Symptoms of attention‐deficit/hyperactivity disorder in long‐term survivors of childhood leukemia

Abstract

Background Survivors of childhood acute lymphoblastic leukemia (ALL) sometimes have clinical features that suggest Attention-Deficit/Hyperactivity Disorder (ADHD), though few studies have examined specific symptoms in survivors. Procedure Long-term survivors of childhood ALL (n=161) received a neurological examination, while parents completed rating scales to establish formal criteria for ADHD. Symptom profiles were generated and compared across demographic and treatment characteristics, as well as medical tests associated with brain pathology. Results Prevalence rates of ADHD were similar in survivors (10.5%) compared to those reported in the general population (7–10%). However, 25.5% of survivors reported symptoms that impair functioning in multiple settings, with attention problems being most common. These symptoms were associated with cranial radiation therapy (CRT) (mean inattentive symptoms [SD] = 3.6 [3.19] for group treated with CRT vs. 1.6 [2.40] for non-CRT group, p=0.0006), and survivors who demonstrated impaired anti-saccades during the neurologic exam (mean inattentive symptoms [SD] = 3.4 [3.29] for those with impaired anti-saccades vs. 1.4 [2.41] for those with normal anti-saccades; p = 0.0004). Conclusions The presence of a neurologically-based phenotype of attention problems in survivors of leukemia that is not fully captured by the syndrome of ADHD suggests that treatments specific to childhood ALL should be explored.

4.1 Medical and Psychiatric Comorbidities in Korean Children and Adolescents With Attention-Deficit/Hyperactivity Disorder

“…ADHD had a reported prevalence of 9.0-10.5% in survivors of childhood leukemia or brain tumor. 36,37 These rates are similar to those in the general population. However, another study reported that the prevalence of ADHD in childhood cancer may be lower than in the general population 38 for several reasons.…”

Neurologic morbidity and quality of life in survivors of childhood acute lymphoblastic leukemia: a prospective cross-sectional study

“…Comparison of participants and non-participants is already published [15]. There was no difference between participants and non-participants ( n =270) in gender distribution ( p =0.89), age at ALL diagnosis ( p = 0.99), ALL risk group ( p =0.53), B or T cell lineage ( p =0.94), high dose methotrexate ( p =0.26) or intrathecal methotrexate use ( p =1.00), prednisone ( p =0.98) or dexamethasone use ( p = 0.28), and treatment with cranial radiation ( p =0.29).…”

“…As previously published [15], participants responded to an 18-item questionnaire probing symptoms of attention deficit hyperactivity disorder consistent with the Vanderbilt Attention-Deficit Hyperactivity Disorder Parent Rating Scale [16]. DSM-IV criteria were then applied to determine if a participant had attention deficit, hyperactivity, or both.…”

Acute Lymphoblastic Leukemia: What Have We Learned About the Effects of This Disease and Its Treatment on the Nervous System?

“…More than one half of survivors (54%) received intrathecal methotrexate, cranial radiation, or both and treatments with cranial radiation and/or intrathecal methotrexate were specific risk factors for depression/anxiety, attention deficit, antisocial behaviors, and diminished social competence. Attention problems are commonly reported in these patients (up to 25.5% of the survivors), but the rate of patients meeting the full criteria for ADHD is only of 10.5%-just slightly higher than the reported rate in the general population (Krull et al, 2011). Also, similar rates of ADHD were seen in boys and girls, and especially in the patients that have received cranial radiation therapy.…”

“…In addition, many survivors also have multiple behavioral symptoms suggestive of attention deficit/hyperactivity disorder (ADHD) (Krull et al, 2011). These abnormalities are assessed by behavioral ratings-especially from the family and classroom teachers.…”