Are we friends? Best friend nominations in pediatric brain tumor survivors and associated factors.

BACKGROUND: Pediatric brain tumor survivors (PBTSs) are at risk of impairments in social competence. Limited information is available regarding nominations and reciprocated nominations of PBTSs as best friends and factors which may predict these. PROCEDURE: Caregivers of children (n = 32) aged 8-16 (38% low-grade glioma, 34% medulloblastoma, 28% other) completed ratings of child adjustment at baseline (T1) and PBTSs and classmates completed the Three Best Friends measure approximately 12 months later (T2). Sociometric data yielded ratings of best friend nominations and reciprocated best friend nominations. RESULTS: Nominations of PBTSs as best friends were not significantly different than controls, but PBTSs had fewer reciprocated best friend nominations than controls. Approximately half of PBTSs in this study did not have any reciprocated best friend nominations and 25% were not nominated by any peer as a best friend. Greater symptoms of depression and lower social skills in PBTSs were associated with fewer nominations as a best friend by peers and a greater likelihood of no reciprocal best friend nominations. Greater difficulties in emotional control were associated with fewer nominations as a best friend by peers. CONCLUSIONS: The discrepancy between reciprocated best friend nominations and best friend nominations highlights a need to attend to reciprocal friendships in PBTSs and further understand social information processes in this population. Longitudinal analyses illustrate the impact of emotional adjustment on PBTS friendships.

Predicting social withdrawal, anxiety and depression symptoms in pediatric brain tumor survivors.

OBJECTIVE: Pediatric brain tumor survivors (PBTSs) are at risk for impairments in social adjustment and psychological distress. This study investigated longitudinal associations between symptoms of social withdrawal and anxiety/depression in PBTS, as well as medical, demographic, and personal characteristics that may also influence reports of social withdrawal and anxiety/depression. METHOD: About 91 PBTS (51% male, mean age 11.21 years, off-treatment) participated. At baseline and 8 months follow-up, primary caregivers of PBTS completed measures of social withdrawal, anxiety, and depression symptoms. Medical information (e.g. tumor type and location, cranial irradiation therapy) and child personal characteristics (e.g. child's age and gender, executive function, social skills) were obtained at baseline. RESULTS: Baseline reports of depression symptoms and social skills predicted social withdrawal 8 months later. Social withdrawal at baseline predicted greater combined anxiety and depression symptoms 8 months later. Depression alone predicted greater anxiety symptoms at follow-up. Anxiety symptoms and poor global executive functioning predicted greater depression symptoms at follow-up. CONCLUSIONS: The social adjustment and psychological distress of PBTSs are interrelated and can influence each other across time. These findings support the importance of multifaceted interventions targeting both psychological distress and social adjustment, in order to support the optimal psychosocial adjustment of PBTSs.

A randomized control intervention trial to improve social skills and quality of life in pediatric brain tumor survivors.

BACKGROUND: To determine if a group social skills intervention program improves social competence and quality of life (QOL) in pediatric brain tumor survivors (PBTS). METHODS: We conducted a randomized control trial in which PBTS (8-16 years old, off therapy for over 3 months) were allocated to receive social skills training (eg, cooperation, assertion, using social cognitive problem solving strategies, role playing, games, and arts and crafts) in 8 weekly 2-hour sessions, or an attention placebo control (games and arts and crafts only). Outcomes were self-reported, proxy-reported (caregiver), and teacher-reported using the Social Skills Rating System (SSRS), to measure social competence, and the Pediatric Quality of Life (PedsQL4.0, generic) to measure QOL at baseline, after intervention, and at 6 months follow-up. At baseline, SSRS were stratified into low and high scores and included as a covariate in the analysis. RESULTS: Compared to controls (n = 48), PBTS in the intervention group (n = 43) reported significantly better total and empathy SSRS scores, with improvements persisting at follow-up. The PBTS in the intervention group who had low scores at baseline reported the greatest improvements. Proxy and teacher reports showed no intervention effect. CONCLUSIONS: Participating in group social skills intervention can improve self-reported social competence that persisted to follow up. The PBTS should be given the opportunity to participate in social skills groups to improve social competence.

Determinants of quality of life outcomes for survivors of pediatric brain tumors.

