Central nervous system (CNS) prophylaxis involving cranial irradiation has frequently been found to result in cognitive deficits in survivors of childhood acute lymphoblastic leukaemia. The existence of this effect is still controversial, however, as is the question of factors that might affect its severity. The literature is surveyed and a meta-analysis undertaken on 30 IQ comparisons, which shows a substantial average decrement in irradiated subjects. The effect is larger when radiation is administered at a younger age and appears to be progressive. The effect may comprise two elements, one common to young cancer patients and one specific to CNS prophylaxis.

We assessed neuropsychologically 106 children with acute lymphoblastic leukemia (ALL) who had all received cranial irradiation for the prevention of central nervous system (CNS) leukemia 1-13 years previously. Children were assessed for adverse late effects of their therapy, using age-appropriate Wechsler measures of overall intellectual ability and supplementary tests. Forty-five siblings near in age to the patients were tested as controls. The patients who had had the most intensive central nervous system (CNS) prophylaxis were found to have a WISC-R Full Scale IQ 17 points lower than the sibling control group. Performance IQ was more affected than verbal IQ. The patients were more easily distracted and less able to concentrate. The severity of the aftereffects was related to younger age at the time of CNS prophylaxis and to a higher dose of cranial irradiation but not to time since CNS prophylaxis. CNS prophylaxis using a combination of cranial irradiation and intrathecal methotrexate has lowered the incidence of CNS relapse in childhood ALL but is associated with considerable long-term morbidity in survivors.

Male students (n=95) and female students (n=77) in their penultimate year at a metropolitan high school completed the Bern Sex Role Inventory (BSRI) to provide masculinity (M) and femininity (F) scores and also nominated their choices of ideal and realistic occupations, the former being the occupation they would most prefer to work in and the latter the occupation that they realistically expected to choose. They then' rated each choice for male dominance and status or prestige. Those subjects who indicated that they would not continue in the realistically chosen occupation until retirement also rated the likelihood that each of 10 reasons would be their reason for leaving. Results indicated strong gender effects for the male dominance ratings, males preferring gender-congruent ideal and realistic occupations more than females. Strong gender effects also occurred from the analyses of the likelihood ratings for some of the reasons. Effects involving masculinity (M) and femininity (F) scores and their joint classification (androgynous, masculine, feminine, undifferentiated) were mostly non-significant but the significant effects that did emerge were theoretically meaningful, especially those that concerned reasons for quitting the realistic occupation. Results were taken as support for the view that the effects of sex-role expectations and attitudes should be distinguished from the effects of instrumental and expressive personality traits when occupational choices are considered.

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