INS NYC 2024 Program

Poster	Poster Session 09 Program Schedule 02/16/2024 03:30 pm - 04:45 pm Room: Majestic Complex (Posters 61-120) Poster Session 09: Epilepsy \| Oncology \| MS \| Infectious Disease Final Abstract #84 Functional Language Concerns and Longitudinal Outcomes Following Pediatric Brain Tumor in Early Childhood Meghan O'Brien, Children's Hospital of Philadelphia, Philadelphia, United States Iris Paltin, Children's Hospital of Philadelphia, Philadelphia, United States Hannah-Lise Schofield, Children's Hospital of Philadelphia, Philadelphia, United States Megan Sy, Children's Hospital of Philadelphia, Philadelphia, United States Kelly Janke, Children's Hospital of Philadelphia, Philadelphia, United States Category: Cancer Keyword 1: brain tumor Keyword 2: language Keyword 3: pediatric neuropsychology Objective: Pediatric brain tumor (PBT) survivors are at risk for speech (e.g., articulation, prosody, fluency) and language (e.g., vocabulary, grammar, narratives, pragmatics) difficulties (Hodges et al., 2020). In a large clinical sample of PBT patients diagnosed in early childhood, a majority of the sample struggled with one or more language-related measures and demonstrated more weaknesses over time. We aim to 1) characterize functional language concerns, 2) identify specific risk factors and 3) explore correspondence between measures and clinical Language Concerns. Participants and Methods: Sixty patients (61.7% male; 73.3% white; 70% top two quintiles childhood opportunity index [COI]) were diagnosed with a brain tumor prior to age 6 years (M=3.64, SD=1.98). Participants were English dominant, with 16.7% exposed to another language at home. Lesions were primarily supratentorial (53.3%), with 5% disseminated. Treatments included surgery, chemotherapy, and radiation; 31.7% received all three by their second evaluation. Other risk factors included hearing concerns (28.3%), history of posterior fossa syndrome (13.3%), relapse (30%), NF-1 diagnosis (18.3%), and premorbid language concern (30%). Mean age was 7.12 years (SD=3.43; range 2-15) at first neuropsychological evaluation, and 11.43 years (SD=4.08; 5-19) at second evaluation, with an average of 4.37 years (SD=2.39) between evaluations. Measures included verbal IQ and working memory, fluencies, comprehension, and parent-reported functional communication. Weakness was defined as 1SD or more below the normative mean. Patients were determined to have clinically significant “Language Concerns” by a relevant diagnosis (e.g., articulation concerns, language disorder, intellectual disability, autism spectrum disorder), current speech/language services, or recommendation for further evaluation or treatment. All records were double coded for interrater agreement. Results: At the second evaluation, 60% showed Language Concerns. Those with Language Concerns at Time 2 had significantly lower verbal IQ and parent-reported functional communication at both evaluations, and lower scores in sentence repetition, comprehension of instructions, and verbal memory at Time 2. Clinician-rated language impairment was highly aligned with parent report (72.2%) and performance measures (68.3%) overall. However, 40% of those with Language Concerns were not detected by questionnaire and many (66.7%) without Language Concerns showed weakness on at least 1 performance measure. Patients showed significantly more weaknesses on language measures at Time 2 compared to Time 1 [t(58) = -3.27, p <.001]. Those with premorbid language concerns generally showed persisting clinical concerns at both time points and were more likely to be receiving services. There was no evidence for disproportionate risk with low COI. Language outcomes were not related to other individual or disease/treatment factors. Conclusions: The causes for persisting Language Concerns in PBT survivors are complex and cannot be linked to specific demographic, disease, or treatment variables alone. Neither parent-reported nor performance-based measures can fully identify patients at risk. As early screening and identification are important due to the increased prominence of language weaknesses over time, use of brief performance-based measures in conjunction with parent report may be useful screening tools administered during oncology visits.

Poster

02/16/2024
03:30 pm - 04:45 pm
Room: Majestic Complex (Posters 61-120)

Poster Session 09: Epilepsy | Oncology | MS | Infectious Disease

Final Abstract #84

Functional Language Concerns and Longitudinal Outcomes Following Pediatric Brain Tumor in Early Childhood

Meghan O'Brien, Children's Hospital of Philadelphia, Philadelphia, United States
Iris Paltin, Children's Hospital of Philadelphia, Philadelphia, United States
Hannah-Lise Schofield, Children's Hospital of Philadelphia, Philadelphia, United States
Megan Sy, Children's Hospital of Philadelphia, Philadelphia, United States
Kelly Janke, Children's Hospital of Philadelphia, Philadelphia, United States

Category: Cancer

Keyword 1: brain tumor
Keyword 2: language
Keyword 3: pediatric neuropsychology

Objective:

Pediatric brain tumor (PBT) survivors are at risk for speech (e.g., articulation, prosody, fluency) and language (e.g., vocabulary, grammar, narratives, pragmatics) difficulties (Hodges et al., 2020). In a large clinical sample of PBT patients diagnosed in early childhood, a majority of the sample struggled with one or more language-related measures and demonstrated more weaknesses over time. We aim to 1) characterize functional language concerns, 2) identify specific risk factors and 3) explore correspondence between measures and clinical Language Concerns.

Participants and Methods:

Sixty patients (61.7% male; 73.3% white; 70% top two quintiles childhood opportunity index [COI]) were diagnosed with a brain tumor prior to age 6 years (M=3.64, SD=1.98). Participants were English dominant, with 16.7% exposed to another language at home. Lesions were primarily supratentorial (53.3%), with 5% disseminated. Treatments included surgery, chemotherapy, and radiation; 31.7% received all three by their second evaluation. Other risk factors included hearing concerns (28.3%), history of posterior fossa syndrome (13.3%), relapse (30%), NF-1 diagnosis (18.3%), and premorbid language concern (30%). Mean age was 7.12 years (SD=3.43; range 2-15) at first neuropsychological evaluation, and 11.43 years (SD=4.08; 5-19) at second evaluation, with an average of 4.37 years (SD=2.39) between evaluations. Measures included verbal IQ and working memory, fluencies, comprehension, and parent-reported functional communication. Weakness was defined as 1SD or more below the normative mean. Patients were determined to have clinically significant “Language Concerns” by a relevant diagnosis (e.g., articulation concerns, language disorder, intellectual disability, autism spectrum disorder), current speech/language services, or recommendation for further evaluation or treatment. All records were double coded for interrater agreement.

Results:

At the second evaluation, 60% showed Language Concerns. Those with Language Concerns at Time 2 had significantly lower verbal IQ and parent-reported functional communication at both evaluations, and lower scores in sentence repetition, comprehension of instructions, and verbal memory at Time 2. Clinician-rated language impairment was highly aligned with parent report (72.2%) and performance measures (68.3%) overall. However, 40% of those with Language Concerns were not detected by questionnaire and many (66.7%) without Language Concerns showed weakness on at least 1 performance measure. Patients showed significantly more weaknesses on language measures at Time 2 compared to Time 1 [t(58) = -3.27, p <.001]. Those with premorbid language concerns generally showed persisting clinical concerns at both time points and were more likely to be receiving services. There was no evidence for disproportionate risk with low COI. Language outcomes were not related to other individual or disease/treatment factors.

Conclusions:

The causes for persisting Language Concerns in PBT survivors are complex and cannot be linked to specific demographic, disease, or treatment variables alone. Neither parent-reported nor performance-based measures can fully identify patients at risk. As early screening and identification are important due to the increased prominence of language weaknesses over time, use of brief performance-based measures in conjunction with parent report may be useful screening tools administered during oncology visits.