QOS-57: BEHAVIOR IN SURVIVORS OF PEDIATRIC MEDULLOBLASTOMA: THE IMPACT OF COGNITIVE FLEXIBILITY, INTELLIGENCE, AND NEGATIVE AFFECT

Characterization of medical and neurocognitive outcomes has been a primary focus in survivors of pediatric medulloblastoma. Less studied is the effect of treatment for medulloblastoma on behavioral functioning, and the contribution of cognitive and affective factors. Elevated rates of behavior problems (i.e., withdrawal, poor social functioning) have been documented in survivors of medulloblastoma compared to age-matched peers. We investigated behavioural outcome in survivors compared to controls, and evaluated the mediating impact of intelligence, cognitive flexibility and affect on the associations between treatment and behavior using path analysis. We assessed behavior in twenty-five survivors of medulloblastoma and twenty healthy children using the Child Behavior Checklist. Intelligence, cognitive flexibility and affect were measured with the Wechsler Abbreviated Scale of Intelligence, the Delis-Kaplan Executive Function System and the Early Adolescent Temperament Questionnaire-Revised, respectively. We found that survivors had increased social problems and internalizing behavior compared to controls (p < .01). In our path model, treatment for medulloblastoma predicted subsequent negative affect (β = .38,z = 2.75,p < .01), that in turn was associated with internalizing behavior (β = .48,z = 4.20,p < .0001), which significantly predicted social problems (β = .44,z = 3.17,p < .01). Similarly, treatment for medulloblastoma was associated with subsequent cognitive flexibility deficits (β = -.57,z = -4.58,p < .0001), that in turn predicted internalizing behavior (β = -.34,z = -2.71,p < .01), which significantly predicted social problems (β = .44,z = 3.17,p < .01). Our findings help explain the reported behavior problems in survivors; namely, poor cognitive flexibility and negative affect contribute to reduced social competence and maladaptive internalizing behavior following treatment for medulloblastoma. This increased understanding may help guide and develop intervention programs to promote successful and positive social and emotional functioning in survivors.