Early interventions may improve long-term academic achievement in young childhood brain tumor survivors

"Even in very young children, we found academic readiness was starting to lag behind healthy children their age," said corresponding author Heather Conklin, PhD, St. Jude Department of Psychology and Biobehavioral Sciences member and Section of Neuropsychology chief. "They were gradually falling behind their same-age peers in academic fundamentals, such as learning their letters, numbers and colors."

Previous research has focused on school-aged children, but this is one of the first studies to examine academic readiness after brain tumor treatment in infants and young children (less than 3 years old). The scientists uncovered the gap in readiness skills by following a group of 70 patients who had been treated for brain tumors over time. Six months after diagnosis and annually for five years, "we found an increasing gap between these young patients treated for brain tumors and their typically developing peers because their academic readiness skills were not developing as fast," Conklin said.

Even though the scientists observed gaps between the children's abilities as they aged, it was present early and had predictive power. "Early academic readiness was predictive of long-term reading and math outcomes," Conklin said. "The effect isn't temporary. These children don't just catch up naturally."

Intervening early may protect academic readiness and achievement

While presenting a challenge, the findings also offer a strategy to address this problem: early intervention. Since the difference in academic readiness arises early after treatment, intervening then, as opposed to in elementary school (when most conventional interventions begin), may improve outcomes.

"We now know that we don't need to wait until patients are struggling with math and reading; we can intervene earlier," Conklin said. "We showed that the variability we're seeing early on predicts longer-term academic skills, which highly suggests earlier interventions will be beneficial and make a real difference."

Early interventions need to be informed by what increases vulnerability to or protects against the academic readiness gap to succeed. The researchers looked at the factors involved, such as treatment type and demographics, and found only one characteristic mattered.

Socioeconomic status protects and suggests early interventions may work

"The only clinical or demographic factor we found that predicted academic readiness was socioeconomic status," Conklin said. "Being from a family of higher socioeconomic status had a protective effect on children's academic readiness."

The finding that higher socioeconomic status is partially protective suggests that investing in resources to replace lost early enrichment experiences can mitigate the readiness gap. By increasing access to those replacement opportunities, more children could be protected.

"We know that being away from their home environment, caregivers, daycare, play dates, parks and early intervention services during these critical developmental years is probably having a negative impact on very young patients," Conklin said. "Our results suggest that families can make play meaningful, and by making little changes in how they interact with their child, with the support of their medical team and receiving appropriate resources, they may be able to make a difference in their child's cognitive and academic outcomes."

Authors and funding

The study's first author is Melanie Somekh, formerly of St. Jude. The study's other authors are Michelle Swain, Queensland Children's Hospital; Lana Harder, Children's Medical Center Dallas; Bonnie Carlson-Green, Children's Minnesota; Joanna Wallace, Lucile Packard Children's Hospital Stanford; Ryan Kaner, Rady Children's Hospital San Diego; Jeanelle S Ali, The Children's Hospital of Eastern Ontario and Jason Ashford, Jennifer Harman, Catherine Billups, Arzu Onar-Thomas, Thomas Merchant and Amar Gajjar, all of St. Jude.

The study was supported by grants from the National Cancer Institute (St. Jude Cancer Center Support [CORE] Grant (P30 CA21765)) and ALSAC, the fundraising and awareness organization of St. Jude.