ABSTRACT
OBJECTIVE: To compare the effects of two intravenous (IV) methotrexate (MTX) infusion protocols on cognitive function in children newly diagnosed with acute lymphoblastic leukemia (ALL). METHODS: We compared 19 children treated with 1 g/m(2) of IV MTX over 24 hr (Group 1) to 13 children treated with 2 g/m(2) of IV MTX over 4 hr (Group 2) on measures of working memory, nonverbal, and verbal skills shortly after diagnosis (Time 1) and 1 year later (Time 2). RESULTS: A significant GroupxTime interaction was found for a composite measure of working memory with Group 2 declining from Time 1 to Time 2. Group 2 performed significantly worse than Group 1 on a composite measure of nonverbal skills at both time points. CONCLUSIONS: Findings suggest that difficulties in working memory and nonverbal skills may be evident during the first year of treatment for ALL and that severity may be dependent on IV MTX dose and/or infusion rate.
Subject(s)
Antimetabolites, Antineoplastic/adverse effects , Memory Disorders/chemically induced , Methotrexate/adverse effects , Neuropsychological Tests , Precursor Cell Lymphoblastic Leukemia-Lymphoma/drug therapy , Verbal Learning/drug effects , Antimetabolites, Antineoplastic/administration & dosage , Child , Child, Preschool , Dose-Response Relationship, Drug , Female , Humans , Infusions, Intravenous , Longitudinal Studies , Male , Memory Disorders/diagnosis , Memory Disorders/psychology , Memory, Short-Term/drug effects , Methotrexate/administration & dosage , Psychomotor Performance/drug effects , Vocabulary , Wechsler ScalesABSTRACT
Difficulties in math are the most frequently reported area of academic deficit in survivors of acute lymphoblastic leukemia (ALL) and the most frequent academic complaint among parents of ALL survivors. However, previous studies that included measures of math skills have been limited by the use of only a single measure of math skills, most often a measure of written calculations, without any assessment of math reasoning or math application skills. Further, the nature of these math difficulties has not been adequately investigated. The purpose of this study was to examine the performance of ALL survivors using multiple measures of math skills. Performance was compared to a group of healthy controls matched for age and sex as well as to normative levels. Other measures of neuropsychological function were also administered, and the relationships between these measures and the math measures were explored. Converging evidence for math difficulties in ALL survivors compared to healthy controls and normative levels was found. While ALL survivors generally performed within the average range on measures of math skills, math performance was mostly related to memory function and dominant-hand psychomotor speed. By contrast, math performance of healthy children was mostly related to basic reading skills and visual-motor integration. These findings shed light on the nature of math difficulties in ALL survivors and have implications for intervention.
Subject(s)
Learning Disabilities/diagnosis , Mathematics , Precursor Cell Lymphoblastic Leukemia-Lymphoma/psychology , Survivors/psychology , Adolescent , Antineoplastic Combined Chemotherapy Protocols/administration & dosage , Antineoplastic Combined Chemotherapy Protocols/adverse effects , Attention/drug effects , Child , Female , Humans , Injections, Spinal , Learning Disabilities/chemically induced , Learning Disabilities/psychology , Male , Mental Recall , Neuropsychological Tests , Precursor Cell Lymphoblastic Leukemia-Lymphoma/drug therapy , Problem Solving , Psychomotor Performance/drug effects , Reaction Time/drug effects , Reading , Reference ValuesABSTRACT
OBJECTIVE: To evaluate the effectiveness of a manual-based, social-skills training, group intervention to improve social skills and social functioning of children treated for brain tumors, and to assess the impact of cognitive functioning on the effectiveness of the intervention. METHODS: Three social-skills training group interventions, each comprised of 5 to 7 children ages 8 to 14 years, were conducted. A parent component was included. In total, 13 children and their parents and teachers completed standard measures prior to and 9 months after the intervention. Children participated in a neuropsychological test battery at baseline. RESULTS: Social skills and social functioning variables changed in the direction of improved functioning, with several scores showing significant improvement from baseline to the follow-up assessment. Small to medium effect sizes were documented. Higher verbal and nonverbal functioning were associated with greater improvement. CONCLUSIONS: Findings are suggestive of the potential effectiveness of social-skills training in groups for children with brain tumors. Multisite, randomized, controlled studies are recommended as the next step.