INTRODUCTION: To describe the quality of life (QOL) of pediatric brain tumor survivors (PBTSs) prospectively and to identify potential medical, personal and family contextual factors associated with QOL. METHODS: Ninety-one PBTSs (8-16 years) who were off treatment and attending a regular classroom participated. Self- and caregiver-proxy-reported on QOL at baseline, 2 and 8 months. At baseline, cognitive, executive function, attention and memory, medical and demographics information were attained. RESULTS: Significant improvements over time in PBTS's emotional QOL were self- and proxy-reported (P < 0.01) and global QOL proxy-reported (P = 0.04). Receiving cranial irradiation therapy (CIT) and poor behavioral regulation predicted poor global QOL scores reported by both informants (P < 0.017). Poor behavioral regulation also predicted poor self-reported school functioning, and poor proxy-reported emotional and social QOL (P < 0.037). Boys reported better emotional QOL (P = 0.029), and PBTSs over 11 years old were reported to have better emotion and school-related QOL. Finally, being non-White and having low income predicted poor self-reported global and emotional QOL (P = 0.041). CONCLUSIONS: Receiving CIT, having poor behavioral regulation, being a female, under 11 years old and coming from low-income, non-White families place PBTSs at risk for poor QOL.

Determinants of social competence in pediatric brain tumor survivors who participated in an intervention study.

PURPOSE: This prospective study describes disease/treatment, personal characteristics, and social/family contextual variables as risk and resilience factors that predict social competence in pediatric brain tumor survivors (PBTS). METHODS: Ninety-one PBTS (51% male, mean age 11.21 years, off-treatment, attending a regular classroom >50% of the time) participated. PBTS and their primary caregivers (proxy) completed the Social Skills Rating System (SSRS) to assess social competence at baseline, 2, and 8 months follow-up. At baseline, medical information (e.g., tumor type and location, cranial irradiation therapy (CIT)), personal characteristics (e.g., child's age and gender, intelligence, executive function, attention, and memory), and social/family factors (family income and ethnicity) were obtained. RESULTS: Using mixed model multivariable analyses with a longitudinal component, tumor type (medulloblastoma) (p < 0.01) and poor executive function, specifically, emotional control, were the best predictors of low total and assertion self-reported SSRS scores (p < 0.02). Receiving CIT was associated with low proxy-reported assertion (p = 0.035), and cooperation score (p = 0.02). Poor emotional control was associated with low proxy-reported total (p = 0.032), assertion (p = 0.023), and self-control scores (p = 0.007). Being non-White was associated with low proxy-reported total (p = 0.016), self-control (p = 0.040), responsibility (p = 0.035), and cooperation scores (p = 0.002). There were no significant changes over time. CONCLUSIONS: This study supports a multifactorial model of insult and non-insult factors (medical, personal, and social context) as determinants of social competence in PBTS. Data from both informants identify determinants of social competence. These factors need to be considered in future interventions to help children better improve their social competence.

Neuropsychological late effects of treatment for acute leukemia in children with Down syndrome.

BACKGROUND: Children with Down syndrome (DS) have an elevated risk of developing acute leukemia, but little is known about treatment-related neuropsychological morbidity because they are systematically excluded from research in this area. The current study investigated neuropsychological outcomes in children with DS treated for acute lymphoblastic leukemia (ALL) or acute myeloid leukemia (AML) compared to children with DS with no history of cancer. PROCEDURE: Participants were 4 to 17 years of age at testing and were administered measures of intelligence, academic achievement, language, visual-motor and fine-motor skills, and adaptive function. Patients had been off treatment for at least 2 years. RESULTS: The AML group (N = 12) had significantly lower verbal intelligence and receptive vocabulary compared to controls (N = 21). By contrast, the ALL group (N = 14) performed significantly worse than controls on measures of verbal intelligence, spelling, receptive and expressive vocabulary, visual-motor skills, and adaptive function. CONCLUSIONS: Patients with DS treated for AML may have specific post-treatment morbidity in verbal function, whereas those treated for ALL have broader morbidity affecting multiple neuropsychological domains and overall adaptive function. We hypothesize that the broader impairment profile of ALL survivors may be related to a combination of the longer duration of central nervous system-directed treatment for ALL compared to AML and the concomitant limited access to intervention opportunities during active treatment.

Bringing Dance to Older Adults: Program Experts' Perspectives on the Role of Community Dance Classes to Support Older Adults.

BACKGROUND: Dancing offers several health and wellness benefits for older adults: it may promote physical literacy (PL) and positively influence the aging process. Yet, limited research considers the perspectives of those with experience working with older adults and in community dance programming. OBJECTIVE: The purpose of this study was to understand program experts' perspectives on how older adult community dance can promote PL and contribute to age-friendly cities and community initiatives. METHODS AND FINDINGS: Four themes were identified from semi-structured interviews with five program experts: (1) expert instructors tailor classes to participants' needs and interests; (2) the heart of what draws us to dancing: authentic experience and social connection; (3) elitist, ableist, and gendered assumptions of dance prevent social inclusion of older adults in dancing spaces; and (4) collaboration across sectors is needed to offer accessible, sustainable, and valued dance programming. DISCUSSION: Recommendations for developing and implementing older adult community dance programming are described.

