EXECUTIVE FUNCTION AND COPING IN SURVIVORS OF
CHILDHOOD ACUTE LYMPHOCYTIC LEUKEMIA
LAURA KEYS CAMPBELL
Dissertation under the direction of Professor Bruce Compas
The current study examined executive function, coping, and emotional and behavioral problems in childhood ALL survivors and a matched control sample of healthy children. It was hypothesized that compared to healthy controls, childhood ALL survivors would evince poorer executive functioning, more maladaptive patterns of coping with stress, and more emotional and behavioral problems. In addition, because adaptive coping relies on intact executive functions, it was hypothesized that poorer executive functioning would be associated with greater use of maladaptive patterns of coping; that is, greater reliance on disengagement coping and less use of primary and secondary control coping, particularly in ALL survivors. Participants included 30 children and adolescents between 10 and 20 years of age who completed treatment for ALL and 30 healthy controls matched on age, sex, and when possible SES. Both ALL and healthy control participants were administered behavioral tests of executive function, and their parents were administered a questionnaire asking them to report on their children’s executive functions. In addition, both participants and their parents completed questionnaires on the child’s coping and behavioral/emotional problems.
The findings indicated that ALL survivors performed more poorly than healthy controls on several domains of executive function, even when differences in parent education were taken into account. The results of this study also provide preliminary evidence that some survivors of childhood ALL are susceptible to impaired executive function and therefore experience difficulties in coping effectively with stress, leading to emotional and behavior problems. The findings of this study support the hypothesis that the ability to employ adaptive coping skills is dependent on intact executive functioning, including the domains of working memory, cognitive flexibility, self-monitoring, and behavioral inhibition. When the ability to perform these higher-level cognitive tasks is impaired, children and adolescents appear to rely more heavily on maladaptive patterns of coping, such as denial and avoidance, and less on strategies considered more adaptive, such as problem-solving, acceptance, and cognitive restructuring. Clinical implications and directions for future research are discussed.