Poster #58 - Indirect Effects of Sluggish Cognitive Tempo on Control-Based Coping Among Pediatric Brain Tumor Survivors

• In Event: Poster Session 17

Abstract

Background: Pediatric brain tumor survivors (PBTS) are at risk for neurodevelopmental late-effects due to the impacts of disease and toxic treatment on their developing brain. Emerging research suggests PBTS demonstrate sluggish cognitive tempo (SCT), a distinct pattern of cognitive and behavioral lethargy (Willard et al., 2013), in addition to neurocognitive deficits, such as executive-functioning and working-memory challenges (Stavinoha et al., 2018). Due to its cardinal characteristics (i.e., daydreaming, mental confusion, and lethargy), SCT may reflect difficulties sustaining behavioral engagement. Engagement is central to a leading control-based model of coping (Compas et al., 2001) that identifies voluntary and involuntary stress responses in explaining adjustment difficulties in children with cancer (Miller et al., 2009). Research has not examined whether SCT symptoms in PBTS are linked to how they respond to stressors. Thus, we examined whether differences in SCT symptoms between PBTS and healthy comparison classmates (CC) accounted for less engagement and more disengagement in both coping and involuntary responses to peer relationship stressors.
Methods: PBTS (n=70; Mage=12.40(2.43), 58.60% male, 97.14% White/non-Hispanic) and CC matched for age, sex, and race (n=67; Mage=12.30(2.31), 56.72% male, 97.01% White/non-Hispanic) participated along with a primary caregiver (n=137, Mage=40.44(6.42), 92.70% female). Children completed the Responses to Stress Questionnaire-Social Stress version (RSQ), scored for empirically derived subscales of active coping and involuntary responses. Voluntary (i.e., coping) responses included Primary-Control Coping (e.g., problem-solving), Secondary-Control Coping (e.g., cognitive restructuring), and Disengagement Coping (e.g., wishful thinking). Involuntary responses included Involuntary Engagement (e.g., rumination), and Involuntary Disengagement (e.g., inaction). Caregivers completed a proxy-reported RSQ and the Child Behavior Checklist (CBCL; Achenbach, 2001) to assess SCT. Indirect effects (Table 1) were tested using least ordinary squares regression (PROCESS; Hayes, 2013) and post-hoc bootstrapping (10,000 replications), while controlling for age and sex. Indirect effects were significant if the 95% confidence interval (CI) did not include zero.
Results: Models (See Table 1) indicated that compared to CC, PBTS had significantly higher levels of parent-reported SCT, which in turn, was related to fewer parent-reported primary control coping behaviors (CI: -.008, -.001) and fewer child (CI: -.009, -.0004) and parent-reported (CI: -.011, -.001) secondary control coping behaviors. Elevated levels of SCT in PBTS partially explained more parent-reported involuntary disengagement (CI: .001, .008) and more parent-reported involuntary engagement (CI: .001, .009) responses for PBTS.
Conclusion: Consistent with hypotheses, PBTS demonstrated greater levels of SCT, which were associated with responses to stress characterized by less voluntary engagement coping (i.e., primary and secondary control) and more involuntary responses. This pattern was more evident for proxy-reported stress responses than child self-reported. Less primary and secondary coping has been consistently linked with poorer psychosocial adjustment for childhood cancer survivors (Miller et al., 2009). Thus, future work should consider examining how SCT and coping may contribute to adjustment for PBTS and in longitudinal samples to establish directionality. Findings suggest that clinical psychosocial interventions may require modifications, such as increased parental and school support to encourage behavioral engagement and subsequent adaptive coping for PBTS with SCT.

Authors

• Eva L. Darow, Nationwide Children's Hospital
  Presenting Author

• Emily L Moscato, Nationwide Children's Hospital

• Dana Garcia, Nationwide Children's Hospital

• Amber Tayson Riggs, Nationwide Children's Hospital

• Cynthia A. Gerhardt, The Research Institute at Nationwide Children's Hospital

• Christina G. Salley

• Kathryn Vannatta, Ohio State University & The Research Institute at Nationwide Children’s Hospital