Early Cognitive and Adaptive Functioning of Clinically Referred Infants and Toddlers with Cancer

  • Ansley E. Kenney
  • Jennifer L. Harman
  • Andrew E. MolnarJr.
  • Niki Jurbergs
  • Victoria W. WillardEmail author


Many children with cancer are diagnosed during infancy and toddlerhood (< 3 years of age), potentially resulting in disrupted and/or missed developmental opportunities. Our objective was to describe the functioning of infants and toddlers with cancer who were clinically referred for evaluation at a hospital-based psychology clinic. Data from 29 very young children with cancer (Mage = 23.62 ± 6.6 months; 55.2% male) who completed clinically referred assessments from 2010 to 2015 were abstracted. Children were 11.3 months post-diagnosis (SD = 7.77, range 1–29 months) with just over half off-therapy at the time of assessment (55.2%). Overall, developmental functioning was significantly below expectations [t(22) = − 8.99, p < .001]. Adaptive functioning [t(25) = − 6.41, p < .001] was also significantly below expectations. Infants and toddlers with cancer appear to be at significant risk for weaknesses in early cognitive and adaptive functioning. The margin of deficits found in this study warrant the need for further investigation and consideration of this young population to ensure optimal functional development.


Childhood cancer Infants and toddlers Deficits Psychological functioning 


Compliance with Ethical Standards

Conflict of interest

Authors Ansley E. Kenney, Jennifer L. Harman, Andrew E. Molnar, Jr., Niki Jurbergs, and Victoria W. Willard declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee (St Jude Children’s Research Hospital) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.


