Predictors of Social Adjustment in Pediatric Brain Tumor Survivors: A Comparison of Proton and Photon Radiation Therapy Groups

Although pediatric brain tumor survivors are at risk for poor social outcomes and deficits in neurocognitive function, little is known about cognitive predictors of social adjustment in this population. Further, the degree to which proton beam radiation therapy (PBRT) spares neurocognitive function and thereby reduces long-term deficits in social functioning relative to conventional radiation therapy (XRT) remains unknown. In the present study, pediatric brain tumor survivors (Total N = 83) having undergone PBRT (N = 54) or XRT (N = 29) were evaluated in several neurocognitive domains (i.e., executive function (EF), attention, processing speed, verbal learning and memory) and social adjustment (i.e., peer relations, social skills). We hypothesized that neurocognitive function would mediate the relation of RT group to social adjustment outcomes. Results suggest a potential neuroprotective benefit of PBRT over XRT, with the PBRT group outperforming the XRT group on measures of performance-based EF, verbal learning, and processing speed (all p < 0.01). However, groups did not differ on rating-based EF, attention, or either social adjustment outcome (all p > 0.05). Parents rated both RT groups as at risk for peer relation difficulties (M = 63.17 XRT; M = 61.17 PBRT). While there was no significant mediation effect, attention (β = -0.179, p = 0.041 Social Skills; β = -0.205, p = 0.047 Peer Relations) and rating-based executive function (β = -0.567, p < 0.001 Social Skills; β = 0.578, p < 0.001 Peer Relations) predicted social adjustment. These findings support the need for long-term monitoring of neurocognitive and social outcomes, with attention and parent-rated EF as indicators of potential social impairment. The present study also highlights the need for careful social adjustment measurement within a well-developed theoretical model of social competence.Psychology, Department o