Assessment of executive function (EF) among pediatric survivors of acute lymphoblastic leukemia (ALL).

Abstract

9584 Background: Childhood ALL survivors are at increased risk of impaired EF. Both parent ratings and performance-based measures are used to identify vulnerable patients. We seek to assess the association between these modalities to 1) each other, and 2) need for special education and stimulants. Methods: This 22-site cross-sectional study included 256 children in remission for standard-risk precursor-B ALL previously enrolled on legacy Children's Oncology Protocols from 1993 - 2000. Patients had no history of CNS leukemia, cranial radiation, or pre-existing neurodevelopmental disorders; were ≥1 year off-therapy; and were 6-16 years at evaluation. Patients were administered performance-based measures of working memory, Digit Span (DS) and Letter-Number Sequencing (LNS) comprising the Working Memory Index (WMI) from the Wechsler Intelligence Scales for Children - Fourth Edition. Patients completed the Controlled Oral Word Association Test (COWAT). Parents completed demographic surveys and a Likert-scale assessment of executive processes, Behavior Rating Inventory of Executive Function (BRIEF). Results: There were modest correlations between BRIEF-WM scale and WMI (r=-0.20, p<0.01) and subscales, DS (r=-0.17, p<0.01) and LNS (r=-0.19, p<0.01). BRIEF-Initiate and COWAT (r=-0.22, p<0.01) were correlated. However, impaired classification based on performance-based measures was a poor predictor of parent assessment classification. The WMI and BRIEF-WM independently predicted receipt of special education (p=0.0017 and 0.0003). The BRIEF-WM and Initiate scales predicted stimulant medication use (p<0.0001 and p=0.0037); however, performance-based measures did not. Conclusions: Rater and performance-based measures provide related, but different information about EF indicating the need for both. Both measurement modalities capture educational difficulties; however, only parent ratings are associated with stimulants. This may reflect the medication's success in modifying cognition in controlled environments and the BRIEF's sensitivity to the child's ability to execute tasks in the real-world setting.