later, though this pattern was not repeated in the latter 6 months of treatment. Conclusion: Targeting problems in marital relationships soon after diagnosis may prevent conflict from developing in the parent-child relationship.


Subject(s)
Family Conflict/psychology , Marriage/psychology , Neoplasms/psychology , Neoplasms/therapy , Parent-Child Relations , Adaptation, Psychological , Child , Child, Preschool , Family Relations/psychology , Female , Humans , Longitudinal Studies , Male , Marriage/statistics & numerical data , Parents/psychology , Prospective Studies , Stress, Psychological/psychology , United States
11.
J Pediatr Psychol ; 43(6): 588-598, 2018 07 01.
Article in English | MEDLINE | ID: mdl-29474676

ABSTRACT

Objective: The current study examined the effect of stress on sibling conflict during the first year of pediatric cancer treatment. Method: Families (N = 103) included a child with cancer (aged 2-17 years, Mage = 6.46, SD = 3.52) and at least one sibling aged <5 years of the child with cancer (Mage = 8.34, SD = 5.61). Primary caregivers completed monthly questionnaires throughout the first year of treatment assessing five sources of stress (i.e., general life, cancer-related, financial, perceived treatment intensity, and life threat) and level of sibling conflict. Using multilevel modeling, we explored the effects of these stressors on conflict both at the within- and between-family levels to examine if changes in stress resulted in concurrent changes in conflict within an individual family, and whether greater average stress affected the trajectory of conflict between families, respectively. Results: At the between-family level, higher average levels of cancer-related stress, general life stress, and financial stress were associated with higher sibling conflict at the end of the first year of treatment. Perceived treatment intensity and life threat were not associated with conflict. No stressors were associated with conflict at the within-family level. Conclusions: During pediatric cancer treatment, some stressors may spill over into family relationships and contribute to increases in sibling conflict.


Subject(s)
Caregivers/psychology , Family Conflict/psychology , Neoplasms/psychology , Sibling Relations , Siblings/psychology , Stress, Psychological/etiology , Adolescent , Adult , Child , Child, Preschool , Female , Humans , Longitudinal Studies , Male , Models, Psychological , Neoplasms/therapy , Stress, Psychological/diagnosis , Surveys and Questionnaires
12.
Psychooncology ; 27(4): 1244-1250, 2018 04.
Article in English | MEDLINE | ID: mdl-29405486

ABSTRACT

OBJECTIVE: Pediatric cancer is highly stressful for parents. The current prospective study examines the impact of several stressors (financial strain, life threat, treatment intensity, treatment-related events, and negative life events) on the trajectory of marital adjustment across the first year following diagnosis. We examined whether average level of stressors across the year was related to (1) levels of marital adjustment at the end of the first year of treatment and () the rate of change in marital adjustment. METHOD: One hundred and thirty families of children newly diagnosed with cancer (M age = 6.33 years, SD = 3.61) participated. Primary caregivers provided 12 monthly reports on marital adjustment and stressors. RESULTS: Multilevel models indicated that although marital adjustment was stable across the first year on average, random effect estimates suggested that this was the result of differing trajectories between families (eg, some increasing and others decreasing). Five individual stress constructs and a cumulative stress composite were then used to predict this variability. Higher average economic strain was related to consistently poorer marital adjustment across time. Higher average frequency of treatment-related events and negative life events were associated with decreasing adjustment over time and lower adjustment at the end of the first year of treatment. Perception of life threat and treatment intensity were not associated with final levels or trajectory of adjustment. Finally, higher cumulative stress was associated with consistently poorer marital adjustment across time. CONCLUSION: Implications for identification of at-risk families are discussed, and importance of delivering tailored interventions for this population.


Subject(s)
Marriage/psychology , Neoplasms , Parents/psychology , Stress, Psychological/psychology , Adolescent , Adult , Caregivers , Child , Child, Preschool , Female , Humans , Male , Multilevel Analysis , Prospective Studies , Time Factors
13.
Neurology ; 89(21): 2151-2156, 2017 Nov 21.
Article in English | MEDLINE | ID: mdl-29030453

