Young children (<3 years) with cancer are at risk for delays in development due to their disease and its required treatments and restrictions. In the United States, Part C of the Individuals with Disabilities Education Act describes a system of early intervention (EI) services for young children with delays or the potential for delays in development. Children with cancer may be eligible for EI but are rarely referred. Our objectives are to describe the critical impact of early childhood development on long-term outcomes, review current considerations for EI, and advocate for the referral to EI for young children with cancer.
Early childhood is a time of remarkable growth that sets the foundation for subsequent development. Cognitive, speech and language, emotional, behavioral, and problem-solving skills begin to emerge during these years and mature on a developmental time line (Brown & Jernigan, 2012). These abilities are vital to positive long-term outcomes including academic success
Young children with cancer may be at significant risk of deficits in intellectual, adaptive, and preacademic functioning. Although our sample is biased by those who were referred for clinical evaluations, the severity of deficits highlights the potential vulnerability of young patients, even before most have entered formal school. Interventions-such as hospital-based preschool programs to increase preacademic skills-should be designed that explicitly target preschool-aged children and focus on a wide range of domains.
Pain and emotional distress are relevant risk factors as clinicians assess for aberrant opioid-associated behavior and provide adequate and responsible pain relief to patients who engage in behaviors that may be interpreted as drug seeking in nature. The present case illustrates how undertreated pain and treatment-related anxiety affected the opioid use of a young adult with cancer. Because these risk factors were identified during the initial consult, the treatment team was able to implement a multimodal and multidisciplinary treatment approach that provided the patient with better analgesia and coping skills for anxiety.
Objective: Through the use of quality improvement methodology, we aimed to increase the percent of eligible patients seen for developmental testing at our institution from 2.6% to 25% within a 36-month timeframe. Method: The Model for Improvement (Langley et al., 2009) was utilized as a framework to develop and implement an interdisciplinary, hospitalbased early intervention program that included comprehensive developmental assessments intended to inform intervention services. A kaizen event was used to map current processes, identify desired future state, and identify potential interventions. Outcomes were demonstrated through use of an annotated run chat and calculation of the percent of eligible patients seen. Descriptive feedback was solicited by e-mail from interdisciplinary team members. Results: The percent of eligible patients seen for clinical comprehensive developmental assessments and provided in-house early intervention services increased to 35.5% (N ϭ 155). Multidisciplinary team members reported that collaboration has improved, leading to enhanced developmental service delivery. Conclusions: This quality improvement initiative resulted in a program that filled a substantial clinical need at our institution. Pediatric psychologists could utilize the model for improvement to similarly enhance the quality of care for very young patients with cancer in their hospital settings. In doing so, professionals who work at hospitals dependent upon clinical revenues may consider utilization of Medicaid's early and periodic screening, diagnostic, and treatment benefit.
Implications for Impact StatementEfforts to increase the number of very young children with cancer seen for developmental assessments were successful at one institution. Other settings could implement similar processes to enhance services for young children.
Objective
One of the peak incidences of childhood cancer is during the early childhood years. This is also an important time for psychosocial and personality development, and it is well known that early childhood temperament influences later psychosocial functioning. However, this association has not been examined in young children with cancer.
Methods
Parents of children with cancer (N = 39) and healthy comparisons (N = 35) completed an indicator of temperament (Children’s Behavior Questionnaire) when children were young (Mage=4.99 ± 1.05 years). Five years later, parents and youth completed measures of psychosocial functioning (Mage=10.15 ± 1.10 years; Behavior Assessment Scale for Children, 2nd edition and Social Emotional Assets and Resilience Scale).
Results
Parents of healthy comparisons reported that their children demonstrated greater surgency than youth with cancer; there were no differences in negative affect or effortful control. Children with cancer and healthy comparisons were rated similarly on measures of psychosocial functioning. Health status was not a significant predictor of later functioning, but socioeconomic status and temperament were. The influence of temperament was stronger for strengths-based functioning (e.g., social competence, adaptive functioning) versus distress (internalizing and externalizing problems).
Conclusions
Early childhood temperament is a strong predictor of later psychosocial functioning, regardless of health status. Findings highlight the need to consider temperament in the clinical assessment of psychosocial functioning in children with cancer. Additional research is needed to specifically assess how a diagnosis of cancer in early childhood influences temperament over time.
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