The Behavior Rating Inventory of Executive Function (BRIEF) to Identify Pediatric Acute Lymphoblastic Leukemia (ALL) Survivors At Risk for Neurocognitive Impairment

Abstract

Neurocognitive problems, including executive dysfunction, are potential late effects of pediatric acute lymphoblastic leukemia (ALL) treatment. Surveillance for neurocognitive impairment in a timely and efficient manner is imperative to ongoing clinical care. We sought to determine if the Behavior Rating Inventory of Executive Function (BRIEF) Parent Form identified leukemia survivors with cognitive impairment. In this 28-site cross-sectional study, parents of 256 children, a mean of 8.9 ± 2.2 years after treatment for standard-risk precursor-B ALL and in first remission, completed the BRIEF. We used a multivariate logistic regression to calculate the association between elevated scores on three composite BRIEF indices (Behavioral Regulation Index (BRI), Metacognition Index (MI), Global Executive Composite (GEC)) and special education and Attention-Deficit/Hyperactivity Disorder (ADHD) outcomes. All BRIEF index scores were significantly associated with receipt of special education services or ADHD. The BRI was most strongly associated with ADHD (OR = 4.33; 95% confidence interval (95% CI) = 1.72 – 10.9). The GEC was most strongly associated with ADHD (OR = 4.46, 95% CI 1.77 – 11.22). Elevated scores on the BRIEF GEC were associated with low sensitivity (24.1 – 39.1) for detecting the outcomes but better specificity (range 87.7 – 89.3). These results suggest that the parent-completed BRIEF is associated with clinical outcomes but is not a sensitive tool to identify leukemia survivors that require a comprehensive neuropsychological assessment.

Psychological Problems in Boys with Acute Myeloid Leukemia (AML) with Central Nervous System (CNS) Involvement; A Descriptive Study

“…Graef et al (27) also found that childhood cancer survivors have more anxiety, depression, and antisocial behaviors. Warris et al (28), Viola et al (29), and Plas et al (30) also showed more behavioral and emotional problems in children with AML after the treatment, which is consistent with the present study.…”

Monitoring neurocognitive functioning in childhood cancer survivors: evaluation of CogState computerized assessment and the Behavior Rating Inventory of Executive Function (BRIEF)

“…These results are consistent with two other studies that have investigated the use of parent-report measures as surveillance tools for identification of pediatric leukemia and brain tumor survivors with neurocognitive or learning problems [11, 12]. As in the current study, these measures had good specificity but were not sensitive enough to identify survivors with negative outcomes.…”

“…[11] Similarly, in another study parent-completed BRIEF questionnaires demonstrated good specificity, but results were not sensitive enough to identify those leukemia survivors demonstrating real-life difficulties in the form of receiving special education services or problems with attention. [12]…”

“…[10] Among pediatric leukemia and brain tumor survivors, parent-report measures have demonstrated good specificity, but showed low sensitivity in identifying those with neurocognitive or psychosocial problems or those demonstrating real-life difficulties, e.g., receiving special education services. [11] [12] In contrast, Bull, Liossi [13] showed moderate to high sensitivity in using a combination of parent-, self-, and teacher-completed reports to identify those brain tumor survivors with below average IQ. These patients, however, had a particularly high prevalence of poor neurocognitive outcomes, and it is unclear if these findings generalize to survivors with a range of less severe neuropsychological difficulties.…”

Longitudinal Trajectories of Neurocognitive Functioning in Childhood Acute Lymphoblastic Leukemia

“…Monitoring batteries that are sensitive and time efficient will be necessary to follow these patients. Other studies have examined the utility of neurocognitive monitoring or screening batteries in long-term survivors of leukemia (Boulet-Craig et al, 2018;Viola et al, 2017) or various pediatric cancers (Balsamo et al, 2019;Bull et al, 2015;Krull et al, 2008), and batteries that are sensitive to impairments starting early in treatment and continuing into survivorship are an area of active research (Sands et al, 2017). Results from the current study and previous research suggest that performance measures and parent/ teacher ratings of attention, executive functioning, and learning are important to include in a battery.…”