ABSTRACT

OBJECTIVE: To evaluate whether frontal-lobe magnetic resonance spectroscopy measures of γ-aminobutyric acid (GABA) would be altered in a sample of adolescents scanned after sport concussion because mild traumatic brain injury is often associated with working memory problems. METHODS: Eleven adolescents (age 14-17 years) who had sustained a first-time sport concussion were studied with MRI/magnetic resonance spectroscopy within 23 to 44 days after injury (mean 30.4 ± 6.1 days). Age- and sex-matched healthy controls, being seen for sports-related injuries not involving the head and with no history of concussion, were also examined. GABA/creatine + phosphocreatine (Cre) was measured in left-sided frontal lobe and central posterior cingulate regions. The frontal voxel was positioned to overlap with patient-specific activation on a 1-back working memory task. RESULTS: Increased GABA/Cre was shown in the frontal lobe for the concussed group. A decreased relationship was observed in the parietal region. High correlations between GABA/Cre and task activation were observed for the control group in the frontal lobe, a relationship not shown in the concussed participants. CONCLUSIONS: GABA/Cre appears increased in a region colocalized with working memory task activation after sport concussion. Further work extending these results in larger samples and at time points across the injury episode will aid in refining the clinical significance of these observations.


Subject(s)
Athletic Injuries/complications , Brain Concussion/etiology , Frontal Lobe/metabolism , Gyrus Cinguli/metabolism , gamma-Aminobutyric Acid/metabolism , Adolescent , Brain Concussion/diagnostic imaging , Brain Concussion/pathology , Case-Control Studies , Child , Child, Preschool , Creatine/metabolism , Female , Frontal Lobe/diagnostic imaging , Gyrus Cinguli/diagnostic imaging , Humans , Magnetic Resonance Imaging , Magnetic Resonance Spectroscopy , Male , Memory, Short-Term/physiology , Oxygen/blood , Time Factors
14.
J Clin Psychol Med Settings ; 21(4): 329-36, 2014 Dec.
Article in English | MEDLINE | ID: mdl-25224583

ABSTRACT

Parental intrusiveness is associated with internalizing problems in healthy children. Given the unique demands that childhood cancer places on parents, it is important to determine whether intrusiveness operates differently in survivors of childhood cancer. The current study tested whether cancer survivorship moderates the relation between maternal directiveness-one aspect of intrusiveness-and children's internalizing problems. Survivors (7-12 years old) of acute lymphoblastic leukemia (ALL) (n = 25) and their mothers, and healthy controls (n = 22) and their mothers engaged in parent-child interactions. Mothers completed a measure of children's psychosocial adjustment, and observations of 10-min parent-child interactions were obtained. Cancer survivorship moderated the relation between directiveness and children's withdrawn/depressed symptoms. Maternal directiveness was associated with increased withdrawn/depressed symptoms for children in the control group. This association was not significant for survivors of ALL. Findings suggest that childhood cancer may alter the context in which children experience maternal directiveness.


Subject(s)
Child Behavior Disorders/psychology , Mother-Child Relations , Mothers/psychology , Parenting/psychology , Precursor Cell Lymphoblastic Leukemia-Lymphoma/psychology , Survivors/psychology , Adaptation, Psychological , Adult , Child , Child Behavior Disorders/complications , Female , Humans , Male , Precursor Cell Lymphoblastic Leukemia-Lymphoma/complications
16.
J Am Acad Child Adolesc Psychiatry ; 51(5): 496-505, 2012 May.
Article in English | MEDLINE | ID: mdl-22525956

ABSTRACT

OBJECTIVE: To assess neurocognitive outcomes following antipsychotic intervention in youth enrolled in the National Institute of Mental Health (NIMH)-funded Treatment of Early-Onset Schizophrenia Spectrum Disorders (TEOSS). METHOD: Neurocognitive functioning of youth (ages 8 to 19 years) with schizophrenia or schizoaffective disorder was evaluated in a four-site, randomized, double-blind clinical trial comparing molindone, olanzapine, and risperidone. The primary outcomes were overall group change from baseline in neurocognitive composite and six domain scores after 8 weeks and continued treatment up to 52 weeks. Age and sex were included as covariates in all analyses. RESULTS: Of 116 TEOSS participants, 77 (66%) had post-baseline neurocognitive data. No significant differences emerged in the neurocognitive outcomes of the three medication groups. Therefore, the three treatment groups were combined into one group to assess overall neurocognitive outcomes. Significant modest improvements were observed in the composite score and in three of six domain scores in the acute phase, and in four of six domain scores in the combined acute and maintenance phases. Partial correlation analyses revealed very few relationships among Positive and Negative Syndrome Scale (PANSS) baseline or change scores and neurocognition change scores. CONCLUSIONS: Antipsychotic intervention in youth with early-onset schizophrenia spectrum disorders (EOSS) led to modest improvement in measures of neurocognitive function. The changes in cognition were largely unrelated to baseline symptoms or symptom change. Small treatment effect sizes, easily accounted for by practice effects, highlight the critical need for the development of more efficacious interventions for the enduring neurocognitive deficits seen in EOSS. Clinical trial registry information-Treatment of Early-Onset Schizophrenia Spectrum Disorders (TEOSS); http://www.clinicaltrials.gov; NCT00053703.


