Children's National Health System, Washington, DC.
St Jude Children's Research Hospital, Memphis, Tennessee.
Neuro Oncol. 2018 Apr 9;20(5):705-715. doi: 10.1093/neuonc/nox174.
Attention and working memory symptoms are among the most common late effects in survivors of pediatric brain tumors, and are often associated with academic and psychosocial difficulties. Diagnostic and treatment approaches derived from the literature on attention-deficit hyperactivity disorder (ADHD) have frequently been applied to survivors, yet the extent of overlap in cognitive profiles between these groups is unclear. The objective of the present study is to compare neurocognition in survivors of brain tumors and children with neurodevelopmental ADHD.
Neuropsychological data were abstracted from clinically referred brain tumor survivors (n = 105, Mage = 12.0 y, 52.4% male) and children with ADHD (n = 178, Mage = 11.1 y, 64.0% male). Data consist of a battery of parent-report questionnaires and performance-based neuropsychological measures.
Twenty-five survivors (23.8%) of pediatric brain tumors met symptom criteria for ADHD. Participants with neurodevelopmental ADHD and survivors who met ADHD criteria had significantly greater parent- (P < 0.001) and teacher-reported (P < 0.001) working memory and behavior regulation difficulties than survivors of tumor who did not meet criteria. Children with ADHD symptoms also performed worse on measures of sustained attention than survivors without ADHD symptoms (P < 0.001). Additionally, survivors with ADHD symptoms had greater performance-based working memory difficulties than either survivors without attention problems or children with neurodevelopmental ADHD (P = 0.002).
Nearly a quarter of survivors with attention symptoms have functional profiles that are similar to children with neurodevelopmental ADHD. They also experience more neurocognitive impairments than survivors without attentional difficulties, particularly in working memory. Screening for ADHD symptoms may help providers triage a subset of individuals in need of earlier or additional neuropsychological assessment.
注意和工作记忆症状是儿科脑肿瘤幸存者中最常见的晚期效应之一，常与学业和心理社会困难有关。源自注意力缺陷多动障碍（ADHD）文献的诊断和治疗方法经常被应用于幸存者，但这些群体之间认知特征的重叠程度尚不清楚。本研究的目的是比较脑瘤幸存者和神经发育性 ADHD 儿童的神经认知。
从临床转诊的脑瘤幸存者（n=105，平均年龄=12.0 岁，52.4%为男性）和 ADHD 儿童（n=178，平均年龄=11.1 岁，64.0%为男性）中提取神经心理学数据。数据包括一系列家长报告问卷和基于表现的神经心理学测试。
25 名（23.8%）脑瘤幸存者符合 ADHD 的症状标准。有神经发育性 ADHD 的参与者和符合 ADHD 标准的幸存者在家长报告（P<0.001）和教师报告（P<0.001）的工作记忆和行为调节困难方面明显多于不符合 ADHD 标准的肿瘤幸存者。有 ADHD 症状的儿童在持续注意力方面的表现也比没有 ADHD 症状的幸存者差（P<0.001）。此外，有 ADHD 症状的幸存者在基于表现的工作记忆困难方面的表现比没有注意力问题的幸存者或有神经发育性 ADHD 的儿童更差（P=0.002）。
近四分之一有注意力症状的幸存者的功能特征与神经发育性 ADHD 儿童相似。他们也比没有注意力困难的幸存者经历更多的神经认知障碍，特别是在工作记忆方面。对 ADHD 症状进行筛查可能有助于提供者对需要早期或额外神经心理学评估的一部分人进行分诊。
