The impact of attention on social functioning in survivors of pediatric acute lymphoblastic leukemia and brain tumors.

Deficits in attention are a significant consequence of the diagnosis and treatment of childhood cancer that affects the central nervous system (CNS) [1, 2]. While risk factors (e.g., diagnosis, treatment intensity, time since treatment) may be associated with increased severity of attention deficits [3–5], the majority of survivors of pediatric brain tumors and acute lymphoblastic leukemia (ALL) will evidence some degree of impairment [6–8]. Given the prevalence of these deficits, recent research has sought to describe the effect of attention problems on daily functioning and quality of life. The objective of the current paper is to examine the impact of attention on one aspect of quality of life – social functioning (the ability to competently interact with others across settings [9]) – in a large sample of survivors. Survivors who receive CNS-directed treatment may experience a constellation of late effects that includes both cognitive problems such as inattention and psychosocial difficulties such as internalizing psychopathology, withdrawal, and social problems [10, 11]. Attention dysfunction has been previously associated with social problems in this population [12, 13], and has been suggested as a contributing factor to inadequate processing of social stimuli [14]. These findings are consistent with recent integrative models of social functioning in children with brain injury which suggest that cognitive and affective functions are interrelated [15]. Specifically, social functioning is theorized to depend on individual developmental and personal characteristics and on interactions between the child and his/her social world. Cognitive and affective functioning may then be influenced by brain insult-related risk and resiliency factors, and ultimately impact how a child understands and responds to social information [15]. Consistent with this model, social difficulties such as difficulty coping with or engaging in social interactions [16–18], appear to be specific to those survivors who underwent CNS-directed treatment [13]. Over time, the relatively poor cognitive and social functioning experienced by these survivors is associated with disruptions in their achievement of developmental milestones, including maintaining both stable employment and romantic relationships [11, 19–22]. Given this long term impact on quality of life, it is important to understand whether survivors of pediatric cancer are experiencing functional problems as a result of changes in attention. Such knowledge will be particularly important for the development of clinical interventions and the determination of relevant outcomes. Although the literature suggests that inattention is correlated with social problems [12, 17, 23], it is unknown whether attention offers a unique contribution to the characterization of social dysfunction relative to known medical and demographic risk factors. To address this gap in the literature, the relationship between attention and social functioning was examined in survivors of ALL and brain tumors. We hypothesized that: (a) a significant proportion of survivors would have clinically elevated attention deficits relative to the measure’s normative group and that known demographic and treatment variables would predict these deficits; (b) key demographic and treatment variables would be associated with difficulties in social functioning; and (c) parent- and teacher-rated attention problems would be uniquely associated with social functioning, over and above the influence of demographic and treatment variables.