Development delays and temperament in children with leukemia after the first year of therapy

Background: Children with leukemia are often hospitalized for long periods because of their immunosuppressed status and because of the therapies; this might place them at further risk for psychosocial developmental delays. The cognitive impairments related to antitumoral drugs and to the blood stem cell transplantation, the general psycho-social difficulties in schooling tasks and in social relationships impact upon their development. This chapter has two aims: one is to show the adaptation of the children with leukemia during the first year of therapies; the other is to identify the possible developmental deficits in adaptive behaviors in children with leukemia post 1 year from diagnosis and the possible associations with the fixed factor children’s temperament, showing also some clinical intervention guidelines. Method: Seventy-three leukemic children and their families recruited at the Haematology-Oncologic Clinic of the Department of Child and Woman Health, University of Padua, participated in the study. Children’s mean age was 5.78 years (SD = 2.45, range = 1 year-11 years), 39 males and 34 females. Mostly children had Acute Lymphoblastic Leukemia (ALL) (N =65), while 8 had Acute Myeloid Leukemia (AML). All parents were Caucasian with a mean age of 36.85 years (SD = 6.29) and a mean of 11.72 years of schooling (SD=3.69). The parents who participated were mostly mothers (N = 61) and only a few were fathers (N = 12) because the mothers were more proximal to the child during hospitalization. while fathers stayed with other siblings. or continued to work to maintain the family. The families were contacted by a clinical psychologist during the first hospitalization of the children. Project aims were explained and informed consent was asked for. The VABS (Sparrow et al., 1984; Italian edition by Balboni & Pedrabissi, 2003) and QUIT-Questionari Italiani del Temperamento (Axia et al., 2002) were administered post 1 year from the diagnosis. Results: The results showed child’s developmental delays of almost three months at one year post treatment for leukemia in all the domains measured by the Vineland Scales: the domain mostly affected is Socialization,, followed by Motor and Daily Living Skills. Children with AML, with more days of hospitalization and with higher negative emotionality were more at risk for developmental delays in their motor abilities. Discussion: These findings can guide specific interventions for parents and for children to fill the potential developmental delay due to therapies and hospitalization. Children with AML and with more days of hospitalization are more at risk for motor delays. At this purpose specific physiotherapy and psycho-motor programmes can be implemented during hospitalization. Also socialization and educational programmes can be proposed both during hospitalization and in occasion of day-hospital follow-ups. Social plays and educative guidelines can be taught to parents to stimulate their child also at home.