The Association between Neuropsychological Functioning and Cognitive Engagement and Their Associations with Reading Achievement in Pediatric Brain Tumor Survivors
Authors:   , Turner Elise M. , Daly Brian P. 
Published: July 2021

Background: Survivorship rates in children with pediatric brain tumors have increased over the last few decades. During the same time period there has been a dramatic increase in the presence of cognitive late effects in survivors (Landier et al., 2004). Neuropsychological late effects are demonstrated across a variety cognitive abilities and may be responsible for impairments in academic functioning seen in survivors (Robinson et al., 2010). Declines in pediatric brain tumor survivors' academic achievement include a variety of subjects such as math, spelling and reading; however, reading ability is more vulnerable to impairment in this population (Mabbott et al., 2005). In healthy peers, reading achievement is predicted by a variety of neuropsychological processes that survivors often demonstrate deficits in, including intelligence, attention, processing speed, working memory and executive functioning (Best, Miller, & Naglieri, 2011; Evans, Floyd, McGrew, & Leforgee, 2001). While an established link exists between neurocognitive functioning and reading achievement, little is known about how cognitive functioning specifically impacts reading ability. Rose (2005) theorized that cognitive functioning impairs learning if one is unable to use skillful strategies in order to recognize, interpret or select important incoming information. This theory is conceptually related to cognitive engagement, a derivative of school engagement that involves cognitive strategies used during learning (Greene, Miller, Crowson, Duke, & Akey, 2004). Aims: The current study examined the association between neuropsychological functioning and reading achievement in children that recently completed treatment for a brain tumor. More specifically, the study examined associations between working memory, executive functioning and reading achievement. Additionally, indirect effects of working memory and executive functioning on reading achievement through cognitive engagement were evaluated. Methods: This study utilized data collected as part of a longitudinal study of pediatric brain tumor survivors following the completion of tumor-directed treatment. The study sought to identify associations between survivor neuropsychological functioning and indicators of survivor, caregiver and family functioning. Child participants completed a neuropsychological assessment battery along with psychosocial measures immediately following completion of tumor-directed treatment, then at 6 months post-treatment, and again at 1 year post-treatment. Caregivers completed neurobehavioral and psychosocial questionnaires. Results: Lower executive function abilities as assessed by parent-report significantly predicted reduced use of rehearsal- and organization-based cognitive strategies for learning. In contrast, working memory did not reveal any associations with cognitive engagement. Neither overall, nor strategy specific, cognitive engagement mediated the association between executive functioning/working memory and reading achievement. Conclusions: Pediatric brain tumor survivors who display difficulties in executive functioning may also exhibit less use of rehearsal- and organization-based cognitive learning strategies. Coaching of learning strategies implemented by teachers may prove useful in promoting the use of other advantageous learning strategies (e.g., elaboration and critical thinking), and also suppress the use of shallow learning strategies (rehearsal).