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(2004). ReviewNeurocognitive sequelae of childhood cancers and their treatment. Pediatric Rehabilitation: Vol. 7, No. 1, pp. 1-14.

Summary This article describes a cognitive-behavioral therapy intervention for teaching mothers of newly diagnosed patients with pediatric cancer to solve their problems, problems related to their child's illness, and the family's emotional reactions to the illness. The authors discuss the challenges and effects of maternal adjustment throughout the various stages of the child's illness, review the characteristics of adult learners, describe a maternal problem-solving therapy program, and provide an overview of the structured educational process, followed by a detailed discussion of a six-step maternal problem-solving therapy intervention. Finally, they describe an inventory that measures the effects of the intervention, which is being tested in a randomized controlled trial.

Cross-cultural aspects of siblings' adaptation to childhood cancer were examined in two studies as part of a cooperative multi-institutional investigation in Israel and the United States. Study 1 compared the behavioral adaptation of Israeli siblings of patients with childhood cancer with matched clinically referred and normal Israeli children. Study 2 compared the behavioral adaptation of case-matched samples of Israeli and American siblings and assessed the contribution of family relations and parental coping to the siblings' behavioral adjustment. Israeli patients' siblings and normal samples scored significantly lower on the Child Behavior Checklist (CBCL) than the clinically referred sample did, indicating fewer behavior problems, with no differences between the sibling and normal samples. The CBCL scores of the Israeli and American samples did not differ significantly on the Externalizing and Internalizing subscales and the Total Behavior Problem score. Significant correlations were found in both the Israeli and American samples between the parental coping and family relations variables and the CBCL scores, indicating that greater internal family support and emotional expressiveness and lower conflict were associated with less behavior disturbance in the sibling. The authors consider cross-cultural and methodologic issues when interpreting similarities and differences among Israeli and American siblings of pediatric cancer patients.

We investigated the epidemiology of pediatric anxiety and distress associated with magnetic resonance imaging procedures (MRIPs). Scores on the State-Trait Anxiety Inventory (Spielberger, Gorsuch, Lushene, Vagg, & Jacobs, 1983) and the State-Trait Anxiety Inventory for Children (Spielberger, Edwards, Lushene, Montuori, & Platzek, 1973), and subjective ratings of distress associated with MRIP were obtained from 55 pediatric oncology patients and their parents. Approximately 30% of children and their parents reported that MRIP produced significant distress. However, parents' ratings of their child's distress were significantly higher than children's self-ratings, and agreement between child and parent pairs was poor. Insertion of an intravenous line was identified as the most aversive component of MRIP by both parents (55%) and children (38%). The selective application of cognitive-behavioral interventions for noninvasive diagnostic procedures is suggested.

To establish the relationship between physical distress and depression, we assessed the severity of physical symptoms as well as depressive symptoms on the Children's Depression Inventory (CDI; Kovacs, 1983), a modified version of the CDI excluding physical symptoms (CDI-23), maternal reports on the Depression scale of the Child Behavior Checklist (Achenbach & Edelbrock, 1983), and maternal ratings twice within a 6-week interval among 92 children with cancer. Fewer than 10% of children ever exhibited symptomatology at or above threshold for diagnosis of mild depression. Approximately 40% of children displayed changes in severity of their depressive symptoms in the same direction as changes in severity of their physical symptoms. Children who were more vulnerable to continuing symptoms of depression following improvement in physical condition were correctly classified on the basis of their initial symptoms with 66% to 73% accuracy. These results can assist in discriminating children who may benefit from ps...

Compared the social and behavioral adjustment of 40 long-term survivors of childhood brain tumors to a matched control group of children surviving cancers that did not involve the central nervous system. Both groups exhibited significant elevations on the Behavior Problems scales of the Child Behavior Checklist (CBCL) relative to nonclinical norms, although approximately 50% of the children in both groups did not have significantly elevated scores on the CBCL. Contrary to expectations, the brain tumor group did not have significantly more signs of psychopathology than did the cancer control group and examination of serial evaluations suggested a significant decrease in symptoms of emotional disturbance since diagnosis in most children treated for brain tumors. Children in the brain tumor group did display more problems in the Social Competence scales than did children in the cancer control group, especially those related to inhibition of activities and school performance.

Although children with brain tumors account for 20% of all pediatric cancer and comprise a theoretically important population for the study of brain‐behavior relationships, surprisingly few neuropsychological investigations have been forthcoming. Evidence regarding the effects of hydrocephalus, age at diagnosis, extent of irradiation treatment, and tumor location on the subsequent neuropsychological status of survivors is reviewed. Failure to adequately analyze these variables and their potential interactions, equivocal findings across studies, a lack of sophistication in neuropsychological assessment and study design, and conclusions based upon small and oftentimes heterogenous samples are prevalent problems. Although it appears that young children with supratentorial tumors who receive cranial irradiation are at highest risk for intellectual, academic, and emotional dysfunction, further research is sorely needed to define the relationship between disease‐ and treatment‐related variables and subsequent n...