Willard Victoria W, Cox Lauren E, Russell Kathryn M, Kenney Ansley, Jurbergs Niki, Molnar Andrew E, Harman Jennifer L
*Department of Psychology, St. Jude Children's Research Hospital, Memphis, TN; †Department of Psychology, University of Memphis, Memphis, TN.
J Dev Behav Pediatr. 2017 Oct;38(8):638-645. doi: 10.1097/DBP.0000000000000512.
Most children with cancer are diagnosed in early childhood, potentially resulting in missed developmental opportunities. The most common diagnoses-brain tumors, leukemia-are also associated with increased risk of neurocognitive deficits. Unfortunately, research regarding the functioning of preschool-aged children with cancer is limited. Our objective is to describe the cognitive and psychosocial functioning of preschool-aged children with cancer who completed a clinical evaluation at a hospital-based psychology clinic.
Assessment data from 98 preschool-aged children with cancer (M = 5.17 years old, SD = 0.54; 54.1% male) who completed clinically referred evaluations from 2011 to 2015 were abstracted. Because of variability in assessment measures used across clinicians, indicators of cognitive, adaptive, preacademic, and emotional/behavioral functioning were collapsed before analyses.
Children were 2.56 years from diagnosis (SD = 1.46, range 0-5.25 years) and most were off therapy (79.6%). Primary diagnostic categories were represented: brain tumor (68.4%), solid tumor (15.3%), and leukemia (16.3%). Mean IQ scores were significantly below expectations (t[80] = -7.95, p < .001). There were no differences based on diagnostic category, treatment status, or sex. Adaptive functioning (t[73] = -8.42, p < .001) and preacademic skills (t[77] = -6.20, p < .001) were also significantly below expectations. Mean scores on a measure of parent-reported emotional/behavioral functioning were in the average range.
Young children with cancer may be at significant risk of deficits in intellectual, adaptive, and preacademic functioning. Although our sample is biased by those who were referred for clinical evaluations, the severity of deficits highlights the potential vulnerability of young patients, even before most have entered formal school. Interventions-such as hospital-based preschool programs to increase preacademic skills-should be designed that explicitly target preschool-aged children and focus on a wide range of domains.
大多数癌症患儿在幼儿期被诊断出来，这可能导致发展机会的错失。最常见的诊断——脑肿瘤、白血病——也与神经认知缺陷风险增加有关。不幸的是，关于患癌学龄前儿童功能状况的研究有限。我们的目的是描述在一家医院心理门诊完成临床评估的患癌学龄前儿童的认知和心理社会功能。
提取了98名患癌学龄前儿童（平均年龄M = 5.17岁，标准差SD = 0.54；54.1%为男性）在2011年至2015年期间完成临床转介评估的评估数据。由于不同临床医生使用的评估方法存在差异，在分析之前对认知、适应、学前和情绪/行为功能指标进行了汇总。
患儿距确诊时间为2.56年（标准差SD = 1.46，范围0 - 5.25年），大多数已停止治疗（79.6%）。涵盖了主要诊断类别：脑肿瘤（68.4%）、实体瘤（15.3%）和白血病（16.3%）。平均智商得分显著低于预期（t[80] = -7.95，p < .001）。在诊断类别、治疗状态或性别方面没有差异。适应功能（t[73] = -8.42，p < .001）和学前技能（t[77] = -6.20，p < .001）也显著低于预期。家长报告的情绪/行为功能测量的平均得分处于平均范围。
患癌幼儿在智力、适应和学前功能方面可能存在显著缺陷风险。尽管我们的样本受那些被转介进行临床评估的患儿影响存在偏差，但缺陷的严重程度凸显了即使在大多数患儿进入正规学校之前，年轻患者也存在潜在的脆弱性。应该设计干预措施，如以医院为基础的学前项目来提高学前技能，明确针对学龄前儿童并关注广泛领域。
