QOL-02. Executive Functions and Externalizing Symptoms in Pediatric Brain Tumor Survivors

Abstract Introduction Pediatric brain tumor survivors (PBTS) experience greater psychosocial and executive function (EF) challenges than peers and other cancer survivors, but much less is known about their risk for externalizing problems (EP). Cognitive deficits, including EF and processing speed (PS), predict EP in the general population, but this relationship has not been examined among PBTS. This study tested the hypothesis that problems with EF and PS will relate to EP among PBTS. Methods Neuropsychological data were abstracted from clinically referred PBTS (N = 177, 58.2% male, Mean age at diagnosis=6.26 yrs, SD = 4.67, Mean time since diagnosis=4.87 yrs, SD = 3.96). Data included BRIEF and CBCL parent-report, and an age-appropriate Wechsler Scale. Hierarchical regressions examined the effect of 1) demographic and disease factors, 2) parent-reported EF (GEC), and 3) working memory (WMI) and processing speed (PSI), on EP. Results Per parent-report, 13% of PBTS exhibited clinically significant EP (M = 49.71, SD = 11.53), and 26% exhibited clinically elevated GEC (M = 56.40, SD = 12.72). The final model explained 64.3% of EP (F(6, 117)=35.14, p0.001), with GEC (b = 0.76, p0.001) and PSI (b = 0.15, p=0.025) as significant predictors. For Aggression, the final step accounted for 57.2% of the variance, with significant effects of GEC (b = 0.72, p0.001) and PSI (b = 0.22, p=0.002). PSI added unique variance to Aggression (ΔR2=0.05, p = 0.002). The final model accounted for 42.5% of Rule-Breaking, with GEC (b = 0.64, p0.001) and PSI (b = 0.22, p=0.009) as significant predictors. PSI added unique variance to Rule-Breaking (ΔR2=0.04, p = 0.032). Conclusions Parent-reported EF and PS account for unique variance in EP among PBTS. Most survivors do not exhibit EP, but those with PS and EF difficulties appear at greater risk. These impairments may limit PBTS’ ability to navigate social and environmental demands, increasing frustration and impulsivity. Longitudinal surveillance of these potential risk factors could clarify temporal relationships in EP development and inform preventative intervention for PBTS.