Cognitive training programs for childhood cancer patients and survivors: A critical review and future directions

A robust literature has developed documenting neurocognitive late effects in survivors of leukemia and central nervous system (CNS) tumors, the most frequent cancer diagnoses of childhood. Patterns of late effects include deficits in attention and concentration, working memory, processing speed, and executive function, as well as other domains. As childhood cancer survivors are living longer, ameliorating deficits both in broad and specific neurocognitive domains has been increasingly recognized as an endeavor of paramount importance. Interventions to improve cognitive functioning were first applied to the field of pediatric oncology in the 1990s, based on strategies used effectively with adults who had sustained a traumatic brain injury (TBI). Compilation and modification of these techniques has led to the development of structured cognitive training programs, with the effectiveness and feasibility of such interventions currently an active area of research. Consequently, the purpose of this critical review is to: (1) review cognitive training programs intended to remediate or prevent neurocognitive deficits in pediatric cancer patients and survivors, (2) critically analyze training program strengths and weaknesses to inform practice, and (3) provide recommendations for future directions of clinical care and research.     

Depressive and Anxious Symptomatology Moderate the Relationship Between Childhood Emotional Abuse Severity and Attentional Bias on the Modified Stroop Task

Research has demonstrated that the impact of childhood abuse often outlasts the initial abuse experiences, paving the way for a myriad of psychological difficulties in adulthood. Attentional bias might serve as a pathway from childhood abuse to negative outcomes associated with such experiences. The primary aim of the study was to investigate the impact of childhood emotional abuse (CEA) experiences on the presence of attentional bias in a sample of college women by comparing performance on a modified Stroop task between CEA survivors (n = 28) and a nonabused control group (n = 31). Results suggest that for CEA survivors, psychological symptoms moderated the relationship between CEA severity and attentional bias to specific word types. Results underscore the importance in continued exploration of the relationship among childhood emotional abuse, attentional bias, and concurrent psychopathology. Results also suggest that modification of attentional biases, via cognitive bias modification procedures, could help mitigate the impact of childhood abuse experiences on psychological well-being in adult survivors.     

Integrating Religious Resources Within a General Model of Stress and Coping: Long-Term Adjustment to Breast Cancer

The purpose of the present cross-sectional study was to explore the role of religious resources in long-term adjustment to breast cancer. A sample of fifty-two survivors was assessed on indices of religious resources (e.g., image of God), nonreligious resources (e.g., cognitive appraisal) and emotional and spiritual well-being. Results indicated that both relationship with God/God image and religious coping behaviour were related to the nonreligious mediator variables of cognitive appraisal and coping in response to the current cancer situation. Various experiences of relationship with God (e.g., Presence) were related to more positive appraisals of the current cancer situation as well as to the greater use of the nonreligious coping behaviour of focusing on the positive. In contrast, religious coping behaviours demonstrated more complex associations with cognitive appraisal and nonreligious coping factors. The same coping behaviour, for example religious avoidance, could be related to both positive and negative appraisals of the cancer situation. Finally, religious resources, but not nonreligious resources predicted emotional and spiritual well-being for these long-term breast cancer survivors.     

The Survivor Health and Resilience Education (SHARE) Program: Development and Evaluation of a Health Behavior Intervention for Adolescent Survivors of Childhood Cancer

Few evidence-based health behavior interventions for adolescent survivors of childhood cancer currently exist. These interventions are necessary to address a range of lifestyle and behavioral factors (e.g., diet and physical activity, tobacco and alcohol use, excessive sun exposure) that may place survivors at increased risk for secondary cancers other chronic diseases. To address this need, the development and evaluation of a health promotion and disease prevention program for childhood cancer survivors is described, with an emphasis on the steps leading up to conducting a randomized controlled trial to test its efficacy. Data gathered from trial participants suggest the preliminary evaluation of the intervention is favorable. Trends and future directions in behavioral intervention research with childhood cancer survivors are discussed, along with the role of behavioral research in health promotion and disease prevention.     

