Long-Term Efficacy of Methylphenidate in Enhancing Attention Regulation, Social Skills, and Academic Abilities of Childhood Cancer Survivors

Conklin, Heather M.; Reddick, Wilburn E.; Ashford, Jason M.; Ogg, Susan; Howard, Scott C.; Morris, E. Brannon; Brown, Ronald T.; Bonner, Melanie J.; Christensen, Robbin; Wu, Shengjie; Xu, Xiaoping; Khan, Raja B.

doi:10.1200/jco.2010.28.4026

Cited by 127 publications

(76 citation statements)

References 27 publications

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“…Interventions aimed at improving attention and processing speed should consider lapses of attention among primary outcomes. Pharmacologic stimulant treatment has proven to effectively decrease lapses of attention in children with ADHD 34 and pediatric cancer survivors, 35 possibly providing a promising treatment of children with TBI as well. …”

Section: Discussionmentioning

confidence: 99%

Pediatric Traumatic Brain Injury and Attention Deficit

Königs

Heij

Sluijs³

et al. 2015

Pediatrics

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BACKGROUND: We investigated the impact of pediatric traumatic brain injury (TBI) on attention, a prerequisite for behavioral and neurocognitive functioning.METHODS: Children aged 6 to 13 years who were diagnosed with TBI (n = 113; mean 1.7 years postinjury) were compared with children with a trauma control injury (not involving the head) (n = 53). TBI severity was defined as mild TBI with or without risk factors for complicated TBI (mild RF+ TBI, n = 52; mild RF2 TBI, n = 24) or moderate/severe TBI (n = 37). Behavioral functioning was assessed by using parent and teacher questionnaires, and the Attention Network Test assessed alerting, orienting, and executive attention. Ex-Gaussian modeling determined the contribution of extremely slow responses (lapses of attention) to mean reaction time (MRT). RESULTS:The TBI group showed higher parent and teacher ratings of attention and internalizing problems, higher parent ratings of externalizing problems, and lower intelligence than the control group (P , .05, d $ 0.34). No effect of TBI on alerting, orienting, and executive attention was observed (P $ .55). MRT was slower in the TBI group (P = .008, d = 0.45), traced back to increased lapses of attention (P = .002, d = 0.52). The mild RF2 TBI group was unaffected, whereas the mild RF+ TBI and moderate/severe TBI groups showed elevated parent ratings of behavior problems, lower intelligence, and increased lapses of attention (P # .03, d $ 0.48). Lapses of attention fully explained the negative relation between intelligence and parent-rated attention problems in the TBI group (P = .02).CONCLUSIONS: Lapses of attention represent a core attention deficit in children with mild RF+ TBI (even in the absence of intracranial pathology) or moderate/severe TBI, and relate to daily life problems after pediatric TBI. WHAT'S KNOWN ON THIS SUBJECT:Attention is a prerequisite for neurocognitive and behavioral functioning, having a crucial role in academic and social child development. Children with traumatic brain injury have pronounced deficits in attention, but the nature and consequences of these deficits remain unclear.WHAT THIS STUDY ADDS: Lapses of attention represent a core attention deficit after pediatric mild traumatic brain injury with risk factors for complicated traumatic brain injury, or moderate/severe traumatic brain injury. Importantly, lapses of attention explain the relation between intelligence and parent-rated attention problems.

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Section: Discussionmentioning

confidence: 99%

Pediatric Traumatic Brain Injury and Attention Deficit

Königs

Heij

Sluijs³

et al. 2015

Pediatrics

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“…58 Thus appropriate monitoring of neurocognitive function and intervening when impairments are detected are key to mitigating the long-term effect of cancer therapy in this patient population. Pharmacological and nonpharmacological interventions for remediating problems in working memory, 49 attention, 59,60 and executive function 61,62 continue to be investigated and show promise for the future.…”

Section: Org Frommentioning

confidence: 99%

Chemotherapy-only treatment effects on long-term neurocognitive functioning in childhood ALL survivors: a review and meta-analysis

