Long-Term Efficacy of Computerized Cognitive Training Among Survivors of Childhood Cancer: A Single-Blind Randomized Controlled Trial

Heather M Conklin, Jason M Ashford, Kellie N Clark, Karen Martin-Elbahesh, Kristina K Hardy, Thomas E Merchant, Robert J Ogg, Sima Jeha, Lu Huang, Hui Zhang, Heather M Conklin, Jason M Ashford, Kellie N Clark, Karen Martin-Elbahesh, Kristina K Hardy, Thomas E Merchant, Robert J Ogg, Sima Jeha, Lu Huang, Hui Zhang

Abstract

Objective: To investigate the long-term efficacy of computerized cognitive training in improving cognitive outcomes among childhood cancer survivors.

Methods: Sixty-eight survivors of childhood acute lymphoblastic leukemia (ALL) or brain tumor (BT) were randomly assigned to computerized cognitive intervention (23 ALL/11 BT, age = 12.21 ± 2.47) or a waitlist control group (24 ALL/10 BT, age = 11.82 ± 2.42). Cognitive assessments were completed pre-, immediately post-, and 6 months postintervention.

Results: A prior report showed training led to immediate improvement in working memory, attention and processing speed. In the current study, piecewise linear mixed effects modeling revealed that working memory and processing speed were unchanged from immediate to 6 months postintervention (intervention β = -.04 to .01, p = .26 to .95; control β = -.06 to .01, p = .23-.97), but group differences on an attention measure did not persist.

Conclusion: Cognitive benefits are maintained 6 months following computerized cognitive training, adding to potential clinical utility of this intervention approach.

Keywords: brain tumor; computerized cognitive training; leukemia; pediatric; working memory.

© The Author 2016. Published by Oxford University Press on behalf of the Society of Pediatric Psychology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

Figures

Figure 1.
Figure 1.
Consort diagram.

