The prefrontal cortex modulates executive control processes and structurally matures throughout adolescence. Consistent with these events, prefrontal functions that demand high levels of executive control may mature later than those that require working memory but decreased control. To test this hypothesis, adolescents (9 to 20 years old) completed nonverbal working memory tasks with varying levels of executive demands. Findings suggest that recall-guided action for single units of spatial information develops until 11 to 12 years. The ability to maintain and manipulate multiple spatial units develops until 13 to 15 years. Strategic self-organization develops until ages 16 to 17 years. Recognition memory did not appear to develop over this age range. Implications for prefrontal cortex organization by level of processing are discussed.

Healthy adolescents (79 girls, 66 boys), ages 9-17, completed the Iowa Gambling Task (IGT; A. Bechara, A. R. Damasio, H. Damasio, & S. W. Anderson, 1994) as well as working memory (digit span) and behavioral inhibition (go/no-go) tasks. Cross-sectional age-related changes were seen on all 3 tasks. Gender differences were seen in IGT deck preference and attentional variables (i.e., go/no-go hit rate and forward digit span). After age, gender, and general intellectual abilities were controlled for, IGT performance was not predicted by working memory or behavioral inhibition scores. Findings suggest that the ventromedial prefrontal cortex or its connections are functionally maturing during adolescence in a manner that can be distinguished from maturation of other prefrontal regions. Development of these functions may continue into young adulthood.

A B S T R A C T PurposeWe conducted a prospective trial to evaluate late effects in pediatric patients with low-grade glioma (LGG) treated with conformal radiation therapy (CRT). Patients and MethodsBetween August 1997 and August 2006, 78 pediatric patients with LGG (mean age, 9.7 years; standard deviation, Ϯ4.4 years) received 54 Gy of CRT with a 10-mm clinical target volume margin. Tumor locations were diencephalon (n ϭ 58), cerebral hemisphere (n ϭ 3), and cerebellum (n ϭ 17). Baseline and serial evaluations were performed to identify deficits in cognition, endocrine function, and hearing. Deficits were correlated with clinical factors and radiation dose within specific normal tissue volumes. ResultsCognitive effects of CRT through 5 years after CRT correlated with patient age, neurofibromatosis type 1 status, tumor location and volume, extent of resection, and radiation dose. The effect of age exceeded that of radiation dose; patients younger than 5 years experienced the greatest decline in cognition. Before CRT, growth hormone (GH) secretion abnormality was diagnosed in 24% of tested patients, and 12% had precocious puberty. The 10-year cumulative incidence of GH replacement was 48.9%; of thyroid hormone replacement, 64.0%; of glucocorticoid replacement, 19.2%; and of gonadotropin-releasing hormone analog therapy, 34.2%. The mean Ϯ standard errors of the cumulative incidence of hearing loss at 10 years did not exceed 5.7% Ϯ 3.3% at any frequency. ConclusionTo our knowledge, this is the largest series of prospectively followed children with LGG to undergo irradiation. Adverse effects are limited and predictable for most patients; however, this study provides additional evidence that CRT should be delayed for young patients and identifies the potential benefits of reducing radiation dose to normal brain.