Theory-of-mind, cognitive development, and children's interpretation of anxiety-related physical symptoms

The present study investigated developmental patterns in children's interpretation of anxiety-related physical symptoms and emotional reasoning, and to what extent these phenomena are influenced by children's level of cognitive development. A large sample of 4-13-year-old children (N=358) were exposed to vignettes in which the presence and absence of physical symptoms was systematically varied. In addition, children completed a series of conservation tasks and a theory-of-mind-test. Results demonstrated that from the age of 7, children were increasingly able to link physical symptoms to anxiety. Furthermore, cognitive development appeared to enhance children's ability to interpret physical symptoms as a sign of anxiety. Further, children's tendency to infer danger from vignettes with physical symptoms (i.e., emotional reasoning) was already prominent in 4-6-year-olds. The implications for physical symptom-based theories of childhood anxiety are briefly discussed.     

Cognitive processes supporting episodic memory formation in childhood: The role of source memory,binding, and executive functioning

Episodic memories contain various forms of contextual detail (e.g., perceptual, emotional, cognitive details) that need to become integrated. Each of these contextual features can be used to attribute a memory episode to its source, or origin of information. Memory for source information is one critical component in the formation of episodic memories. Likewise, the establishment of episodic memories also requires binding, which reflects the process of encoding the relations among stimuli and provides the experience that certain features of a memory episode belong together. The aims of the present review are to explore the roles of (1) cognitive and neural mechanisms involved in source memory and binding and how the development of these cognitive processes relates to episodic memory formation in childhood and (2) other higher-order cognitive processes, namely executive functioning, in early episodic memory development. We conclude by examining the challenges within this field of research, highlighting the role of other cognitive processes (e.g., sense of self, language, use of strategies) that may contribute to episodic memory formation, addressing areas that can be improved with additional research, and exploring directions for future work.     

Adolescents and Young Adults Living with Congenital Heart Disease: Coping,Stress Reactivity,and Emotional Functioning

Living with congenital heart disease (CHD) presents survivors with numerous stressors, which may contribute to emotional problems. This study examined (a) whether coping with CHD-related stress predicts symptoms of depression and anxiety, and (b) whether associations between coping and emotional distress are moderated by involuntary stress reactivity. Adolescents and young adults diagnosed with CHD (M_age?=?26.4) were recruited from pediatric and adult outpatient cardiology clinics. Participants (N?=?168) completed online self-report measures. Hierarchical multiple regression analyses revealed that secondary control coping (e.g., cognitive restructuring, positive thinking) predicted lower depression and anxiety. Primary control coping (e.g., problem-solving) and stress reactivity (e.g., rumination, emotional numbing) interacted to predict depression and anxiety: the higher individuals were in involuntary stress reactivity, the stronger was the association between primary control coping and lower depression and anxiety. These results can inform clinical efforts to prevent or reduce emotional distress among CHD survivors.     

Functional neuroimaging of working memory in survivors of childhood brain tumors and healthy children: Associations with coping and psychosocial outcomes

Purpose: Pediatric brain tumors are the second most common cancer diagnosis in individuals under age 20 and research has documented significant neurocognitive, psychosocial, and emotional late effects. Associations among these deficits have not been adequately considered and the role of survivors’ coping with stress in relation to deficits is unknown. Further, research has yet to examine neurobiological processes related to neurocognitive, psychosocial, and emotional difficulties in survivors through the use of functional neuroimaging. Method: Questionnaire measures and functional neuroimaging were used to examine the neurocognitive, psychosocial, and emotional functioning and coping responses of survivors of pediatric brain tumors (N = 17; age 8–16) and healthy children (N = 15). Results: Survivors experienced elevated levels of psychosocial and behavioral/emotional difficulties relative to healthy controls and normative data. Increases in brain activation in prefrontal and other anterior regions in response to a working memory task were associated with better psychosocial functioning, use of engagement coping strategies, and less use of disengagement coping strategies. Regression analyses suggest coping accounts for a significant portion of the association between brain activation and behavioral/emotional functioning. Conclusions: This study extends late-effects research by examining neurobiological processes associated with psychosocial and emotional difficulties. These findings contribute to our understanding of difficulties in survivors and provide a foundation for research exploring these associations and mediators of deficits in future longitudinal studies.     