  1. Abdullah, S., Qaddoumi, I., & Bouffet, E. (2008). Advances in the management of pediatric central nervous system tumors. Annals of the New York Academy of Sciences, 38, 22–31. Scholar
  2. Anderson, F. S., & Kunin-Batson, A. S. (2009). Neurocognitive late effects of chemotherapy in children: The past 10 years of research on brain structure and function. Pediatric Blood & Cancer, 52, 159–164. Scholar
  3. Baud, O., Cormier-Daire, V., Lyonnet, S., Desjardins, L., Turleau, C., & Doz, F. (1999). Dysmorphic phenotype and neurological impairment in 22 retinoblastoma patients with constitutional cytogenetic 13q deletion. Clinical Genetics, 55, 478–482. Scholar
  4. Bayley, N. (1993). Bayley scales of infant development (2nd ed.). San Antonio, TX: The Psychological Corporation.Google Scholar
  5. Bornstein, M. H., Scrimin, S., Putnick, D. L., Capello, F., Haynes, O., Falco, S., … Pillon, M. (2012). Neurodevelopmental functioning in very young children undergoing treatment for non-CNS cancer. Journal of Pediatric Psychology, 37, 660–673.
  6. Casey, B. J., Geidd, J. N., & Thomas, K. M. (2000). Structural and functional brain development and its relation to cognitive development. Biological Psychology, 54, 241–257. Scholar
  7. Caspi, A., Houts, R. M., Belsky, D. W., Harrington, H., Hogan, S., Ramrakha, S., …, Moffit, T. E. (2016). Childhood forecasting of a small segment of the population with large economic burden. Nature Human Behaviour, 1, 0005.
  8. Dhall, G., Grodman, H., Ji, L., Sands, S., Gardner, S., Dunkel, I. J., …, Finlay, J. L. (2008). Outcome of children less than three years old at diagnosis with non-metastatic medulloblastoma treated with chemotherapy on the “Head Start” I and II protocols. Pediatric Blood & Cancer, 50, 1169–1175.
  9. Fay-McClymont, T. B., Ploetz, D. M., Mabbott, D., Walsh, K., Smith, A., Chi, S. N., & Lafay-Cousin, L. (2017). Long-term neuropsychological follow-up of young children with medulloblastoma treated with sequential high-dose chemotherapy and irradiation sparing approach. Journal of Neurooncology, 133, 119–128. Scholar
  10. Fouladi, M., Gilger, E., Kocak, M., Wallace, D., Buchanan, G., Reeves, C., & Mulhern, R. (2005). Intellectual and functional outcome of children 3 years old or younger who have CNS malignancies. Journal of Clinical Oncology, 23, 7152–7160. Scholar
  11. Grieco, J., Pulsifer, M., Seligsohn, K., Skotko, B., & Schwartz, A. (2015). Down syndrome: Cognitive and behavioral functioning across the lifespan. American Journal of Medical Genetics Part C (Seminars in Medical Genetics), 169, 135–149. Scholar
  12. Guarlnick, M. J. (2011). Why early intervention works: A systems perspective. Infants Young Child, 24, 6–28. Scholar
  13. Harman, J. L., Wise, J., & Willard, V. W. (2018). Early intervention for infants and toddlers: Applications for pediatric oncology. Pediatric Blood & Cancer, 65, e26921. Scholar
  14. Harrison, P., & Oakland, T. (2003). Adaptive behavior assessment system (2nd ed.). San Antonio, TX: The Psychological Corporation.Google Scholar
  15. Hebbeler, K., Spiker, D., Bailey, D., Scarborough, A., Mallik, S., Simeonsson, R., …, Nelson, L. (2007). Early intervention for infants and toddlers with disabilities and their families: Participants, services, and outcomes: Final report of the National Early Intervention Longitudinal Study (NEILS). Menlo Park, CA: SRI International.Google Scholar
  16. Individuals with Disabilities Education Act, 20 S.S.C. § 1400 (2004).Google Scholar
  17. Jernigan, T. L., Baare, W. F. C., Stiles, J., & Madsen, K. S. (2011). Postnatal brain development: Structural imaging of dynamic neurodevelopmental processes. Progress in Brain Research, 189, 77–92. Scholar
  18. Kingston, D., McDonald, S., Austin, M. P., & Tough, S. (2015). Association between prenatal and postnatal psychological distress and toddler cognitive development: A systematic review. PLoS ONE, 10(1–16), e0126929. Scholar
  19. Lafay-Cousin, L., Bouffet, E., Hawkins, C., Amid, A., Huang, A., & Mabbott, D. J. (2009). Impact of radiation avoidance on survival and neurocognitive outcome in infant medulloblastoma. Current Oncology, 16, 21–28. Scholar
  20. Meltzoff, A. N., & Kuhl, P. K. (2016). Exploring the infant social brain: What’s going on in there? Zero to Three, 36, 2–9.Google Scholar
  21. Moleski, M. (2000). Neuropsychological, neuroanatomical, and neurophysiological consequences of CNS chemotherapy for acute lymphoblastic leukemia. Archives of Clinical Neuropsychology, 15, 603–630. Scholar
  22. Mulhern, R. K., & Butler, R. W. (2004). Neurocognitive sequelae of childhood cancers and their treatment. Pediatric Rehabilitation, 7(1), 1–14. Scholar
  23. Mulhern, R. K., Merchant, T. E., Gajjar, A., Reddick, W. E., & Kun, L. E. (2004). Late neurocognitive sequelae in survivors of brain tumors in childhood. Lancet Oncology, 5, 399–408. Scholar
  24. Mulhern, R. K., Palmer, S. L., Reddick, W. E., Glass, J. O., Kun, L. E., Taylor, J., …, Gajjar, A. (2001). Risks of young age for selected neurocognitive deficits in medulloblastoma are associated with white matter loss. Journal of Clinical Oncology, 19, 472–479.
  25. Mullen, E. M. (1995). Mullen Scales of Early Learning. Circle Pines, MN: American Guidance Service.Google Scholar
  26. Nagayoshi, M., Hirose, T., Toju, K., Suzuki, S., Okamitsu, M., Teramoto, T., & Takeo, N. (2017). Related visual impairment to mother-infant interaction and development in infants with bilateral retinoblastoma. European Journal of Oncology Nursing, 28, 28–34. Scholar
  27. National Research Council, Institute of Medicine. (2000). From neurons to neighborhoods: The science of early childhood development. Washington, DC: National Academy Press.Google Scholar
  28. Olsson, I. T., Perrin, S., Lundgren, J., Hjorth, L., & Johanson, A. (2014). Long-term cognitive sequelae after pediatric brain tumor related to medical risk factors, age, and sex. Pediatric Neurology, 51, 515–521. Scholar
  29. Sands, S. A., Oberg, J. A., Gardner, S. L., Whiteley, J. A., Glade-Bender, J. L., & Finlay, J. L. (2010). Neuropsychological functioning of children treated with intensive chemotherapy followed by myeloablative consolidation chemotherapy and autologous hematopoietic cell rescue for newly diagnosed CNS tumors: An analysis of the head start II survivors. Pediatric Blood & Cancer, 54, 429–436. Scholar
  30. Siegel, R. L., Miller, H. D., & Jemal, A. (2015). Cancer statistics, 2015. CA Cancer Journal for Clinicians, 65, 5–29. Scholar
  31. Sparrow, S. S., Cicchetti, D. V., & Balla, D. A. (2005). Vineland adaptive behavior scales (2nd ed.). San Antonio, TX: Pearson.Google Scholar
  32. Stargatt, R., Rosenfeld, J. V., Anderson, V., Hassall, T., Maixner, W., & Ashley, D. (2006). Intelligence and adaptive function in children diagnosed with brain tumour during infancy. Journal of Neurooncology, 80, 295–303. Scholar
  33. Stiles, J. (2008). The fundamentals of human brain development. Integrating nature and nurture. Cambridge, MA: Harvard University Press.Google Scholar
  34. Ward, E., DeSantis, C., Robbins, A., Kohler, B., & Jemal, A. (2014). Childhood and adolescent cancer statistics. CA Cancer Journal for Clinicians, 64, 83–103. Scholar
  35. Willard, V. W., Leung, W., Huang, Q., Zhang, H., & Phipps, S. (2014a). Cognitive outcome after pediatric stem-cell transplantation: Impact of age and total-body irradiation. Journal of Clinical Oncology, 32, 3982–3988. Scholar
  36. Willard, V. W., Qaddoumi, I., Chen, S., Zhang, H., Brennan, R., Rodriguez-Galindo, C., …, Phipps, S. (2014). Developmental and adaptive functioning in children with retinoblastoma: A longitudinal investigation. Journal of Clinical Oncology, 32, 2788–2793.

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of PsychologySt. Jude Children’s Research HospitalMemphisUSA

Personalised recommendations