Intervention may help kids who beat brain tumors recover their social skills

By Liz Meszaros, MDLinx
Published July 18, 2016

Key Takeaways

Children with brain tumors are surviving longer, but still dealing with cognitive, physical, and social problems long after their treatment ends. A school-based intervention to help them recover their skills may be both feasible and well accepted by their families, according to a study published in the July issue of the Journal of Developmental & Behavioral Pediatrics.

Katie Devine, PhD, MPH, Rutgers Cancer Institute of New Jersey behavioral scientist, and colleagues from universities in the United States and Canada conducted this study to assess if a peer-mediated intervention at the public schools for cancer survivors was feasible and acceptable to family members.

“We conducted this study because childhood brain tumor survivors, as a group, tend to have social problems with peers after treatment ends. Right now there are very few evidence-based interventions to help these children improve their social relationships, which are a critical component of normal development,” explained Dr. Devine.

“Available interventions tend to work directly with the survivors on improving their social skills, but it is unclear whether any improvements in these skills translate to improvements in peer relationships.  Also, when centers have offered social skills training for children surviving brain tumors, few parents/children use the service. Therefore, we chose to adapt and evaluate a peer intervention that had been shown to positively affect the peer relationships of children with autism spectrum disorders. We adapted the intervention for our group and tested the feasibility and acceptability of using the program in schools,” she added.

Although social strains and lack of social competence can be common in children who are recovering from malignant brain tumors, the causes of these problems are—as yet—not understood, said Dr. Devine.

“Impairments in neurocognitive functioning due to the disease or treatment exposures are associated with poorer social functioning. We think the social problems might be related to processing speed, short-term memory, or attention/concentration. Children who are younger when diagnosed are also at greater risk for social competence problems and have more of these types of neurocognitive problems,” she said.

“Much of the research documenting social competence problems has relied on parent report, though parents often tell us that they do not know how their children interact with peers at school. The data on self-reported problems is more mixed, and there is some evidence to suggest that brain tumor survivors may have inaccurate perceptions of their own social functioning compared with typically developing peers (Salley et al., 2014),” added Dr. Devine.  

The intervention was designed to encourage peer leaders to include socially isolated children via small group instruction.

For their study, Dr. Devine and colleagues enrolled 12 children who had survived childhood brain tumors in grades 1 through 8, and 217 of their classmates, who comprised eight intervention classrooms. Most surviving children were at least 2 years past their treatment.

In each classroom, the children chose two to three children as their leaders, who were taught to engage classmates during five to eight small group sessions over 4 to 6 weeks. These sessions were focused on including children not socially connected, and included a brain tumor survivor, who was anonymous to the other children in the group.

They discussed topics such as tolerating and noticing differences, initiating and responding to interactions with potential new friends, and how to include others in games/social situations.

They concluded that they had achieved an adequate recruitment rate of families of brain tumor survivors (81%) and schools (100%), found that the peer leaders were satisfied with the intervention. Their preliminary data on outcomes showed a trend toward some benefits in an increase in the number of friend nominations for survivors of brain tumors, but no changes in other peer-reported measures. There were also some positive effects on classroom levels of victimization and rejection.

Dr. Devine and colleagues did not assess whether these peer interventions helped the brain tumor survivor, but rather, whether the intervention itself was acceptable to the families of the brain tumor survivors and whether the program could be carried out in a public school setting.

“The take-home message is that programs that work with peers to teach strategies to include children who may not usually be included in social interactions, such as brain tumor survivors, are feasible and should be considered as potential intervention for children with social competence problems,” concluded Dr. Devine.

Reference:

Salley CG, Gerhardt CA, Fairclough DL, et al. Social self-perception among pediatric brain tumor survivors compared with peers. Journal of Developmental & Behavioral Pediatrics. 2014;35(7):427-434.    

This study was funded by the St. Baldrick’s Foundation, and was also supported by grants from the National Cancer Institute at the National Institutes of Health (NIH) (K07CA174728 & P30CA072720) to Dr. Devine.

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