Subject(s)
Antipsychotic Agents/therapeutic use , Benzodiazepines/therapeutic use , Cognition Disorders/drug therapy , Molindone/therapeutic use , Neuropsychological Tests , Psychotic Disorders/drug therapy , Risperidone/therapeutic use , Schizophrenia/drug therapy , Schizophrenic Psychology , Adolescent , Antipsychotic Agents/adverse effects , Benzodiazepines/adverse effects , Child , Cognition Disorders/diagnosis , Cognition Disorders/psychology , Double-Blind Method , Female , Follow-Up Studies , Humans , Male , Molindone/adverse effects , Olanzapine , Psychotic Disorders/diagnosis , Psychotic Disorders/psychology , Risperidone/adverse effects , Schizophrenia/diagnosis
17.
Blood ; 117(19): 5243-9, 2011 May 12.
Article in English | MEDLINE | ID: mdl-21389320

ABSTRACT

Human herpesvirus 6 (HHV-6) is detected in the plasma of approximately 40% of patients undergoing hematopoietic cell transplantation (HCT) and sporadically causes encephalitis in this population. The effect of HHV-6 reactivation on central nervous system function has not been fully characterized. This prospective study aimed to evaluate associations between HHV-6 reactivation and central nervous system dysfunction after allogeneic HCT. Patients were enrolled before HCT. Plasma samples were tested for HHV-6 at baseline and twice weekly after transplantation until day 84. Delirium was assessed at baseline, 3 times weekly until day 56, and weekly on days 56 to 84 using a validated instrument. Neurocognitive testing was performed at baseline and at approximately day 84. HHV-6 was detected in 111 (35%) of the 315 included patients. Patients with HHV-6 were more likely to develop delirium (adjusted odds ratio = 2.5; 95% confidence interval, 1.2-5.3) and demonstrate neurocognitive decline (adjusted odds ratio = 2.6; 95% confidence interval, 1.1-6.2) in the first 84 days after HCT. Cord blood and unrelated transplantation increased risk of HHV-6 reactivation. These data provide the basis to conduct a randomized clinical trial to determine whether prevention of HHV-6 reactivation will reduce neurocognitive morbidity in HCT recipients.


Subject(s)
Cognition Disorders/virology , Delirium/virology , Hematopoietic Stem Cell Transplantation/adverse effects , Roseolovirus Infections/complications , Virus Activation/physiology , Adult , Cognition Disorders/epidemiology , Delirium/epidemiology , Female , Herpesvirus 6, Human/physiology , Humans , Male , Middle Aged , Neuropsychological Tests , Roseolovirus Infections/epidemiology , Roseolovirus Infections/virology , Transplantation , Young Adult
18.
J Pediatr Psychol ; 36(2): 237-47, 2011 Mar.
Article in English | MEDLINE | ID: mdl-20522423

ABSTRACT

OBJECTIVE: To use observational methods to assess the quality of peer relationships in 51 7- to 12-year-old acute lymphoblastic leukemia survivors as compared to healthy children. METHODS: Children were audiotaped as they engaged in free play with their best friend and interactions were coded to assess their ability to maintain engagement with one another during play as well as the affective dimension of their play. RESULTS: Results indicated that dyads with survivors of childhood cancer were less likely to be highly engaged with their best friend and more likely to experience disengagement than dyads with healthy participants. There were no group differences in positive or negative affect. CONCLUSIONS: Overall, these data suggest that survivors of childhood cancer's relationships with their best friend may be compromised in some specific areas when compared to the relations of healthy children. Implications for intervention are discussed.


