Skip to main content
×
×
Home

Attentional processes and their remediation in children treated for cancer: A literature review and the development of a therapeutic approach

  • ROBERT W. BUTLER (a1) and DONNA R. COPELAND (a2)
Abstract

It is now generally accepted that central nervous system treatments for childhood cancer can result in significant cognitive impairment, most commonly in the areas of attention/concentration. We review the literature on attentional and neurocognitive deficits in this population, and also efforts to remediate attentional deficits in other brain injured populations. It was our goal to develop an innovative, psychologically based outpatient rehabilitation program that would improve dysfunctional attentional processes and associated neuropsychological deficits. The characteristics of this program and a pilot study of its effectiveness are described. Participants were 31 off-therapy cancer survivors with documented attention deficits. Twenty-one completed the cognitive remediation program (CRP) and 10 served as comparisons. All participants completed a test of vigilance attention, 2 tests with an attentional component, and an arithmetic academic achievement measure. When the scores of the 2 groups were compared, the CRP group exhibited statistically significant improvement on all attentional measures. In contrast, the comparison group did not manifest any significant changes. Neither group demonstrated statistically significant changes on the arithmetic achievement test. We believe that the CRP has potential for improving attention/concentration, but generalization to academic achievement remains unproven. Phase 3 clinical trials and the documentation of long-term treatment gains are needed. Furthermore, it will be necessary to demonstrate the ecological validity of the CRP. With these caveats, this therapeutic approach may be helpful in other populations of cognitively impaired children and young adults, such as patients who have suffered traumatic brain injury. (JINS, 2002, 8, 115–124.)

Copyright
Corresponding author
Reprint requests to: Robert W. Butler, Ph.D., Oregon Health Sciences University, Department of Pediatrics,CDRCP, Division of Hematology/Oncology, 3181 SW Sam Jackson Park Road, Portland, OR 97201-3098. E-mail: butlerr@ohsu.edu
References
Hide All

