Electronic Theses and Dissertations

Date of Award


Document Type


Degree Name

Ph.D. in Psychology



First Advisor

Karen A. Christoff

Second Advisor

Stephanie E. Miller

Third Advisor

Carey Dowling

Relational Format



Children treated with CNS-directed therapy for brain tumor (BT) are at significant risk for developing late effects secondary to both disease and treatment. Executive functions (EF) encompass those skills necessary for appropriate problem solving and other goal-directed behaviors. Although no homogenous neuropsychological profile exists in patients with brain tumors, the most affected cognitive domains include EF and related processes, with the magnitude of effect increasing over time. Deficits in EF have been implicated in the etiology of internalizing, externalizing, and social disorders suggesting that EF is a foundational cognitive process. With a growing population of pediatric BT survivors at risk for EF deficits, it is important to consider the relationship between EF and psychosocial outcomes. The aim of the current study was to determine the relationship between EF and psychosocial outcomes over time among pediatric BT survivors. This study examined divergent trajectories of psychosocial outcomes and the association of change in executive function with these trajectories. Survivors of pediatric embryonal tumors (n = 166) treated on an international, multi-site protocol for newly diagnosed brain tumors were included in the current study. Participants were approximately 9 years at enrollment (SD = 3.10), mostly male (61.45%), Caucasian (75.90%), and treated for average risk disease (75.30%). Multiple tumor types were represented; however, most were diagnosed with medulloblastoma (83.73%). Participants and their families completed measures of psychosocial and executive functioning at baseline and yearly thereafter for five years. Growth mixture modeling revealed the presence of three latent class trajectories for Internalizing, Externalizing, and Total Problems. Two latent class trajectories were observed for Social Competence. Most did not report clinically significant concerns related to psychosocial functioning; however, a small subset did. Impairment persisted across 5-year follow-up. Working memory, attention, behavior regulation, and metacognition abilities declined over time. Binary and multinomial logistic regression demonstrated that change in EF over time is predictive of psychosocial trajectory. Findings suggest that a subset of pediatric BT survivors experience psychosocial difficulties secondary to disease and treatment that persist without intervention. EF appears to be foundationally related to psychosocial difficulties and may be an appropriate target of intervention.


Emphasis: Clinical Psychology



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