Iyer

Balsamo

Bracken

et al. 2015

Blood

161

132

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• Children treated for ALL without cranial radiation display significant IQ deficits of 6 to 8 points compared with healthy controls.• Moderate deficits occur in other neurocognitive domains including working memory, information processing speed, and fine motor functioning.Therapy for childhood acute lymphoblastic leukemia (ALL) is associated with 5-year survival rates of ∼90% even after largely eliminating cranial radiation. This meta-analysis assesses the long-term neurocognitive functioning after chemotherapy-only regimens among survivors of childhood ALL. We conducted a systematic review to identify studies that evaluated long-term neurocognitive functioning following treatment of ALL by searching MEDLINE/PubMed, Database of Abstracts of Reviews of Effects, and secondary sources. Studies were included if ALL survivors were in continuous first remission, did not receive any radiation, were at least ‡2 years off therapy or ‡5 years since diagnosis, and were compared with a healthy control group. Weighted mean differences with 95% confidence intervals (CIs) were calculated. Ten nonexperimental studies met all eligibility criteria and included 509 patients and 555 controls. Meta-analysis demonstrated statistically significant moderate impairment across multiple neurocognitive domains evaluated, with intelligence most affected. Significant differences in standard deviation (SD) scores were found for Full Scale intelligence quotient (IQ) (20.52 SD; 95% CI, 20.68 to 20.37), Verbal IQ (20.54 SD; 95% CI, 20.69 to 20.40), and Performance IQ (20.41 SD; 95% CI, 20.56 to 20.27); these SD scores correspond to changes in IQ of 6 to 8 points. Working memory, information processing speed, and fine motor domains were moderately, but statistically significantly, impaired. Meta-analysis of ALL survivors treated without cranial radiation demonstrated significant impairment in IQ and other neurocognitive domains. Patients and their families should be informed about these potential negative effects to encourage surveillance and educational planning. Both preventive and intervention strategies are needed. (Blood. 2015;126(3):346-353) IntroductionAcute lymphoblastic leukemia (ALL) is the most common malignancy in children, accounting for 18% of all cancers and 74% of all leukemias.1 As a result of improvements in treatment and supportive care over recent decades, the current 5-year relative survival rate is 89% for children diagnosed with ALL before age 20 years 1 and exceeds 93% for children with standard risk features diagnosed before age 10 years.2 Because the vast majority of children with ALL are expected to survive their disease, it is important to understand the long-term burden of therapy.Neurocognitive and psychological difficulties as a result of chemotherapy have been documented in survivors of adult cancer across a variety of cancer types.3 However, most pediatric studies have focused on children with brain tumors or central nervous system (CNS)-directed radiation treatment. 4 Although the deleterious neurocognitive ...

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“…Additionally, there has been little practical research on the design of interventions to address the poor educational outcomes commonly observed among pediatric medulloblastoma survivors. Studies of computerized and medication-based interventions have shown no significant effects on academic achievement among survivors of childhood cancer (e.g., Butler & Copeland, 2002;Butler & Mulhern, 2005;Conklin et al, 2010).…”

Section: The Present Studymentioning

confidence: 99%

Effect of motivation on academic fluency performance in survivors of pediatric medulloblastoma

Holland¹,

Hughes

Harder³

et al. 2015

Child Neuropsychology

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It has been proposed previously that extrinsic motivation may enable survivors of childhood medulloblastoma to significantly improve aspects of neurocognitive performance. In healthy populations, enhanced motivation has been shown to promote academic fluency, a domain likely more relevant to the educational outcomes of pediatric medulloblastoma survivors than academic skill development. The present study investigates the effect of enhanced extrinsic motivation on fluent (i.e., accurate and efficient) academic performance in pediatric medulloblastoma survivors. Participants were 36 children, ages 7-18, who had completed treatment for medulloblastoma. Participants completed a neuropsychological battery that included administration of equivalent tasks on Forms A and B of the Woodcock-Johnson III Tests of Achievement. Half were randomly assigned to an incentive condition prior to the administration of Form B. Provision of a performance-based incentive resulted in statistically significant improvement, but not normalization of function, in performance on measures of academic fluency. No demographic, treatment-related, academic, neuropsychological, or self-perception variables predicted response to incentive. Findings suggest that academic performance of survivors may significantly improve under highly motivating conditions. In addition to implications for educational services, this finding raises the novel possibility that decreased motivation represents an inherent neuropsychological deficit in this population and provides a rationale for further investigation of factors affecting individual differences in motivational processes. Further, by examining effort in a context where effort is not inherently suspect, present findings also significantly contribute to the debate regarding the effects of effort and motivation on neuropsychological performance.

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Long-Term Efficacy of Methylphenidate in Enhancing Attention Regulation, Social Skills, and Academic Abilities of Childhood Cancer Survivors

Cited by 127 publications

References 27 publications

Pediatric Traumatic Brain Injury and Attention Deficit

Pediatric Traumatic Brain Injury and Attention Deficit

Chemotherapy-only treatment effects on long-term neurocognitive functioning in childhood ALL survivors: a review and meta-analysis

Effect of motivation on academic fluency performance in survivors of pediatric medulloblastoma

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