REFERENCES

Anderson, V.A., Godber, T., Smibert, E., Weiskop, S., & Ekert, H. ( 2000). Cognitive and academic outcome following cranial irradiation and chemotherapy in children: A longitudinal study. British Journal of Cancer, 82, 255262.
Ben-Yishay, Y., Cohen, J., Delayer, L., Lakin, P., Ross, B., & Rattock, J. ( 1980). A remedial “module” for the systemic amelioration of basic attentional disturbances in head trauma subjects. In working approaches to remediation of cognitive deficits in brain damaged. Rehabilitation Monograph, 61, 71127.
Bleyer, A., Sposto, R., & Sather, H. ( 1997, May). In the United States, pediatric brain tumors and other nervous system tumors (NST) are now more common than childhood acute lymphoblastic leukemia (ALL) and have a 3-fold greater national mortality rate than ALL. Paper presented at the 8th International Symposium on Pediatric Neuro-Oncology, Rome, Italy.
Bleyer, W.A. & Griffin, T.W. ( 1980). White matter necrosis, mineralizing microangiopathy, and intellectual abilities in survivors of childhood leukemia: Associations with central nervous system irradiation and methotrexate therapy. In H.A. Gilbert & A.R. Kagan (Eds.), Radiation damage to the nervous system (pp. 155174). New York: Raven Press.
Bouchard, J. ( 1966). Radiation therapy of tumors and diseases of the nervous system. Philadelphia: Lea & Febiger.
Brandt, J. ( 1997). Editorial introduction to Wilson/Prigatano dialogue. Journal of the International Neuropsychological Society, 3, 486.
Brookshire, D., Copeland, D.R., Moore, B.D., & Ater, J. ( 1990). Pretreatment neuropsychological status and associated factors in children with primary brain tumors. Neurosurgery, 27, 887891.
Brouwers, P. & Poplack, D. ( 1990). Memory and learning sequelae in long-term survivors of acute lymphoblastic leukemia: Association with attention deficits. American Journal of Pediatric Hematology/Oncology, 12, 174181.
Brouwers, P., Riccardi, R., & Fedio, P. ( 1984). Attentional deficits in long-term survivors of childhood acute lymphoblastic leukemia (ALL). Journal of Clinical Neuropsychology, 6, 325336.
Brown, R.T., Sawyer, M.B., Antoniou, G., Toogood, I., Rice, M., Thompson, N., & Madan-Swain, A. ( 1996). A 3-year follow-up of the intellectual and academic functioning of children receiving central nervous system prophylactic chemotherapy for leukemia. Developmental and Behavioral Pediatrics, 17, 392398.
Brown, R.T., Madan-Swain, A., Walco, G.A., Cherrick, I., Ievers, C.E., Conte, P.M., Vega, R., Bell, B., & Lauer, S.J. ( 1998). Cognitive and academic late effects among children previously treated for acute lymphocytic leukemia receiving chemotherapy as CNS prophylaxis. Journal of Pediatric Psychology, 23, 333340.
Burger, P.C. & Boyko, O.B. ( 1991). The pathology of central nervous system radiation injury. In P.H. Gutin, S.A. Leibel, & G.E. Sheline (Eds.), Radiation injury to the nervous system (pp. 191208). New York: Raven Press.
Buono, L.A., Morris, M.K., Morris, R.D., Krawiecki, N., Norris, F.H., Foster, M.A., & Copeland, D.R. ( 1998). Evidence for the syndrome of nonverbal learning disabilities in children with brain tumors. Child Neuropsychology, 4, 114.
Butler, R.W. ( 1998). Attentional processes and their remediation in childhood cancer. Medical and Pediatric Oncology Supplement, 1, 7578.
Butler, R.W. & Copeland, D.R. ( 1993). Neuropsychological effects of central nervous system prophylactic treatment in childhood leukemia: Methodological considerations. Journal of Pediatric Psychology, 18, 319338.
Butler, R.W., Hill, J.M., Steinherz, P.G., Meyers, P.A., & Findlay, J.L. ( 1994). The neuropsychological effects of cranial irradiation, intrathecal methotrexate and systemic methotrexate in childhood cancer. Journal of Clinical Oncology, 12, 26212629.
Butler, R., Kerr, M., & Marchand, A. ( 1999). Attention and executive functions following cranial irradiation in children. Journal of the International Neuropsychological Society, 5, 108.
Butler, R.W. & Namerow, N.W. ( 1988). Cognitive retraining in brain-injury rehabilitation: A critical review. Journal of Neurological Rehabilitation, 2, 97101.
Conners, C.K. ( 1992). Conners' Continuous Performance Test (Version 3.0). Toronto, Canada: Multi-Health Systems, Inc.
Copeland, D.R., deMoore, C., Moore, B.D., & Ater, J.L. ( 1999). Neurocognitive development of children after a cerebellar tumor in infancy: A longitudinal study. Journal of Clinical Oncology, 17, 34763486.
Copeland, D.R., Dowell, R.E., Fletcher, J.M., Sullivan, M.P., Jaffe, N., Frankel, L.S., Ried, H.L., Cangir, A., & Bordeaux, J.D. ( 1988). Neuropsychological effects of childhood cancer treatment. Journal of Child Neurology, 3, 5362.
Copeland, D.R., Moore, B.D., Francis, D.J., Jaffe, N., & Culbert, S.J. ( 1996). Neuropsychologic effects of chemotherapy on children with cancer: A longitudinal study. Journal of Clinical Oncology, 14, 28262835.
