BACKGROUND: Neurocognitive late effects are a common outcome of treatments for pediatric acute lymphoblastic leukemia (ALL). Specifically, executive functioning (EF) late effects have received increasing attention with mixed results. However, a control for generalized performance ability has not been implemented in most of these studies. Well-documented factors affecting neurocognitive late effects include differential treatments, age at treatment, and gender. Further, family stress may play a role in neurocognitive outcomes. The purpose of this study was to examine late EF effects in pediatric ALL survivors, while controlling for generalized performance ability. METHOD: Sixty-five children with ALL (“Cancer Group;” ages 8-16) and thirty-five children with psychiatric diagnoses (e.g., ADHD) and no identified CNS insult (“Psychiatric Group;” ages 8-16) completed an abbreviated IQ measure as well as multiple measures of executive functioning. Parents completed self-report measures of family stress. RESULTS: Generalized performance ability and age at treatment were significantly negatively correlated with multiple measures of executive functioning. Age at treatment was significantly positively correlated with FSIQ. Several unexpected findings emerged such that children in the Cancer Group evidenced significantly fewer executive functioning deficits than children in the Psychiatric Group. In addition, children treated with chemotherapy alone evidenced fewer executive functioning deficits than children treated with combination chemotherapy and cranial radiation. Using an age cutoff of 4 years, age at treatment did not significantly affect executive functioning. Gender differences were not significant. Finally, family stress did not have a differential impact on executive functioning. CONCLUSIONS: In general, some evidence for neurocognitive EF late effects was found as the Cancer group showed lower executive functioning scores as compared to standardized norms. However, differential late effects were not found in expected ways. When a control for FSIQ was implemented, executive functioning differences did not emerge based on age at treatment or gender, suggesting frontal lobe development is distinct from the development of generalized performance ability. Differential treatment effects may be a result of differences in age at evaluation. In addition, there may be etiological differences in underlying cognitive processes that contributed to differential executive functioning deficits in children in the Cancer Group versus the Psychiatric Group.
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