Assessing neuropsychological phenotypes of pediatric brain tumor survivors.

Abstract

Pediatric brain tumor survivors (PBTS) are at risk for both neurocognitive impairments and psychological difficulties, yet these two domains have historically been discretely examined, with assessment of psychosocial outcomes rarely included in studies of cognitive outcomes. Taking a person-centered approach, the current study aimed to more comprehensively evaluate PBTS late effect profiles, including both neurocognitive and psychological sequelae, and predictors of these profiles. PBTS (N=89) were assessed in a pediatric neuropsychological clinic between May 2009 and May 2018, diagnosed at least 1year prior, and off-treatment for at least 3months (Mage =6.57years, SD=4.53; 46.1% female). Parent- and teacher-report of psychological symptoms, and performance-based measures of neurocognitive functioning were examined using latent profile analysis. The R3STEP procedure identified predictors of class membership. The optimal model identified four classes characterized by: (1) average functioning across all measures ("Average," n=47), (2) average psychosocial functioning and impaired neurocognitive functioning ("Cognitive Deficit," n=25), (3) elevated social problems and significant neurocognitive impairments ("Social/Cognitive Deficit," n=9), and (4) impaired visual planning and problem-solving and elevated parent-reported psychosocial problems, but average processing speed, working memory, and teacher-reported psychosocial outcomes ("Discrepant," n=8). Ethnicity, race, radiation treatment, and diagnoses of neurofibromatosis 1, hydrocephalus, and cerebellar mutism syndrome were significant predictors of class membership (ps<0.05). The present study identified distinct phenotypes with unique patterns of relations among neurocognitive and psychological domains. These findings are a vital first step toward identifying those at highest risk for poor outcomes and informing interventions that effectively address interrelated treatment targets for specific groups.