Neurodevelopmental consequences of pediatric cancer and its treatment: applying an early adversity framework to understanding cognitive,behavioral, and emotional outcomes

Today, children are surviving pediatric cancer at unprecedented rates, making it one of modern medicine’s true success stories. However, we are increasingly becoming aware of several deleterious effects of cancer and the subsequent “cure” that extend beyond physical sequelae. Indeed, survivors of childhood cancer commonly report cognitive, emotional, and psychological difficulties, including attentional difficulties, anxiety, and posttraumatic stress symptoms (PTSS). Cognitive late- and long-term effects have been largely attributed to neurotoxic effects of cancer treatments (e.g., chemotherapy, cranial irradiation, surgery) on brain development. The role of childhood adversity in pediatric cancer – namely, the presence of a life-threatening disease and endurance of invasive medical procedures – has been largely ignored in the existing neuroscientific literature, despite compelling research by our group and others showing that exposure to more commonly studied adverse childhood experiences (i.e., domestic and community violence, physical, sexual, and emotional abuse) strongly imprints on neural development. While these adverse childhood experiences are different in many ways from the experience of childhood cancer (e.g., context, nature, source), they do share a common element of exposure to threat (i.e., threat to life or physical integrity). Therefore, we argue that the double hit of early threat and cancer treatments likely alters neural development, and ultimately, cognitive, behavioral, and emotional outcomes. In this paper, we (1) review the existing neuroimaging research on child, adolescent, and adult survivors of childhood cancer, (2) summarize gaps in our current understanding, (3) propose a novel neurobiological framework that characterizes childhood cancer as a type of childhood adversity, particularly a form of early threat, focusing on development of the hippocampus and the salience and emotion network (SEN), and (4) outline future directions for research.     

Left-handedness and male-male competition: Insights from fighting and hormonal data

Male-male competition can shape some behavioral or morphological traits of males. Here we investigate if this competition could play a role in the persistence of the polymorphism of handedness in human populations. A negative frequency-dependent selection mechanism has been hypothesized, based on the fact that left-handed men may benefit from a "surprise" advantage during fighting interactions because they are rare in human populations. This advantage may thereby enhance the probability of survival of left- handed men and/or their reproductive success through an increase in social status. In this study, we first explored the association between hand preference and lifetime fighting behavior in a population of 1,161 French men. No effect of hand preference on the probability of fighting was detected, suggesting that the innate propensity to fight does not differ between left- and right-handers. However, among men who had been involved in at least one fight during their lifetime, left-handers reported significantly more fights than right-handers. To explore the biological basis of this behavior, we also investigated the testosterone concentration in saliva samples from 64 French university students. Consistent with frequencies of fights, we found a significantly higher average testosterone concentration in left-handers than in right-handers. We suggest that these behavioral and hormonal differences may be acquired throughout life due to previous experiences in a social context and may favor the persistence of left-handers in humans.     

Learning and forgetting in schizophrenia

Recent studies of patients with schizophrenia have consistently demonstrated marked deficits on measures of initial learning. However, contradictory results have been reported concerning retention and forgetting. The present study examined the level of initial and delayed recall of stories and visual figures in a group of 76 patients with schizophrenia and 51 normal controls. Schizophrenia patients demonstrated marked impairments in initial and delayed recall as well as significantly worse percentage retention scores. However, schizophrenia patients and healthy controls individually matched on level of initial recall had nearly identical delayed recall performance. The results suggest a primary deficit in the initial acquisition of information rather than an accelerated rate of forgetting in schizophrenia.     

Anagram software for cognitive research that enables specification of psycholinguistic variables

Anagram tasks are frequently used in cognitive research, and the generation of new scrambled letter combinations is a task well suited to a software solution. Most available programs, however, do not allow experimenters to generate new anagrams flexibly or to characterize existing anagrams using psycholinguistic criteria. They also do not provide detailed information on their source dictionaries. We present anagram software that interfaces with CELEX2, an internationally recognized psycholinguistic database. This software allows users to capitalize on lexical variables and thus enables direct control of psycholinguistic features that may influence the cognitive processes involved in anagram solution.     

Distinct and common cortical activations for multimodal semantic categories

If semantic representations are based on particular types of perceptual features, then category knowledge that arises from multimodal sensory experiences should rely on distinct and common sensory brain regions depending on the features involved. Using a similarity-based generation-andcomparison task, we found that semantic categories activated cortical areas associated with taste and smell, biological motion, and visual processing. Fruit names specifically activated medial orbitofrontal regions associated with taste and smell. Labels for body parts and clothing activated lateral temporal occipitoparietal areas associated with perceiving the human body. More generally, visually biased categories activated ventral temporal regions typically ascribed to visual object recognition, whereas functional categories activated lateral frontotemporal areas previously associated with the representation of usage properties. These results indicate that semantic categories that are distinguished by particular perceptual properties rely on distinct cortical regions, whereas semantic categories that rely on similar types of features depend on common brain areas.     

Depression After Traumatic Brain Injury: A Review of Evidence for Clinical Heterogeneity

Depression represents a major source of disability among individuals who have suffered a traumatic brain injury (TBI), with estimates of prevalence in this population ranging over 50%. In comparison with other sequelae of TBI, depression is often poorly conceptualized and treated among acute care and rehabilitation professionals. One reason for this is the lack of clear etiological models for the development of depression following TBI. This paper argues that post-TBI depression actually represents a heterogeneous category, with multiple etiologic pathways and clinical implications. The literature in this area is reviewed, with an emphasis on an appreciation of the diversity within this clinical population. Conclusions focus on suggestions for differential diagnosis and treatment options.     

Contents Volume 116 2003

Volume Contents

Contents Volume 116 2003     

Fanatic Hatred and Violence in Contemporary America

The paper is a social psychological and psychoanalytic examination of collective violence in the United States in which fanatic hatred and sheer destructiveness are the central operating principles. The primary character structure of who's involved in fanatic violence are shown here to be people who were raised in authoritarian-oriented backgrounds, who find themselves marginal, and unnecessary persons in postmodern American society.     

Navigating the nuances: a matrix of considerations for ethical-legal dilemmas

At one time or another, we all have encountered cases with serious ethical and legal implications. How can we know that we have thoroughly explored every facet of these dilemmas? The authors present a 7-category matrix of the following considerations: moral principles and personal values, clinical and cultural considerations, ethics codes, agency or employer policies, statues, rules and regulations, and case law. Two clinical examples illustrate the usefulness of this multidimensional framework for professional psychologists. Implications and applications for practitioners and ethics educators are also discussed.