Fletcher, J.M. & Copeland, D.R. ( 1988). Neurobehavioral effects of central nervous system prophylactic treatment of cancer in children. Journal of Clinical and Experimental Neuropsychology, 10, 495538.
Gray, J.M. & Robertson, I. ( 1989). Remediation of attentional difficulties following brain injury: Three experimental single case studies. Brain Injury, 3, 163170.
Haupt, R., Fears, T.R., Robison, L.L., Mills, J.L., Nicholson, H.S., Zelter, L.K., Meadows, A.T., & Byrne, J. ( 1994). Educational attainment in long-term survivors of childhood acute lymphoblastic leukemia. Journal of the American Medical Association, 272, 14271432.
Heideman, R L., Packer, R.J., Leland, A.A., Freeman, C.R., & Rorke, L.B. ( 1989). Tumors of the central nervous system. In P.A. Pizzo & D.G. Poplack (Eds.), Pediatric oncology (pp. 505553). Philadelphia: Lippincott.
Hertzberg, H., Huk, W.J., Ueberall, M.A., Langer, T., Meier, W., Dopfer, R., Skalej, M., Lackner, H., Bode, U., Janssen, G., Zintl, F., & Beck, J.D. ( 1997). CNS late effects after ALL therapy in childhood. Part I: Neuroradiological findings in long-term survivors of childhood ALL—an evaluation of the interferences between morphology and neuropsychological performance. Medical and Pediatric Oncology, 28, 387400.
Hill, D.E., Ciesielski, K.T., Sethre-Hofstad, L., Duncan, M.H., & Lorenzi, M. ( 1997). Visual and verbal short-term memory deficits in childhood leukemia survivors after intrathecal chemotherapy. Journal of Pediatric Psychology, 22, 861870.
Hoppe-Hirsch, E., Renier, D., Lellouch-Tubiana, C., Sainte-Rose, C., Pierre-Kahn, A., & Hirsch, J.F. ( 1990). Medulloblastoma in childhood: Progressive intellectual deterioration. Child's Nervous System, 6, 6065.
Ivnik, R.J., Colligan, R.C., Obetz, S.W., & Smithson, W.A. ( 1981). Neuropsychologic performance among children in remission from acute lymphocytic leukemia. Development and Behavioral Pediatrics, 2, 2934.
Jankovic, M., Brouwers, P., Maria, G.V., Veldhuizen, A.V., Huisman, J., & Kamphuis, R. ( 1994). Association of 1800 cGy cranial irradiation with intellectual function in children with acute lymphoblastic leukemia. Lancet, 334, 224227.
Kendall, P.C. ( 1991). Child and adolescent therapy: Cognitive–behavioral procedures. New York: The Guilford Press.
Kewman, D.G., Seigerman, C., Kintner, H., Chu, S., Henson, D., & Reeder, C. ( 1985). Simulation training of psychomotor skills: Teaching the brain-injured to drive. Rehabilitation Psychology, 30, 1127.
Lockwood, K.A., Bell, T.S., & Colegrove, R.W. ( 1999). Long-term effects of cranial radiation therapy on attention functioning in survivors of childhood leukemia. Journal of Pediatric Psychology, 24, 5566.
Luria, A.R. ( 1963). Restoration of function after brain injury. New York: Pergamon.
Madan-Swain, A. & Brown, R.T. ( 1991). Cognitive and psychosocial sequelae for children with acute lymphocytic leukemia and their families. Clinical Psychology Review, 1, 267294.
Magrath, I.T. ( 1989). Malignant non-Hodgkin's lymphomas. In P.A. Pizzo & D.G. Poplack (Eds.), Pediatric oncology (pp. 415455). London: Lippincott.
Mateer, C.A., Kerns, K.A., & Eso, K.L. ( 1996). Management of attention and memory disorders following traumatic brain injury. Journal of Learning Disabilities, 29, 618632.
Meadows, A.T. & Evans, A.E. ( 1976). A study of parenteral methotrexate in long-term survivors of leukemia and lymphoma in childhood: A study of effects of chemotherapy on the central nervous system. Cancer, 37, 10791085.
Moore, B.D., Copeland, D.R., Ried, H., & Levy, B. ( 1992). Neurophysiological basis of cognitive deficits in long-term survivors of childhood cancer. Archives of Neurology, 49, 809817.
Mostow, E.N., Byrne, J., Connelly, R.R., & Mulvihill, J.J. ( 1991). Quality of life in long-term survivors of CNS tumors of childhood and adolescence. Journal of Clinical Oncology, 9, 592599.
Mulhern, R.K., Hancock, J., Fairclough, D., & Kun, L. ( 1992). Neuropsychological status of children treated for brain tumors: A critical review and integrative analysis. Medical and Pediatric Oncology, 20, 181191.
Mulhern, R.K., Reddick, W.E., Palmer, S.L., Glass, J.O., Elkin, T.D., Kun, L.E., Taylor, J., Langston, J., & Gajjar, A. ( 1999). Neurocognitive deficits in medulloblastoma survivors and white matter loss. Annals of Neurology, 46, 834841.
Niemann, H., Ruff, R.M., & Baser, C.A. ( 1990). Computer-assisted attention retraining in head-injured individuals: A controlled efficacy study of an outpatient program. Journal of Consulting and Clinical Psychology, 58, 811817.
Ochs, J., Mulhern, R., Fairclough, D., Parvey, L., Whitaker, J., Ch'ien, L., Mauer, A., & Simone, J. ( 1991). Comparison of neuropsychologic functioning and clinical neurotoxicity in long-term survivors of childhood leukemia given cranial radiation or parenteral methotrexate: A prospective study. Journal of Clinical Oncology, 9, 145151.
