title: Predictive factors of internalized and externalized behavioral problems in children treated for acute lymphoblastic leukemia.
abstract: BACKGROUND
  Pediatric cancer survivors are at increased risk of various neurological and psychological problems. The prevalence of behavioral problems was assessed in a longitudinal study in pediatric patients with an acute lymphoblastic leukemia (ALL). Multilevel modeling was used to identify associated predictive factors.
  
  
  METHODS
  ALL patients and their parents (n = 138) took part to this study. Patients were treated according to the Dana-Farber Cancer Institute (DFCI) consortium protocols 91-01 or 95-01. Mothers filled out questionnaires providing a measure of behavioral problems for their child at diagnosis and during the subsequent 4 years, and of their perceived familial stress at diagnosis and post-induction.
  
  
  RESULTS
  Prevalence of internalized behavioral problems at diagnosis was increased [42% above 1 standard deviation (SD); P < 0.001], but it normalized over time. Internalized problems resolved more slowly in the presence of medical variables associated with increased stress related to the disease (hospitalization duration, P < 0.001; relapse risk at diagnosis, P < 0.001). Externalized behavioral problems were within the expected normal range, but more sustained over time with the 95-01 than with the 91-01 treatment protocols (P < 0.05), likely due to the type of corticosteroid (CS) used (dexamethasone vs. prednisone).
  
  
  CONCLUSIONS
  Assessment of both internalized and externalized problems is required in this population. The impact of pharmacological variables on externalized behavioral problems is likely related to CS use.
authors.affiliation: Department of Psychiatry, Sainte-Justine Hospital Research Center, Montréal University, Montréal, Québec, Canada.
authors.forename: Sophie
authors.initials: S
authors.lastname: Marcoux
authors.forename: Philippe
authors.initials: P
authors.lastname: Robaey
authors.forename: Maja
authors.initials: M
authors.lastname: Krajinovic
authors.forename: Albert
authors.initials: A
authors.lastname: Moghrabi
authors.forename: Caroline
authors.initials: C
authors.lastname: Laverdière
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects; D002648:Child; D002653:Child Behavior Disorders / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D009035:Mothers / Q000523:psychology; D009483:Neuropsychological Tests; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000188:drug therapy / Q000523:psychology*; D015995:Prevalence; D012307:Risk Factors; D013315:Stress, Psychological / Q000150:complications