Recent findings in adult survivors of childhood acute lymphoblastic leukemia (ALL) suggest the risk for neurocognitive functioning impairment to be more complex than previously appreciated. Specifically, neurocognitive weaknesses may be related not only to demographic and treatment factors, but also to underlying chronic health conditions arising after treatment. These relationships have only been examined in adult survivors of childhood ALL; therefore, the current study aimed to examine the contribution of chronic health conditions to neurocognitive and adaptive functioning in pediatric ALL survivors.

Ninety-five pediatric ALL survivors were identified from a retrospective clinical database. Of the 95 participants, 42 (44.2%) were female, 69 (72.6%) were Non-Hispanic White, and age at evaluation ranged from 5 to 20 years (M=11.80, SD=3.758). Further, 64 (67.4%) were designated as low/standard risk (LR/SR) and 31 (32.6%) were designated as high/very high risk (HR/VHR) during treatment. All participants were evaluated on standardized, performance-based measures of memory and executive functioning, and parent-rated adaptive functioning. Number and type of chronic health conditions, including neurological, endocrine/metabolic, and pulmonary, were abstracted from medical records. Multiple regression analyses, controlling for sex and age at diagnosis, were conducted separately within each risk group to examine the contribution of chronic health conditions to neurocognitive and adaptive functioning.

Sixty-eight percent of pediatric ALL survivors were diagnosed with at least one chronic health condition (M=1.48, SD=1.543). Within the LR/SR group, greater number of any chronic health condition predicted poorer basic attention (β = -0.421, p = 0.003), working memory (β =   -0.307, p = 0.024), and adaptive skills including adaptability (β = -0.318, p = 0.015), leadership (β = -0.334, p = 0.016), and functional communication (β = -0.335, p = 0.013). Further, diagnosis of a neurological, endocrine/metabolic, and/or pulmonary condition specifically predicted poorer basic attention (β = -0.334, p = 0.015). Within the HR/VHR group, diagnosis of an endocrine/metabolic condition predicted poorer selective attention (β = -0.424, p = 0.035). Finally, diagnosis of a neurological, endocrine/metabolic, and/or pulmonary condition within the HR/VHR group predicted poorer visual memory (β = -0.673, p < 0.001) and approached significance in predicting poorer processing speed (β = -0.378, p = 0.054).

Number and type of chronic health conditions increase the risk for neurocognitive and adaptive functioning weaknesses even when controlling for well-established demographic and treatment risk factors. Among the neurocognitive domains that were examined, attention and working memory were found to be most frequently affected by chronic health conditions. These findings are consistent with the literature indicating these two domains to be particularly vulnerable to ALL and its treatment. Further, our results concerning adaptive skills are consistent with those found within other pediatric medical conditions, which suggest children with simultaneous neurocognitive impairment and chronic health conditions to be at greatest risk for adaptive functioning difficulty. Overall, this study highlights the need for better understanding of the neurobiological impact of chronic health conditions within this population.