Unresolved Childhood Sexual Abuse and Older Adults: Late-Life Vulnerabilities

Several long-term correlates of childhood sexual abuse (CSA) have been identified, including depression, fear, anxiety, guilt, anger, and poor interpersonal functioning (e.g., Browne and Finkelhor, 1986). However, little is know about how CSA survivors fare in old age. This article addresses the impact of unresolved CSA on late-life (emotional, cognitive, and behavioral) functioning. Three case studies of older adults ages 60 and older who were struggling with unresolved CSA are presented. Two observed stressors (loss of social support and declining health) and one developmental task (reminiscence or life-review) appear to be linked to exacerbated vulnerabilities in older survivors. Specifically, because CSA may arrest specific childhood developmental tasks (e.g., ability to form secure attachments, autonomy) or facilitate development of coping strategies that are maladaptive when outside of an abusive environment (e.g., generalized interpersonal distrust, avoidance, dissociation), the survivor may be at risk for developmental vulnerabilities for dysfunction in adulthood. These vulnerabilities may exacerbate unresolved CSA, particularly when the adult encounters stressors or developmental tasks that exceed his or her capacity for adaptive coping. Recommendations for mental health professionals and future research are suggested.     

To Add Insight to Injury: Childhood Abuse,Abuse Perceptions,and the Emotional and Physical Health of Young Adults

Although childhood abuse is strongly associated with psychological difficulties, survivors may not perceive their experiences as abusive. Depression, anxiety, dissociation, and physical health complaints may decrease perceptions of abuse and may also be exacerbated by individuals' abuse perceptions. The current study examined abuse perceptions, abuse experiences, and current symptoms among 185 university students. Ninety-six participants repeated the study 1–2 years later. At Time 1, self-labeling as “abused” or “maltreated” was not related to psychological or physical health symptoms. At Time 2, self-labeling as “abused” or “maltreated” was positively related to depression, anxiety, and dissociation. Results indicate that abuse perceptions may change over time and may be connected with emotional and physical symptoms.     

Development and Application of an Innovative Transdiagnostic Treatment Approach for Pediatric Irritability

Recent work has drawn attention to the previously underrecognized role that irritability plays in childhood psychopathology. Despite increased recognition of the clinical importance of pediatric irritability as a transdiagnostic symptom dimension, there is a lack of evidence-based treatments for this population that simultaneously and equitably addresses both child and contextual (e.g., parental) factors implicated in the development and maintenance of associated emotional and behavioral difficulties. In the current pilot study, we adapted the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders in Children (UP-C) for the treatment of pediatric irritability in a sample of 19 children (ages 8 to 12) with primary presenting concerns of irritability and/or disruptive behaviors. Results supported the feasibility and acceptability of this treatment and provided preliminary evidence that such an approach may yield improved outcomes for symptoms of pediatric irritability and disruptive behaviors. Implications of these findings for future research and clinical interventions for pediatric irritability are discussed.     

Neural circuitry of emotion regulation: Effects of appraisal,attention, and cortisol administration

