Social Adjustment in Survivors of Acute Lymphoblastic Leukemia without
Cranial Radiation Therapy
Abstract
Objective: To evaluate group differences in social adjustment in
survivors of pediatric ALL compared to survivor siblings, and controls;
identify disease-related predictors of social adjustment in survivors;
and explore whether executive functioning explained differences in
social adjustment across groups and between disease-related predictors.
Methods: Survivors of pediatric ALL (n=38, average age at diagnosis=4.27
years [SD=1.97]; average time off treatment=4.83 years
[SD=1.52]), one sibling (if available, n=20), and one parent from
each family were recruited from a long-term survivor clinic. Healthy
age- and sex-matched controls (n=38) and one parent from each family
were recruited from the community. Parents completed the Behavioral
Assessment System for Children, Parent Rating Scale (BASC-3) Social
Withdrawal subscale as a measure of social adjustment and the Behavior
Rating Inventory of Executive Functions (BRIEF-2) as a measure of
executive function for each of their children. Results: Parents reported
that survivors had significantly worse social adjustment compared to
controls (b=6.34, p=.004), but not survivor siblings. Among survivors,
greater time off treatment (b=2.06, p=.058) and poorer executive
functioning (b=0.42, p=.006) were associated with worse social
adjustment. Executive function did not mediate differences in social
withdrawal between survivors and controls or the relationship between
time off treatment and social withdrawal among survivors. Conclusions:
Survivors of pediatric ALL presenting to follow-up programs should be
screened for difficulties with social adjustment. Future research should
examine treatment- and non-treatment-related factors contributing to
poorer social outcomes.