15 Practical Adaptive Skills in Pediatric Brain Tumor Survivors

Abstract

Objective:

Adaptive functioning, most notably practical skills, are impacted in pediatric brain tumor survivors. This study aimed to examine the individual components of practical adaptive functions that are most impacted in pediatric brain tumor survivors, and to identify specific medical and socio-demographic factors that contribute to weaknesses in this domain.

Participants and Methods:

The sample consisted of 117 pediatric brain tumor patients seen for a clinical neuropsychological evaluation. Inclusion criteria included participants <18 years at time of brain tumor diagnosis, and whose parents were administered the Adaptive Behavior Assessment System, Second (ABAS-II) or Third Edition (ABAS-3) as a measure of adaptive functioning. Medical and socio-demographic variables were gathered from the patient’s medical record. Medical variables examined were age at diagnosis, age at evaluation, time since diagnosis, tumor location (supratentorial or infratentorial), and history of treatment and associated complications as measured by the Neurologic Predictor Scale (NPS). Socio-demographic factors examined included sex, race, insurance type, parental education, and Area Deprivation Index (ADI) as a measure of neighborhood deprivation/access to community resources. One sample t-tests compared the brain tumor sample to population normative means. Correlations examined associations between practical skills and medical and socio-demographic variables. To determine predictors of practical skills, significant correlations were entered into separate linear regressions for each of the four practical subscales (Community Use, Home Living, Health & Safety, Self-Care).

Results:

Participants were diagnosed around 7 years and were approximately 5 years from diagnosis at the time of neuropsychological evaluation. Practical skills were clinically and statistically significantly below the normative mean (Standard Score=85.5, p<.001). Additionally, all practical subscales were statistically significantly below the normative mean (p<.001), with both Community Use (Scale Score=7.6, p<.001) and Home Living (Scaled Score=6.9, p<.001) being clinically significant. Community Use was positively correlated with age at diagnosis (r=.27, p=.004) and negatively correlated with Neurologic Predictor Scale (r=-.33, p<.001), time since diagnosis (r=-.24, p=.01), and ADI (r=-.23, p=.02). Health and Safety was positively correlated with age at diagnosis (r=.21, p=.024). Self-Care was positively correlated with age at diagnosis (r=.202, p=.029) and parental education (r=.203, p=.037); Home Living was not correlated with any of the variables examined. Predictors of Community Use included NPS score (p=.002); ADI approached significance (p=.07). Age at diagnosis predicted Health & Safety practical skills (p=.024), and parental education predicted Self-Care skills (p=.004).

Conclusions:

Pediatric brain tumor survivors demonstrate clinically significant weakness in practical skills. While specific medical and socio-demographic factors contribute to lower practical adaptive functioning (e.g., younger age at diagnosis, higher NPS score suggestive of greater treatment burden, longer time since diagnosis, lower ADI score suggestive of greater neighborhood deprivation, and lower parental education), medical and socio-demographic factors do not equally impact practical adaptive functions, but rather individual factors predict specific practical skills. While there is appreciation for the contribution of medical factors in pediatric oncology, few studies have examined socio-demographic factors in this population. This study highlights the importance of considering the role of family and environmental factors on neuropsychological functioning in pediatric oncology in addition to medical factors.