Executive functions and social skills in pediatric brain tumor survivors.

Pediatric brain tumor survivors (PBTSs) may experience impairment in executive functions and social competence, but their interrelation is not well understood. This study aimed to address the specificity of this relationship. PBTSs (n = 91) were on average 11.21 years old, 5 years from diagnosis, and 48.4% female. One parent and PBTS completed the Social Skills Rating System (subscales: Cooperation, Assertiveness, Empathy, Self-Control, and Total), and parents also completed the Behavior Rating Inventory of Executive Function (General Executive Composite [GEC], Metacognition [MI], and Behavioral Regulation [BRI] indices) and the (Withdrawal scale). Based on proxy reports, more PBTSs had deficits in Cooperation, Assertiveness and Responsibility skills relative to normative data. MI was more consistently associated with parent reported social skills deficits than BRI. PBTSs reported fewer deficits in social skills relative to normative data across all scales; none of the correlations between PBTSs reported social skills and executive functions were significant. Time since diagnosis and proxy reported lower total social skills predicted greater withdrawal. These findings highlight the importance of assessing differential perspectives of PBTSs social competence, and that metacognitive strategies may bear particular importance for the social skills of PBTSs.

The impact of periventricular brain injury on reading and spelling abilities in the late elementary and adolescent years.

The present study was designed: (1) to investigate the long-term consequences of both the presence and the severity of periventricular brain injury (PVBI) on intellectual, academic, and cognitive outcome in extremely-low-birthweight (ELBW: < 1,000 grams) children at a mean age of 11 years; and (2) to determine the nature of the underlying difficulties associated with academic problems in these children. The results indicated that ELBW children without PVBI performed as well as full-term children on intelligence, academic, and cognitive ability tests. In contrast, ELBW children with mild and severe PVBI achieved significantly lower scores than either ELBW children without PVBI or children who were born at term. A second analysis indicated that, after accounting for Full Scale IQ, working memory and phonological processing were significant predictors of reading and spelling performance in ELBW children. These findings suggest that the presence and severity of PVBI, and not ELBW status alone, is associated with performance on tests of intelligence, and academic and cognitive functioning, and that some of the same factors known to be associated with learning disabilities in full-term children contribute to learning disabilities in ELBW children.

Auditory temporal processing deficits in children with periventricular brain injury.

The present study investigated whether auditory temporal processing deficits are related to the presence and/or the severity of periventricular brain injury and the reading difficulties experienced by extremely low birthweight (ELBW: birthweight <1000 g) children. Results indicate that ELBW children with mild or severe brain lesions obtained significantly lower scores on a test requiring auditory temporal order judgments than ELBW children without periventricular brain injury or children who were full-term. Structural equation modeling indicated that a model in which auditory temporal processing deficits predicted speech sound discrimination and phonological processing ability provided a better fit for the data than did a second model, which hypothesized that auditory temporal processing deficits are associated with poor reading abilities through a working memory deficit. These findings suggest that an impairment in auditory temporal processing may contribute to the reading difficulties experienced by ELBW children.

Periventricular brain injury, visual motion processing, and reading and spelling abilities in children who were extremely low birthweight.

Among children born at extremely low birthweight (ELBW: < 1000 g at birth) there is an association between the presence of periventricular brain injury (PVBI) and lowered performance on tests of reading and spelling ability. The present study was designed to determine if this association might be related to underlying dysfunction in the subcortical magnocellular visual pathway or its cortical targets in the dorsal stream, a prediction motivated by the magnocellular theory of dyslexia. Thirty-five ELBW children were divided into two groups based upon the presence or absence of PVBI (no PVBI, n = 11; PVBI, n = 24). The performance of these two groups was compared to that of a group of healthy full term children (n = 12) on a motion-defined form recognition task believed to tap into the functioning of the magnocellular pathway and/or the dorsal stream. ELBW children did, in fact, show a striking impairment on this task, with 71% of the sample performing at a level more than three standard deviations below the mean of full term controls. Surprisingly, their difficulties were not found to be related to either the presence of brain injury (verified by neonatal cranial ultrasound) or to problems with reading or spelling. An association was documented, however, between difficulties with motion processing and performance on several subtests of the Performance IQ scale of the Wechsler Intelligence Scale for Children-Third Edition. This latter finding is consistent with our earlier suggestion that magnocellular pathway/dorsal stream dysfunction may underlie problems with visuospatial and visuomotor performance in this population.