Family functioning as a moderator of neurocognitive outcomes among survivors of pediatric Acute Lymphoblastic Leukemia

Chemotherapy treatment for pediatric Acute Lymphoblastic Leukemia (ALL) can affect neurocognitive functioning across many areas, including attention and executive functioning. Some variables that may moderate or protect against neurocognitive deficits following chemotherapy treatment have been identified, including gender, age at diagnosis, time since treatment, and socioeconomic status. Evidence from pediatric traumatic brain injury and pediatric brain tumor populations suggests that positive family functioning serves as a protective factor for neurocognitive outcomes of children who survive these conditions. However, no research was found that examines whether positive family functioning similarly moderates the effects of chemotherapy on the neurocognitive functioning of survivors of pediatric ALL. The purpose of this study was to examine the effect of family functioning upon neurocognitive outcome among survivors of pediatric ALL treated with chemotherapy, specifically in the domains of attention and executive functioning. Participants were 20 children and adolescents who completed chemotherapy-only treatment for ALL and 20 healthy comparison participants, all within the ages of 8 and 15. Participants were administered measures of attention and executive functioning. In addition, one caregiver for each child completed a measure of family functioning and rating forms of their child’s attention and executive functioning. Multiple regression analyses were conducted to examine the relationship between family functioning and neurocognitive functioning. Tests of the interaction between family functioning and group membership in accounting for variance in neurocognitive functioning indicated that family functioning did not have a differential effect on neurocognitive functioning for the survivors as compared to the healthy children. Family functioning accounted for a significant amount of variance in caregiver ratings of attention and executive functioning for all participants, even after controlling for demographic variables in the sample as a whole and demographic and treatment related variables in the clinical group. That is, caregivers who rated their family as having more difficulties with family functioning also rated their child as having more difficulties with attention and executive functioning. Additionally, survivors performed significantly worse than healthy controls on measures of sustained attention, working memory, and processing speed, providing additional evidence that this population is at risk for neurocognitive late effects in these areas.