Executive functioning in pediatric acute lymphoblastic leukemia: CHEXI parent-report vs performance-based assessment

Abstract

Several studies have emphasized the need for comprehensive neuropsychological assessment in pediatric cancer. To date, no study has analyzed Executive functions (EF) in children with Acute Lymphoblastic Leukemia (ALL) undergo treatment by means of both the Childhood Executive Functioning Inventory (CHEXI), parent form and performance-based measures. The aims of the present study were: (1) to explore the sensitivity of ratings vs. cognitive measures of EF to identify executive functions deficits in children with ALL and (2) to analyze the relationship between the parent-rated data and performance-based measures of EF in children with ALL. We assessed EF in typically developing (TD) children (n = 70) and children with ALL (n = 20) aged 6 to 12 years by means of performance-based measures of EFs (including working memory, cognitive flexibility, and inhibition) and the CHEXI parent form, also including IQ, depression, and anxiety measures. When controlling for age, IQ, depression and anxiety, children with ALL exhibited greater difficulties than their TD peers on working memory, cognitive flexibility (spontaneous and reactive) and inhibitory control tasks. Equally, at a behavioral level, differences between groups were observed regarding the CHEXI’s inhibition and WM subscales. However, the CHEXI parent related poorly to EF performance-based measures, supporting earlier research that suggests that ratings and laboratory measures would assess distinct underlying mental constructs. Overall, our results stress the importance of considering both measures when assessing EF in children with ALL as they would offer distinctive but relevant information. The clinical implications of findings are discussed.