Social Skills Training Interventions: A Promising Approach for Children Treated for Brain Tumors.

Pediatric brain tumors represent the second most frequently diagnosed malignancy of childhood (Strother et al., 2002). Children surviving brain tumors experience severe neurocognitive deficits as a result of medical late effects of the tumor and treatment (Butler & Mulhern, 2005; Ris & Noll, 1994). These children experience problems in psychosocial functioning as well, most notably, in the area of social competence. Despite the existence of research which suggests that social skills training interventions may improve social competence in other populations, the effectiveness of social skills training interventions for children surviving brain tumors remains understudied. This paper outlines the specific social deficits exhibited in children treated for brain tumors and their possible etiology, as well as existing social skills interventions and directions for future research. Poor Social Competence is an Outcome in Children Treated for Brain Tumors As life expectancy and survival rates for children with brain tumors have improved over the past two decades, increasing focus has been placed on long-term outcomes and adaptation in this population (Peterson & Drotar, 2006). Although the psychosocial outcomes for these patients are beginning to receive more attention, they remain comparatively less explored than the neuropsychological sequelae and late effects of treatment (Fuemmeler, Elkin, & Mullins, 2002; Peterson & Drotar, 2006). One psychosocial outcome consistently reported among children surviving brain tumors is poor social competence (Barakat et al., 2003; Fuemmeler, Elkin, & Mullins, 2002; Mulhern, Carpentieri, Shema, Stone, & Fairclough, 1993; Mulhern, Hancock, Fairclough, & Kun 1992; Radcliffe, Bennett, Kazak, Foley, & Phillips 1996; Ris & Noll, 1994; Vannatta, Gartstein, Short, & Noll., 1998). In fact, although a recent review by Fuemmeler and colleagues (2002) of 31 studies focused on different areas of psychosocial adjustment of survivors of childhood brain tumors yielded mixed findings regarding the adjustment of these children, the authors did conclude that children treated for brain tumors are indeed at risk for significant deficits in social competence. Definition of Social Competence Multidimensional in nature, the term social competence was conceptualized by Gresham (1986) as incorporating domains such as social skills, adaptive behavior, and peer acceptance (Elliott & Busse, 1991; Fuemmeler et al., 2002). In their review of the literature regarding social competence in children with central nervous system (CNS) related conditions, Nassau and Drotar (1997) highlighted Cavell's (1990) model of children's social competence as a useful framework for describing specific facets of social competence relevant to children with these conditions. As described by Nassau and Drotar (1997), the domains of social competence included in the model are: social adjustment, social performance, and social skills (Cavell, 1990). Specific Deficits of Social Competence in Children with Brain Tumors Studies assessing social competence in children with brain tumors suggest deficits in all of these areas, although oftentimes unclearly delineated (Fuemmeler et al., 2002). For example, children treated for brain tumors have been reported to have higher rates of behavior problems and less social competence on the Child Behavior Checklist (CBCL; Achenbach & Edelbrock, 1983) than children with other cancers (Carpentieri et al., 1993; Fossen, Abrahamson, & Storm-Mathisen, 1988). In addition, in a study of 29 children post-treatment for hypothalamic/chiasmatic tumors, survivors displayed increased behavior problems and decreased social and academic competence as compared to a normative sample (Foley, Barakat, herman-Liu, Radcliffe, & Molloy, 2000). Moreover, during the development of the Miami Pediatric Quality of Life Questionnaire (MPQOLQ) Armstrong and colleagues (1999) found that children with brain tumors had significantly lower scores in the domain of social competence, which included engagement in and enjoyment of activities, as well as involvement with a peer group. …