Executive Function In Survivors Of Childhood Acute Lymphoblastic Leukemia

BACKGROUND Childhood acute lymphoblastic leukemia (ALL) survivors are at risk for impaired executive function, but it is unclear how to best screen for such impairment. We sought to determine 1) the reliability of neurocognitive assessment by performance-based testing versus parent report, and 2) how the measures relate to everyday function. METHODS 256 survivors of standard risk childhood B-ALL (mean age 13.9 years at evaluation) were evaluated for executive function with three performance-based measures (Weschler Intelligence Scale for Children-IV (WISC-IV), Controlled Oral Word Association Test, and Conners\u27 Continuous Performance Test-II) and one parent-report measure (Behavior Rating Inventory of Executive Function (BRIEF)). The intra-class correlations between measures were assessed. The relation of the measures to the use of special education services and stimulants was analyzed with multivariate logistic regression. RESULTS The reliability between performance-based and parent-reported measures was poor, with the highest agreement observed between the WISC-IV Working Memory Index and the BRIEF-Working Memory Scale (kappa=0.143). The use of special education services was significantly associated with impairment indicated by the BRIEF-WM Scale (odds ratio (OR) = 5.94, 95% confidence interval (CI): 2.97, 12.78) and the WISC-IV WM Index (OR = 3.56, 95% CI: 1.61, 7.85). Stimulant use was significantly associated with three BRIEF scales (WM, Inhibit, and Metacognition), but no performance-based measures. CONCLUSIONS Performance-based and parent-reported measures identified different ALL survivors with executive function impairment. The association between the parent-reported BRIEF measures and the use of special education and stimulants suggests that this instrument has an important value for surveillance