Ochs, J., Parvey, L.S., & Mulhern, R. ( 1986). Prospective study of central nervous system changes in children with acute lymphoblastic leukemia receiving two different methods of central nervous system prophylaxis. NeuroToxicology, 7, 217226.
Packer, R.J., Sutton, L.N., Atkins, R.E., Radcliffe, J., Bunin, G.R., D'Angio, G., Siegel, K.R., & Schut, L. ( 1989). A prospective study of cognitive function in children receiving whole-brain radiotherapy and chemotherapy: Two-year results. Journal of Neurosurgery, 70, 707713.
Pizzo, P.A. & Poplack, D.G. (Eds.). ( 1997). Principles and practice of pediatric oncology ( Rev. ed.) Philadelphia: J. B. Lippincott Co.
Ponsford, J.L. & Kinsells, G. ( 1988). Evaluation of remedial programme for attentional deficits following closed head injury. Journal of Clinical and Experimental Neuropsychology, 10, 693708.
Poplack, D.G. ( 1989). Acute lymphoblastic leukemia. In P.A. Pizzo & D.G. Poplack (Eds.), Principles and practice of pediatric oncology (pp. 323366). Philadelphia: Lippincott.
Radcliffe, J., Bunin, G.R., Sutton, L.N., Goldwein, J.W., & Phillips, P.C. ( 1994). Cognitive deficits in long-term survivors of childhood medulloblastoma and other noncortical tumors: Age-dependent effects of whole brain radiation. International Journal of Developmental Neurosciences, 112, 327334.
Rao, S.M. ( 1996). White matter disease and dementia. Brain and Cognition, 31, 250268.
Raymond-Speden, E., Tripp, G., Lawrence, B., & Holdaway, D. ( 2000). Intellectual, neuropsychological, and academic functioning in long-term survivors of leukemia. Journal of Pediatric Psychology, 25, 5968.
Ries, L.A.G., Smith, M.A., Gurney, J.G., Linet, M., Tamra, T., Young, J.L., & Bunin, R.R. (Eds.). ( 1999). Cancer incidence and survival among children and adolescents: United States SEER Program. 19751995, National Cancer Institute, SEER Program. NIH Pub. No. 99-4649. Bethesda, MD: Author.
Ris, M.D. & Noll, R.B. ( 1994). Long-term neurobehavioral outcome in pediatric brain-tumor patients: Review and methodological critique. Journal of Clinical and Experimental Neuropsychology, 16, 2142.
Riva, D., Pantaleoni, C., Milani, N., & Belani, F.F. ( 1989). Impairment of neuropsychological functions in children with medulloblastomas and astrocytomas in the posterior fossa. Child's Nervous System, 5, 107110.
Sheline, G.F., Wara, W.M., & Smith, V. ( 1980). Therapeutic irradiation and brain injury. International Journal of Radiation Oncology and Biological Physics, 6, 12151228.
Sheslow, D. & Adams, W. ( 1990). Wide Range Assessment of Memory and Learning. Wilmington, DE: Jastak Associates, Inc.
Silber, J.H., Radcliffe, J., Peckham, V., Perilongo, G., Kishnani, P., Fridman, M., Goldwein, J.W., & Meadows, A.T. ( 1992). Whole-brain irradiation and decline in intelligence: The influence of dose and age on IQ score. Journal of Clinical Oncology, 10, 13901396.
Sohlberg, M.M. & Mateer, C.A. ( 1986). Attention Process Training (APT). Puyallup, WA: Washington Association for Neuropsychological Research and Development.
Sohlberg, M.M. & Mateer, C.A. ( 1987). Effectiveness of an attention training program. Journal of Clinical and Experimental Neuropsychology, 9, 117130.
Sohlberg, M.M. & Mateer, C.A. ( 1989). Introduction to cognitive rehabilitation. New York: The Guilford Press.
Sohlberg, M.M., McLaughlin, K.A., Heidrich, A., & Posner, M.I. ( 2000). Evaluation of attention process training and brain injury education in persons with acquired brain injury. Journal of Clinical and Experimental Neuropsychology, 22, 656676.
Strache, W. ( 1987). Effectiveness of two modes of training to overcome deficits of concentration. International Journal of Rehabilitation Research, 10, 141145.
Sturm, W., Willmes, K., Orgass, B., & Hartje, W. ( 1997). Do specific deficits need specific training? Neuropsychological Rehabilitation, 7, 81103.
Wechsler, D. ( 1991). Manual for the Wechsler Intelligence Scale for Children–Third Edition. San Antonio, TX: The Psychological Corporation.
Wilkinson, G.S. ( 1993). The Wide Range Achievement Test–Third Revision. Wilmington, DA: Wide Range, Inc.
Wilson, B.A. ( 1997). Cognitive rehabilitation: How it is and how it might be. Journal of the International Neuropsychological Society, 3, 487496.
Wilson, C. & Robertson, I.H. ( 1992). A home-based intervention for attentional slips during reading following head injury: A single case study. Neuropsychological Rehabilitation, 2, 193205.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Journal of the International Neuropsychological Society
  • ISSN: 1355-6177
  • EISSN: 1469-7661
  • URL: /core/journals/journal-of-the-international-neuropsychological-society
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Keywords

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed