Behavioral Adjustment of Children and Adolescents With Cancer: Teacher, Parent, and Self-Report
Purpose/Objectives: To describe behavioral adjustment in children and adolescents with acute lymphoblastic leukemia (ALL) and to determine whether behavioral adjustment is correlated with cognitive and academic abilities.
Design: Descriptive, cross-sectional design.
Setting: Two pediatric oncology treatment centers.
Sample: 47 children and adolescents who had been receiving ALL therapy for at least one year or who were off therapy for no more than three years and their parents and teachers. Wechsler Intelligence Scale for Children-Revised (WISC-R) and Wide Range Achievement Test-Revised (WRAT-R) data were available on a subset of 17 subjects.
Methods: Parent, teacher, and self-report Behavioral Assessment System for Children (BASC) ratings were used to measure behavioral adjustment. WISC-R measured cognitive abilities, and WRAT-R measured academic abilities. Demographic, family, and treatment-related data also were collected.
Main Research Variables: Behavioral adjustment and cognitive and academic abilities.
Findings: At least 20% of teacher ratings for somatization, learning problems, leadership, and study skills; parent ratings for somatization, adaptability, attention problems, withdrawal, anxiety, social skills, and depression; and self-report ratings for anxiety and attitude to school were in the at-risk range (i.e., presence of significant problems that require treatment). The majority of teacher BASC ratings were correlated significantly with WISC-R and WRAT-R scores. Self-report depression and social stress ratings were correlated significantly with some WISC-R and WRAT-R scores. Treatment-related experiences such as body image alterations and mental and emotional problems were associated with problematic behaviors, including depression, somatization, withdrawal, and social stress.
Conclusions: Youth with ALL are at risk for some behavioral adjustment problems, particularly anxiety, somatization, adaptability, attention, and withdrawal. Cognitive and academic abilities are associated with some dimensions of behavioral adjustment.
Implications for Nursing: Findings suggest the need for ongoing assessment of behavioral adjustment and cognitive and academic abilities of children with ALL. Behavioral interventions that target at-risk mannerisms, such as somatization, depression, anxiety, and social stress, are needed. Central nervous system treatment may contribute to behavioral adjustment problems, as well as to cognitive and academic problems. Strategies to improve academic abilities also may have a positive effect on behavioral adjustment.
Anderson, V., Smibert, E., Ekert, H., & Godber, T. (1994). Intellectual, educational, and behavioural sequelae after cranial irradiation and chemotherapy. <i>Archives of Disease in Childhood, 70</i>, 476-483.
Appleton, R.E., Farrell, K., Zaide, J., & Rogers, P. (1990). Decline in head growth and cognitive impairment in survivors of acute lymphoblastic leukaemia. <i>Archives of Disease in Children, 65</i>, 530-534.
Armstrong, F.D., Blumberg, M.J., & Toledano, S.R. (1999). Neurobehavioral issues in childhood cancer. <i>School Psychology Review, 28</i>, 194-203.
Bleyer, W.A. (1990). The impact of childhood cancer on the United States and the world. <i>CA: A Cancer Journal for Clinicians, 40</i>, 355-367.
Bleyer, W.A. (1993). What can be learned about childhood cancer from "Cancer Statistics Review 1973-1988." <i>Cancer, 71</i>(10 Suppl.), 3229-3236.
Bleyer, W.A. (1995). The past and future of cancer in the young. <i>Pediatric Dentistry, 17</i>, 285-290.
Boekaerts, M., & Roer, I. (1999). Stress, coping, and adjustment in children with a chronic disease: A review of the literature. <i>Disability and Rehabilitation, 21</i>, 311-337.
Brown, R.T., Sawyer, M.B., Antoniou, G., Toogood, I., Rice, M., Thompson, N., et al. (1996). A 3-year follow-up of the intellectual and academic functioning of children receiving central nervous system prophylactic chemotherapy for leukemia. <i>Developmental and Behavioral Pediatrics, 17</i>, 392-398.
Butler, R.W., Rizzi, L.P., & Bandilla, E.B. (1999). The effects of childhood cancer and its treatment on two objective measures of psychological functioning. <i>Children's Health Care, 28</i>, 311-327.
Cavusoglu, H. (2001). Depression in children with cancer. <i>Journal of Pediatric Nursing, 16</i>, 380-385.
Copeland, D.R., Moore, B.D., Francis, D.J., Jaffe, N., & Culbert, S. J. (1996). Neuropsychologic effects of chemotherapy on children with cancer: A longitudinal study. <i>Journal of Clinical Oncology, 14</i>, 2826-2835.
Cousens, P., Ungerer, J.A., Crawford, J.A., & Stevens, M.M. (1991). Cognitive effects of childhood leukemia therapy: A case for four specific deficits. <i>Journal of Pediatric Psychology, 16</i>, 475-488.
Eckert, T.L., Dunn, E.K., Codding, R.S., & Guiney, K.M. (2000). Self-report: Rating scale measures. In E.S. Shapiro & T.R. Kratochwill (Eds.), <i>Conducting school-based assessments of child and adolescent behavior</i> (pp. 150-169). New York: Guilford Press.
Fossen, A., Abrahamsen, T.G., & Storm-Mathisen, I. (1998). Psychological outcome in children treated for brain tumor. <i>Pediatric Hematology and Oncology, 15</i>, 479-488.
Jastak, S., & Wilkinson, G. (1984). <i>The Wide Range Achievement Test</i> (revised ed.). Wilmington, DE: Jastak Associates.
Jemal, A., Murray, T., Samuels, A., Ghafoor, A., Ward, E., & Thun, M. (2003). Cancer statistics, 2003. <i>CA: A Cancer Journal for Clinicians, 51</i>, 5-26.
Kramer, J., & Moore, I.M. (1989). The late effects of cancer therapy on the central nervous system. <i>Seminars in Oncology Nursing, 5</i>, 22-28.
McCarthy, D. (1972). <i>McCarthy Scales of Children's Abilities.</i> New York: Psychological Corporation Harcourt Brace Jovanovich.
Merrell, K.W. (2000). Informant report: Rating scale measures. In E.S. Shapiro & T.R. Kratochwill (Eds.), <i>Conducting school-based assessments of child and adolescent behavior</i> (pp. 203-233). New York: Guilford Press.
Moore, I.M., Espy, K.A., Kaufmann, P., Kramer, J., Kaemingk, K., Miketova, P., et al. (2000). Cognitive consequence and central nervous system injury following treatment for childhood leukemia. <i>Seminars in Oncology Nursing, 16</i>, 279-290.
Moore, I.M., Glasser, M.E., & Ablin, A.R. (1988). The late psychosocial consequences of childhood cancer. <i>Journal of Pediatric Nursing, 3</i>, 150-158.
Moore, I.M., Kramer, J., & Ablin, A.R. (1986). Late effects of central nervous system prophylactic leukemia treatment on cognitive functioning. <i>Oncology Nursing Forum, 13</i>, 45-51.
Mulhern, R.K., Armstrong, F.D., & Thompson, S.J. (1998). Function-specific neuropsychological assessment. <i>Medical and Pediatric Oncology, 1</i>(Suppl.), 34-40.
Mulhern, R.K., Wasserman, A.L., Friedman, A.G., & Fairclough, D. (1989). Social competence and behavioral adjustment of children who are long-term survivors of cancer. <i>Pediatrics, 83</i>, 18-25.
Newby, W.L., Brown, R.T., Pawletko, T.M., Gold, S.H., & Whitt, K. (2000). Social skills and psychological adjustment of child and adolescent cancer survivors. <i>Psycho-Oncology, 9</i>, 113-126.
Olson, A.L., Boyle, W.E., Evans, M.W., & Zug, L.A. (1993). Overall function in rural childhood cancer survivors. <i>Clinical Pediatrics, 32</i>, 334-342.
Peckham, V.C. (1991). Educational deficits in survivors of childhood cancer. <i>Pediatrician, 18</i>, 25-31.
Pendley, J.S., Dahlquist, L.M., & Dreyer, D. (1997). Body image and psycho-social adjustment in adolescent cancer survivors. <i>Journal of Pediatric Psychology, 22</i>, 29-43.
Reynolds, C.R., & Kamphaus, R.W. (1992). <i>Behavioral assessment system for children.</i> Circles Pine, MN: American Guidance Service.
Ries, L.A.G., Smith, M.A., Gurney, J.C., Linet, M., Tamra, T., Young, J.L., et al. (1999). <i>Cancer incidence and survival among children and adolescents: United States SEER Program 1975-1995</i> [NIH Pub No. 99-4649]. Bethesda, MD: National Cancer Institute.
Shapiro, E.S., & Kratochwill, T.R. (2000). Introduction: Conducting a multidimensional behavioral assessment. In E.S. Shapiro & T.R. Kratochwill (Eds.), <i>Conducting school-based assessments of child and adolescent behavior</i> (pp. 1-20). New York: Guilford Press.
Sharan, P., Mehta, M., & Chaudhry, V.P. (1999). Psychiatric morbidity in children suffering from acute lymphoblastic leukemia. <i>Pediatric Hematology and Oncology, 16</i>, 49-54.
Silber, J.H., Radcliffe, J., Peckham, V., Perilongo, G., Kishnani, P., Fridman, M., et al. (1992). Whole-brain irradiation and decline in intelligence: The influence of dose and age on IQ score. <i>Journal of Clinical Oncology, 10</i>, 1390-1396.
U.S. Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation. (1997). <i>Trends in the well-being of America's children and youth.</i> Retrieved June 24, 2003, from <a target="_blank" href='http://http://aspe.hhs.gov/hsp/97trends/intro-web.htm'>http://aspe.hhs.g...
Wechsler, D. (1974). <i>Manual for the Wechsler Intelligence Scale for Children.</i> New York: Psychological Corporation.