References

    1. Bennett S., Holmes J., Buckley S. (2013). Computerized memory training leads to sustained improvement in visuo-spatial short-term memory skills in children with Down syndrome. American Journal on Intellectual and Developmental Disabilities, 118, 179–192. doi: 10.1352/1944-7558-118.3.179
    1. Butler R. W., Copeland D. R., Fairclough D. L., Mulhern R. K., Katz E. R., Kazak A. E.,, Noll R. B., Patel S. K., Sahler O. J. (2008). A multicenter, randomized clinical trial of a cognitive remediation program for childhood survivors of pediatric malignancy. Journal of Consulting and Clinical Psychology, 76, 367–378. doi: 10.1037/0022-006X.76.3.367
    1. Conklin H. M., Ashford J. M., Howarth R. A., Merchant T. E., Ogg R. J., Santana V. M.,, Reddick W. E., Xiong X. (2012). Working memory performance among childhood brain tumor survivors. Journal of the International Neuropsychological Society, 18, 996–1005. doi: 10.1017/S1355617712000793
    1. Conklin H. M., Helton S., Ashford J., Mulhern R. K., Reddick W. E., Brown R.,, Bonner M., Jasper B. W., Wu S., Xiong X., Khan R. B. (2010). Predicting methylphenidate response in long-term survivors of childhood cancer: A randomized, double-blind, placebo-controlled, crossover trial. Journal of Pediatric Psychology, 35, 144–155. doi: 10.1093/jpepsy/jsp044
    1. Conklin H. M., Khan R. B., Reddick W. E., Helton S., Brown R., Howard S. C., Bonner M., Christensen R., Wu S., Xiong X., Mulhern R. K. (2007). Acute neurocognitive response to methylphenidate among survivors of childhood cancer: A randomized, double-blind, cross-over trial. Journal of Pediatric Psychology, 32, 1127–1139. doi: 10.1093/jpepsy/jsm045
    1. Conklin H. M., Lawford J., Jasper B. W., Morris E. B., Howard S. C., Ogg S. W. (2009). Side effects of methylphenidate in childhood cancer survivors: A randomized placebo-controlled trial. Pediatrics, 124, 226–233. doi: 10.1542/peds.2008-1855
    1. Conklin H. M., Ogg R. J., Ashford J. M., Scoggins M. A., Zou K. N., Clark K. N., Zhang H. (2015). Computerized cognitive training for amelioration of cognitive late effects among childhood cancer survivors: a randomized controlled trial. Journal of Clinical Oncology, 33, 3894–3902. doi:10.1200/JCO.2015.61.6672
    1. Conklin H. M., Reddick W. E., Ashford J., Ogg S., Howard S. C., Morris E. B.,, Brown R., Bonner M., Christensen R., Wu S., Xiong X., Khan R. B. (2010). Long-term efficacy of methylphenidate in enhancing attention regulation, social skills, and academic abilities of childhood cancer survivors. Journal of Clinical Oncology, 28, 4465–4472. doi: 10.1200/JCO.2010.28.4026
    1. Conners C. K. (1995). Conners’ continuous performance test. Toronto, ON: Multi-Health Systems.
    1. Conners C. K. (2004). Conners’ continuous performance test II. San Antonio, TX: Pearson Corporation.
    1. Conners C. K. (2008). Conners’ rating scales (3rd ed). Toronto, ON: Multi-Health Systems, Incorporated.
    1. Cox L. E., Ashford J. M., Clark K. N., Martin-Elbahesh K., Merchant T. E., Ogg R. J., Zhang H. (2015). Feasibility and acceptability of a remotely-administered computerized intervention to address cognitive late effects among childhood cancer survivors. Neuro-oncology Practice, 2, 78–87. doi: 10.1093/nop/npu036
    1. Crom D. B., Lensing S. Y., Rai S., Snider M. A., Cash D. K., Hudson M. M. (2007). Marriage, employment, and health insurance in adult survivors of childhood cancer. Journal of Cancer Survivorship, 1, 237–245. doi: 10.1007/s11764-007-0026-x
    1. DeSantis C. E., Lin C. C., Mariotto A. B., Siegel R. L., Stein K. D., Kramer J. L., Alteri R., Robbins A. S., Jemal A. (2014). Cancer treatment and survivorship statistics, 2014. CA: A Cancer Journal for Clinicians, 64, 252–271. doi: 10.3322/caac.21235
    1. Gioia G. A., Isquith P. K., Guy S. C., Kenworthy L. (2000). Behavior rating inventory of executive function. Odessa, FL: Psychological Assessment Resources, Incorporated.
    1. Hardy K. K., Willard V. W., Allen T. M., Bonner M. J. (2013). Working memory training in survivors of pediatric cancer: A randomized pilot study. Psychooncology, 22, 1856–1865. doi: 10.1002/pon.3222
    1. Helps S. K., Bamford S., Sonuga-Barke E. J., Soderlund G. B. (2014). Different effects of adding white noise on cognitive performance of sub-, normal and super-attentive school children. PLoS One, 9, e112768. doi: 10.1371/journal.pone.0112768
    1. Holmes J., Gathercole S. E., Dunning D. L. (2009). Adaptive training leads to sustained enhancement of poor working memory in children. Developmental Science, 12, F9–F15. doi: 10.1111/j.1467-7687.2009.00848.x
    1. Hovik K., Saune B., Aarlien A. K., Egeland J. (2013). RCT of working memory training in ADHD: Long-term near-transfer effects. PloS ONE, 8, e80561. doi: 10.1371/journal.pone.0080561
    1. Jacola L. M., Krull K., Pui C.-H., Pei D., Cheng C., Reddick W. E., Conklin H. C. (2016). Longitudinal assessment of neurocognitive outcomes in survivors of childhood acute lymphoblastic leukemia treated on a contemporary chemotherapy protocol. Journal of Clinical Oncology, 34, 1239–1247. doi: 10.1200/JCO.2015.64.3205
    1. Klingberg T., Fernell E., Olesen P. J., Johnson M., Gustafsson P., Dahlstrom K., Gillberg C. G., Forssberg H., Westerberg H. (2005). Computerized training of working memory in children with ADHD- a randomized, controlled trial. Journal of the American Academy of Child and Adolescent Psychiatry, 44, 177–186. doi: 10.1097/00004583-200502000-00010
