Social cognition and adjustment in adult survivors of pediatric central nervous system tumors

Abstract

BackgroundSurvivors of pediatric central nervous system (CNS) tumors are at risk for neurocognitive and social difficulties throughout childhood. This study characterized social cognition (perception and reasoning from social cues) and adjustment in adulthood.MethodsA total of 81 adult survivors of pediatric CNS tumors (51% female; mean [SD] age, 28.0 [5.8] years), were recruited across four groups: (1) no radiation therapy (RT) [n = 21], (2) infratentorial (IT) tumors + focal RT [n = 20], (3) IT tumors + craniospinal irradiation [n = 20], and (4) supratentorial tumors + focal RT [n = 20]. Prevalence of social cognitive and adjustment impairments was compared to test norms. Multivariable models examined clinical and neurocognitive predictors of social cognition and its impact on functional outcomes.ResultsSurvivors demonstrated elevated risk of severe social cognitive impairments (social perception Morbidity Ratio [95% CI] 5.70 [3.46–9.20]), but self‐reported few social adjustment problems. Survivors of IT tumors treated with craniospinal irradiation performed nearly 1 SD worse than survivors treated without RT on multiple measures of social cognition (e.g., social perception: β = −0.89, p = .004). Impaired executive functioning and nonverbal reasoning were associated with worse social cognitive performance (e.g., social perception: β = −0.75, p < .001; β = –0.84, p < .001, respectively). Better social perception was associated with higher odds of attaining full‐time employment (odds ratio, 1.52 [1.17–1.97]) and at least some college education (odds ratio, 1.39 [1.11–1.74]).ConclusionsAdult survivors of CNS tumors are at elevated risk of severely impaired social cognition, but do not perceive social adjustment difficulties. Better understanding of potential mechanisms underlying social cognitive deficits may inform intervention targets to promote better functional outcomes for at‐risk survivors.

Social impairment in survivors of pediatric brain tumors via reduced social attention and emotion‐specific facial expression recognition

“…Similarly, perspective-taking and the arousal of empathic feelings may be inhibited if survivors cannot recognize when a peer is sad. 38,39 Our investigation of expression-specific measures of FER builds on face processing research in SPBT, 17,[20][21][22] and suggests a need for targeted investigation of social affective functions related to social competence in survivors. The lack of significant associations between social attention and social challenges is consistent with past research in children with other developmental disorders.…”

“…7 Moreover, social information processing-and more specifically, underlying social affective functions-influences social behavior and social adjustment. 14,15 Previous research with SPBT has focused on social attention and face processing as predictors of social impairments, 17,[20][21][22] less and worse peer interactions, 18 and fewer friendships. 23 Taken together, these findings provide a more nuanced picture of the interplay between components of key social affective functions (i.e., social attention and FER) and social impairment in SPBT.…”

“…Social attention, or the focus of one's visual gaze in social situations, is one component of social affective functions 16 —and social information processes more broadly—but few have examined it as a risk factor for poor social outcomes among SPBT. In contrast, emotion recognition has been identified as an area in need of future research and a potential intervention target to improve social outcomes in SPBT 17 . Evidence indicates that while the frequency and quality of peer interactions are generally low among SPBT, survivors with more positive social experiences demonstrate superior facial expression recognition (FER) abilities 18…”

“…In contrast, emotion recognition has been identified as an area in need of future research and a potential intervention target to improve social outcomes in SPBT. 17 Evidence indicates that while the frequency and quality of peer interactions are generally low among SPBT, survivors with more positive social experiences demonstrate superior facial expression recognition (FER) abilities. 18 Associations between social attention, FER, and social behaviors have been investigated in children with developmental disorders, namely autism.…”