Subject(s)
Adaptation, Psychological , Friends/psychology , Interpersonal Relations , Play and Playthings , Precursor Cell Lymphoblastic Leukemia-Lymphoma/psychology , Survivors/psychology , Affect , Analysis of Variance , Child , Female , Humans , Male , Peer Group , Quality of Life
19.
J Am Acad Child Adolesc Psychiatry ; 49(1): 52-60, 2010 Jan.
Article in English | MEDLINE | ID: mdl-20215926

ABSTRACT

OBJECTIVE: We examined the neuropsychological functioning of youth enrolled in the NIMH funded trial, Treatment of Early-Onset Schizophrenia Spectrum Disorders (TEOSS). We compared the baseline neuropsychological functioning of youth with schizophrenia (SZ, n = 79) to those with schizoaffective disorder (SA, n = 40), and examined the relationship of different variables of illness severity and adaptive behavior to neuropsychological functioning. METHOD: Participants ranged in age from 8 to 19 years. Diagnostic status was confirmed via structured interview over multiple time points. Domains of neuropsychological functioning included fine-motor, attention, working memory, problem-solving efficiency, inhibitory control, and social cognition. Other variables included intelligence (IQ), academic achievement skills, adaptive behavior, and different measures of illness severity. RESULTS: The two groups did not differ on IQ or on any of the neuropsychological domains. The SZ group performed significantly lower in spelling. A high proportion of individuals in both groups reflected significant intellectual and academic achievement skill deficits. Significant correlations were found between the neurocognitive domains and both illness severity and adaptive behavior variables. CONCLUSIONS: There were few differences between the SZ and SA groups on IQ, achievement, or neuropsychological functioning; however, both groups showed significantly high rates of deficits in IQ and basic academic skills. Correlations of the neurocognitive functions with illness severity and adaptive behavior were small to moderate in magnitude. These findings continue to implicate the importance of neurocognitive functioning as a key area of vulnerability in the study of youth with schizophrenia spectrum disorders.


Subject(s)
Cognition Disorders/diagnosis , Neuropsychological Tests , Psychotic Disorders/diagnosis , Schizophrenia/diagnosis , Schizophrenic Psychology , Achievement , Adolescent , Child , Cognition Disorders/psychology , Female , Humans , Intelligence , Male , Neuropsychological Tests/statistics & numerical data , Psychiatric Status Rating Scales , Psychometrics , Psychotic Disorders/psychology
20.
J Clin Oncol ; 27(35): 5986-92, 2009 Dec 10.
Article in English | MEDLINE | ID: mdl-19884541

ABSTRACT

PURPOSE: For the majority of children with acute lymphoblastic leukemia (ALL), CNS prophylaxis consists of either intrathecal (IT) methotrexate or triple IT therapy (ie, methotrexate with both cytarabine and hydrocortisone). The long-term neurotoxicities of these two IT strategies have not yet been directly compared. PATIENTS AND METHODS: In this multisite study, 171 children with standard-risk ALL, age 1 to 9.99 years at diagnosis, previously randomly assigned to IT methotrexate (n = 82) or to triple IT therapy (n = 89) on CCG 1952, underwent neurocognitive evaluation by a licensed psychologist at a mean of 5.9 years after random assignment. RESULTS: Patients who received IT methotrexate had a mean Processing Speed Index that was 3.6 points lower, about one fourth of a standard deviation, than those who received triple IT therapy (P = .04) after analysis was adjusted for age, sex, and time since diagnosis. Likewise, 19.5% of children in the IT methotrexate group had a Processing Speed Index score in the below-average range compared with 6.9% in the triple IT therapy group (P = .02). Otherwise, the groups performed similarly on tests of full-scale intelligence quotient, academic achievement, attention/concentration, memory, and visual motor integration. The association of treatment with measures of cognitive functioning was not modified by sex or age at diagnosis. In the post-therapy period, there were no group differences in special education services, neurologic events, or use of psychotropic medications. CONCLUSION: This study did not show any clinically meaningful differences in neurocognitive functioning between patients previously randomly assigned to IT methotrexate or triple IT therapy except for a small difference in processing speed in the IT methotrexate group.


Subject(s)
Antimetabolites, Antineoplastic/administration & dosage , Antineoplastic Combined Chemotherapy Protocols/administration & dosage , Cognition/drug effects , Methotrexate/administration & dosage , Precursor Cell Lymphoblastic Leukemia-Lymphoma/drug therapy , Antimetabolites, Antineoplastic/adverse effects , Antineoplastic Combined Chemotherapy Protocols/adverse effects , Attention/drug effects , Child , Child, Preschool , Cross-Sectional Studies , Cytarabine/administration & dosage , Female , Humans , Hydrocortisone/administration & dosage , Infant , Injections, Spinal , Intelligence Tests , Linear Models , Male , Memory/drug effects , Methotrexate/adverse effects , Neuropsychological Tests , Psychomotor Performance/drug effects , Time Factors , Treatment Outcome , United States
SELECTION OF CITATIONS
SEARCH DETAIL
...