Everyday executive function in standard-risk acute lymphoblastic leukemia survivors

Karin S. Walsh, Iris Paltin, Gerard A. Gioia, Peter Isquith, Nina S. Kadan-Lottick, Joseph P Neglia, Pim Brouwers

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25 Scopus citations


We aimed to evaluate parent-rated executive function (EF) in pediatric standard risk acute lymphoblastic leukemia (SR-ALL) survivors compared to a healthy comparison (HC) group. We hypothesized that SR-ALL survivors would have greater reported executive dysfunction compared to HC, and that those younger at the time of treatment would demonstrate greater EF difficulties. A sample of 256 SR-ALL survivors evaluated an average nine years after treatment were compared to HC matched for gender, assessment age, and maternal education. Profile analysis was used to compare the groups across EF scales on the BRIEF. The prevalence of clinical elevations in the groups was compared via chi square, and odds ratios were calculated. Regression models were applied to examine the role of age at diagnosis and age at assessment in reported EF. Results indicated that SR-ALL survivors' mean scores of EF are similar to HC, except for flexibility and initiation. Survivors were rated as having clinical impairments with flexibility, initiation, working memory, and emotional control at rates two to three times that of HC. The risk of working memory and self-monitoring deficits was greater in survivors who were older when assessed. There was no relationship between age at diagnosis or treatment regimen on EF. These findings suggest sparing of extensive and severe EF deficits in SRALL survivors overall. However, a subset of survivors displays clinically significant executive dysfunction. There appears to be a heightened susceptibility to disrupted metacognitive functions as survivors age. This has implications for how we monitor neurocognitive development and functioning of SR-ALL survivors, and highlights opportunities for cognitive interventions.

Original languageEnglish (US)
Pages (from-to)78-89
Number of pages12
JournalChild Neuropsychology
Issue number1
StatePublished - Jan 15 2015

Bibliographical note

Funding Information:
This study was supported by research funding by the American Cancer Society to Joseph Neglia and Nina Kadan-Lottick. Dr. Kadan-Lottick’s effort was additionally funded as a St. Baldrick’s Foundation Scholar. Financial Disclaimers: Drs. Gioia and Isquith are coauthors of the Behavior Rating Inventory of Executive Function and receive royalties from sales of the instrument. Address correspondence to Karin S. Walsh, Children’s National Medical Center, 111 Michigan Avenue, NW Washington, DC, 20010, USA. E-mail: kwalsh@childrensnational.org

Publisher Copyright:
© 2014 Taylor & Francis.


  • Central nervous system
  • Leukemia
  • Neurobehavioral manifestations
  • Neuropsychology
  • Survivors


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