    1. Kronenberger W. G., Pisoni D. B., Henning S. C., Colson B. G., Hazzard L. M. (2011). Working memory training for children with cochlear implants: A pilot study. Journal of Speech, Language, and Hearing Research, 54, 1182–1196. [Database] doi: 10.1044/1092-4388(2010/10-0119)
    1. Lohaugen G. C., Antonsen I., Haberg A., Gramstad A., Vik T., Brubakk A. M., Skranes J. (2011). Computerized working memory training improves function in adolescents born at extremely low birth weight. Journal of Pediatrics, 158, 555–561. doi: 10.1016/j.jpeds.2010.09.060
    1. Louca M., Short M. A. (2014). The effect of one night’s sleep deprivation on adolescent neurobehavioral performance. Sleep, 37, 1799–1807. doi: 10.5665/sleep.4174
    1. Lundqvist A., Gundstrom K., Ronnberg J. (2010). Computerized working memory training in a group of patients suffering from acquired brain injury. Brain Injury, 24, 1173–1183. doi: 10.3109/02699052.2010.498007
    1. Mabbott D. J., Penkman L., Witol A., Strother D., Bouffet E. (2008). Core neurocognitive functions in children treated for posterior fossa tumors. Neuropsychology, 22, 159–168. doi: 10.3109/02699052.2010.498007
    1. Mitby P. A., Robison L. L., Whitton J. A., Zevon M. A., Gibbs I. C., Tersak J. M.; Childhood Cancer Survivor Study Steering Committee. (2003). Utilization of special education services and educational attainment among long-term survivors of childhood cancer: A report from the Childhood Cancer Survivor Study. Cancer, 97, 1115–1126. (doi: 10.3109/02699052.2010.498007
    1. Moore I. M., Hockenberry M. J., Anhalt C., McCarthy K., Krull K. R. (2012). Mathematics intervention for prevention of neurocognitive deficits in childhood leukemia. Pediatric Blood Cancer, 59, 278–284. doi: 10.1002/pbc.23354
    1. Mulhern R. K., Butler R. W. (2004). Neurocognitive sequelae of childhood cancers and their treatment. Pediatric Rehabilitation, 7, 1–14. doi: 10.1080/13638490310001655528
    1. Mulhern R. K., Khan R. B., Kaplan S., Helton S., Christensen R., Bonner M., Brown R., Xiong X., Wu S., Gururangan S., Reddick W. E. (2004). Short-term efficacy of methylphenidate: A randomized, double-blind, placebo-controlled trial among survivors of childhood cancer. Journal of Clinical Oncology, 22, 4795–4803. doi: 10.1200/JCO.2004.04.128
    1. Olesen P. J., Westerberg H., Klingberg T. (2004). Increased prefrontal and parietal activity after training of working memory. Nature Neuroscience, 7, 75–79. doi:10.1038/nn1165
    1. Patel S. K., Katz E. R., Richardson R., Rimmer M., Kilian S. (2009). Cognitive and problem solving training in children with cancer: A pilot project. Journal of Pediatric Hematology Oncology, 31, 670–677. doi: 10.1097/MPH.0b013e3181b25a1d
    1. Reeves C. B., Palmer S. L., Reddick W. E., Merchant T. E., Buchanan G. M., Gajjar A., Mulhern R. K. (2006). Attention and memory function among pediatric patients with medulloblastoma. Journal of Pediatric Psychology, 31, 272–280. doi: 10.1093/jpepsy/jsj019
    1. Reynolds C. R., Kamphaus R. W. (1992). Behavior assessment system for children .Circle Pines, MN: American Guidance Service.
    1. Reynolds C. R., Kamphaus R. W. (2004). Behavior assessment system for children (2nd ed). Bloomington, MN: Pearson Assessments.
    1. Robinson K. E., Kaizar E., Catroppa C., Godfrey C., Yeates K. O. (2014). Systematic review and meta-analysis of cognitive interventions for children with central nervous system disorders and neurodevelopmental disorders. Journal of Pediatric Psychology, 39, 846–865. doi: 10.1093/jpepsy/jsu031
    1. Schatz J., Kramer J. H., Ablin A., Matthay K. K. (2000). Processing speed, working memory and IQ: A developmental model of cognitive deficits following cranial radiation therapy. Neuropsychology, 14, 189–200. doi: 10.1037/0894-4105.14.2.189
    1. Seidel W. T., Joschko M. (1990). Evidence of difficulties in sustained attention in children with ADDH. Journal of Abnormal Child Psychology, 18, 217–229. doi: 10.1007/BF00910732
    1. Thorell L. B., Lindqvist S., Bergman Nutley S., Bohlin G., Klingberg T. (2009). Training and transfer effects of executive functions in preschool children. Developmental Science, 12, 106–113. doi: 10.1111/j.1467-7687.2008.00745.x
    1. Weicker J., Vilringer A., Thone-Otto A. (2016). Can impaired working memory functioning be improved by training? A meta-analysis with a special focus on brain injured patients. Neuropsychology, 30, 190–212. doi: 10.1037/neu0000227
    1. Wechsler D. (1991). Wechsler intelligence scale for children (3rd ed). San Antonio, TX: Psychological Corporation.
    1. Wechsler D. (1999a). Wechsler adult intelligence scale (3rd ed). San Antonio, TX: Harcourt Assessment.
    1. Wechsler D. (1999b). Wechsler abbreviated scale of intelligence. San Antonio, TX: Harcourt Assessment.
    1. Wechsler D. (2004). Wechsler intelligence scale for children (4th ed). San Antonio, TX: Pearson Corporation.
    1. Westerberg H., Jacobaeus H., Hirvikoski T., Clevberge P., Ostensson M. L., Bartfai A., Klingberg T. (2007). Computerized working memory training after stroke- a pilot study. Brain Injury, 21, 21–29. doi: 10.1080/02699050601148726
    1. Woodcock R. W., McGrew K. S., Mather N. (2001). Woodcock-Johnson III tests of achievement. Itasca, IL: Riverside Publishing.
    1. Zelen M. (1974). The randomization and stratification of patients to clinical trials. Journal of Chronic Disease, 27, 365–375. doi: 10.1016/0021-9681(74)90015-0

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