Neurobehavioral Effects and Risk Factors in Survivors of Pediatric Brain Tumors

Overview

Pediatric brain tumor survivors (PBTS) face significant neurobehavioral challenges including ADHD, ASD, and emotional and behavioral difficulties. This study highlights the prevalence of these impairments and identifies patient- and treatment-related risk factors contributing to neurobehavioral outcomes.

Background

Pediatric brain tumors are the most common solid tumors in children and a leading cause of pediatric malignancies. Advances in treatment have improved survival rates, but survivors often experience neurocognitive and neurobehavioral sequelae that impact quality of life. While neurocognitive deficits have been extensively studied, less is known about neurobehavioral impairments such as ADHD, ASD, and emotional difficulties in this population. Understanding these outcomes and their risk factors is critical for optimizing long-term care.

Data Highlights

The retrospective cohort included 299 PBTS diagnosed between 2005 and 2022, with diagnoses of ADHD, ASD, and intellectual developmental disabilities assessed at least two years post-diagnosis. Diagnoses were based on DSM-IV and DSM-V criteria, supported by standardized tools such as ADOS, ADI-R, and SWAN. Endocrine dysfunctions were also documented as potential risk factors. A follow-up survey assessed mental wellbeing through parent- and self-reported questionnaires.

Key Findings

• PBTS exhibit increased prevalence of ADHD and ASD compared to the general pediatric population.
• Neurobehavioral impairments correlate with treatment factors including cranial radiation therapy dosage and brain volume irradiated.
• Age at treatment and duration of remission influence neurobehavioral outcomes.
• Endocrine dysfunctions post-treatment are associated with higher risk of neurobehavioral difficulties.
• Genetic susceptibility may contribute to variability in neurobehavioral impairments among PBTS.
• Early childhood is a critical period where brain vulnerability and disrupted learning exacerbate neurobehavioral risks.

Clinical Implications

Clinicians should monitor PBTS closely for neurobehavioral symptoms such as ADHD and ASD, especially in those who received cranial radiation or have endocrine complications. Early identification and intervention can mitigate long-term psychosocial and functional impairments. Multidisciplinary care involving neuropsychology, endocrinology, and psychiatry is essential for comprehensive survivorship management.

Conclusion

PBTS are at significant risk for neurobehavioral impairments influenced by treatment and patient-related factors. Addressing these challenges through targeted surveillance and intervention is vital to improving quality of life in this vulnerable population.

References

1. Central Brain Tumor Registry of the United States 2020 -- Incidence of Primary Malignant Brain and CNS Tumors
2. Padovani et al. -- Neurocognitive Deficits Following Cranial Radiation Therapy
3. Meta-analysis by Study Team -- Inattention and Psychosocial Problems in PBTS