Psychosocial well-being requires effective regulation of emotional responding in context of threat or stress. Neuroimaging studies have focused on instructed, volitional regulation (e.g., reappraisal or distancing), largely ignoring implicit regulation that does not involve purposeful effort to alter emotional experience. These implicit processes may or may not involve the same neural pathways as explicit regulatory strategies. We examined the neurobiology of implicit emotional regulation processes and the impact of the stress hormone cortisol on these processes. Our study task employed composite pictures of faces and places to examine neural activity during implicit emotional processing (of emotional faces), while these responses were implicitly regulated by attention shift away from the emotionally evocative stimuli, and while subjects reflectively appraised their own emotional response to them. Subjects completed the task in an fMRI scanner after random assignment to receive placebo or hydrocortisone (HCT), an orally administered version of cortisol. Implicit emotional processing activated insula/IFG, dACC/dMPFC, midbrain and amygdala. With attention shifting, we saw diminished signal in emotion generating/response regions (e.g., amygdala) and increased activations in task specific attention regions like parahippocampus. With appraisal of emotions, we observed robust activations in medial prefrontal areas, where activation is also seen in instructed reappraisal studies. We observed no main effects of HCT administration on brain, but males and females showed opposing neural effects in prefrontal areas. The data suggest that different types of emotion regulation utilize overlapping circuits, but with some strategy specific activation. Further study of the dimorphic sex response to cortisol is needed.     

Use of the Behavioral Assessment System for Children 2nd Edition: Parent Report Scale in Pediatric Cancer Populations

This study examined the use of the Behavioral Assessment System for Children—2nd Edition: Parent Report Scale (BASC-2; Reynolds & Kamphaus, Behavior assessment system for children, 2004) in a pediatric cancer population. Comparisons of scale scores were made between pediatric cancer participants and controls. Within group comparisons were also made between subtypes of pediatric cancer. Parents of 111 children and adolescents who had experienced pediatric cancer completed the BASC-2 as part of larger studies of parent-child adjustment to cancer. Scores on the BASC-2 for cancer survivors were compared to a matched control group. Results from MANOVA analyses revealed that children with cancer were categorized as evidencing more emotional and cognitive complaints compared to the control children. Notably, no significant within group differences emerged on the subscales with regard to cancer subtype. Although preliminary, these results suggest that the BASC-2 can identify the cognitive and emotional differences between cancer survivors and controls.     

Antecedents of mothers' emotional and cognitive responses to infant distress: The role of family,mother, and infant characteristics

The antecedents of mothers' emotional and cognitive responses to infant distress were examined. Participants were 67 mothers and their infants. Mothers completed questionnaires assessing their experiences in the family of origin and current marital relationships both pre‐ and postnatally and their coping strategies prenatally. Infant temperament was observed at 6 months, and mothers were interviewed about their emotional and cognitive responses to infant distress 2 years later to assess their emotional competencies (i.e., accurate identification of negative emotions, emotion efficacy, emotional responses to infant distress, and emotion goals). A childhood history of emotional rejection was negatively associated with empathy and efficacy and positively associated with negative emotions. The association between childhood history and some emotional competencies was moderated by current marital dysfunction, engaged coping, and positive intervening relationships. Maternal marital styles and coping strategies and infant temperament correlated with emotional competencies. Theoretical and clinical implications are discussed from an attachment theory perspective.     

Global reports of childhood maltreatment versus recall of specific maltreatment experiences: Relationships with dysfunctional attitudes and depressive symptoms

Although studies have suggested that reports of childhood maltreatment are related to depressive cognitions and symptom levels in adults, it is unclear whether the significant relations reported are due to the recall of specific maltreatment experiences, how individuals globally label their experiences (i.e., whether they believe they were maltreated during childhood), or both. Results from the current study supported the moderating role of global beliefs only for childhood sexual maltreatment. Specifically, the relationship between reports of specific childhood sexual maltreatment experiences and both dysfunctional attitudes and depressive symptom levels was significant only among participants who also globally endorsed a history of childhood sexual maltreatment. In contrast, the correlates of specific childhood emotional and physical maltreatment experiences were, for the most part, independent of whether the participants globally endorsed childhood emotional or physical maltreatment, respectively.     

Childhood Maltreatment and its Effect on Parenting among High-Risk Parents

Research evidence indicates that a childhood history of maltreatment affects parental behaviors in adulthood. The aim of the study was to investigate the predictors for parental behaviors among individuals who reported a history of maltreatment. The current study investigated whether attachment styles, emotional regulation and cognitive appraisals of parenting predicted parental behaviors (positive vs. negative). The study also investigated the differential effects of abuse experiences in childhood (physical, sexual, emotional, and neglect) on parental behaviors. The participants were 213 high-risk Jewish and Arab parents of children aged six and under. Participants completed five self-report questionnaires assessing parental behaviors, childhood experiences of abuse and neglect, attachment styles, emotional regulation, and cognitive appraisal of parenthood. The regression analyses revealed that personal attributes such as ethnicity, childhood experience of emotional abuse/neglect, emotional regulation, and appraisal of parenting, predict negative parental behavior. Anxious attachment and childhood emotional abuse and neglect moderated the impact of parenthood appraisal on parenting behaviors. Although physical and sexual abuse had the highest impact on insecure attachment, emotional abuse/neglect had higher predictive power for non-positive parenting. Clinical interventions for improving the capacity for emotional regulation and parent-child relational skills are suggested.     

Latina breast cancer survivors' lived experiences: diagnosis, treatment, and beyond

Latina breast cancer survivors are not benefiting from advances in psychosocial interventions. Despite their greater breast cancer burden, there is a dearth of information about this population. This qualitative study examined the experiences of 18 immigrant Latina breast cancer survivors along the survivorship continuum, from diagnosis to long-term survivorship. The authors conducted separate focus groups with women in the acute, reentry, and long-term survivorship stages. Through grounded theory analysis, the authors uncovered 5 themes of experience: perceptions of psychological well-being, impact of diagnosis, impact of treatment, need for social support, and development of new attitudes. Some themes were applicable across all survivorship stages, whereas others were more salient at a particular stage. Within themes, the authors identified experiences reported in the general literature (i.e., the debilitating effect of chemotherapy) and distinct cultural experiences (i.e., fear that a cancer diagnosis leads to certain death). Results suggest that treatments tailored for each survivorship stage are more likely to be effective than generic interventions. These findings have the potential to lessen health disparities in utilization of psychosocial treatments by Latina breast cancer survivors.     

Childhood Epilepsy and Autism Spectrum Disorders: Psychiatric Problems, Phenotypic Expression, and Anticonvulsants

Epilepsy and autism spectrum disorders (ASDs) frequently co-occur during childhood, however, the characteristics of psychiatric or behavioural problems in these children remains largely unknown. This article contributes to these discussions by reporting on the prevalence and presentation of psychiatric or behavioural problems in children with epilepsy and ASDs, as well as on the use of anticonvulsants in these children. The current evidence suggests that children with epilepsy and ASDs may present with a distinct clinical profile, with a greater number of developmental difficulties, and a more severe expression of the ASD phenotype that can not solely be accounted for by level of intellectual functioning. Positive effects of anticonvulsants on behavioural symptoms associated with ASDs were also reported, though pharmacoresistance and a lack of clear treatment guidelines may contribute to an elevated risk of adverse side effects. In relation to clinical presentation and management there is a need for careful consideration of potential interaction effects between disorder specific factors (e.g., age of seizure onset/ASD diagnosis), cognitive characteristics (e.g., intellectual functioning, memory), and psychosocial variables (e.g., coping strategies). Ultimately however, many conclusions are tentative and this review highlights the need for more empirically validated research on children with epilepsy and ASDs.     

Langfristige Folgen sexuellen Missbrauchs Minderj?hriger

Beyond its immediate effects, experiences of sexual abuse in childhood have long been analyzed with regard to possible long-term consequences. Based mainly on reviews and meta-analyses, this paper provides an overview on the state of research. Long-term effects of child sexual abuse have been researched with regard to numerous somatic, emotional, cognitive, behavioural and social characteristics. Research also touches upon questions of interindividual variability of long-term effects and factors influencing type, severity, stability and development of sexual abuse in childhood effects. The paper addresses typical research problems related to establishing connections between symptoms found in victim populations and victim experiences made years or decades ago.