COGNITIVE DEFICITS IN CHILDREN TREATED FOR LEUKEMIA
COGNITIVE DEFICITS IN CHILDREN TREATED FOR LEUKEMIA
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DOI：
10.1136/adc.66.1.164
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发表时间：
1991-01-01
影响因子：
5.2
通讯作者：
EISER, C
中科院分区：
文献类型：
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作者：
EISER, C
与患有其他慢性病的儿童一样，白血病患者也受到许多限制和不利条件;学校生活不可避免地中断，许多儿童在确诊后立即缺课几个月。“2所有儿童在治疗过程中都会经常缺席，要么是因为轻微感染，要么是因为其他儿童中爆发了麻疹或水痘等传染病。这种中断可能对他们的学术成就和社会关系产生不利影响。持续的缺课意味着孩子们错过了重要的课程，并在书面作业中持续落后。朋友圈可能会重新组合，把生病的孩子排除在外，他们也可能回到学校，在外表和性格上都改变了。孤立感会减少儿童对学校的归属感和对活动的参与。其他因素也不利于教室里的慢性病儿童。教师对疾病的影响知之甚少，可能对必须教育这些儿童感到沉默。许多人不了解医疗并发症的性质，担心一旦出现医疗紧急情况，他们将无法处理。关于教师在多大程度上降低了对慢性病儿童应该参加所有学校活动或学业表现的期望，也有很多文章。这些困境在哮喘3和糖尿病儿童的教师中尤其明显，4在教师中也是如此。5老师们也倾向于认为癌症儿童比健康的同龄人更不善于交际，更孤立和孤僻。6父母也可能会告诉患病的孩子，在诊断出慢性病后，上学和学习成绩就不那么重要了。许多家长报告说，这样的诊断迫使他们把他们的各种想法的角度来看，并承认少物质和竞争的理想的重要性。7.患有慢性病的儿童通常在活动方面受到一些限制，特别是在行动或参加体育活动方面。鉴于这些限制和不利条件，患有慢性病的儿童通常在智力成就8 910以及行为和社会功能方面表现出缺陷，这并不奇怪。1.某些“风险”因素，特别是社会不利条件或其他医疗并发症的发生，以及疾病本身的特点（如与明显缺陷或降低儿童活动能力有关的程度），似乎加剧了不良心理影响的可能性。对于白血病患者，其治疗方案存在额外的“风险因素”。放疗和化疗都被认为是损害发育中的中枢神经系统的潜在来源。在采用这一治疗方案后的一段时间，家长开始报告其子女在学校遇到困难。典型的，表现不佳，特别是在数学，解决问题，注意力和集中技能方面。
In common with children who have other chronic diseases, those with leukaemiaexperi-ence a great many restrictions and disadvantages; school life is inevitably interrupted, and many children miss several months schooling immediately after diagnosis.'2 All children are regularly absent during the course of their treat-ment either for routine hospital appointments, because of minor infections, or because of outbreaks of contagious diseases-such as measles or chickenpox-among the other children. Such interruptions can have adverse conse-quences both for their academic achievements and for social relationships. Continued absences mean that the children miss essential lessons, and are continuously behind in written work. Circles of friends may regroup and exclude ill children, whomay also returnto school changed people, both in appearance andin character. A feeling of isolation can reduce the children's sense of belonging to the school and their participation in activities. Other factors, too, work against chronically sick children in the classroom. Teachers are poorly informed about the implications of disease and may feel reticent about having to teach such children. Many fail to understand the nature of medical complications, and worry that they will be unable to deal with medical emergencies should they arise. A great deal has also been written about the extent to which teachers have reduced expectations about how far chronically sick children should participate in all school activities, or perform academically. These dilemmas have been noted particularly among teachers of children with asthma3 and diabetes, 4 as well as among teachers generally. 5 Teachers also tend to rate children with cancers as lesssociable and more isolated and with-drawn than their healthy peers. 6 Parents, too, may communicate to sick child-ren that school attendance and academic achievement are less important after the diagno-sis of a chronic condition. Many parents report that such diagnoses forcethem to put their various ideas into perspective, and acknowledge the importance of less materialistic and competitive ideals. 7 Children with chronic diseases typically experience some restrictions of activities, especially in terms of mobility or participation in sports activities. This applies no less to those with leukaemia.Given these restrictions and disadvantages, it should not be surprising that children with chronic diseases commonly show deficits in intellectual achievements, 8 910 and in behavioural and social functioning. 1" Certain'risk'factors-especially social disadvantage or the occurrence of other medical complications, as well as the characteristics of the disease itself (such as the extent to which it is associated with visible deficits or reduces the child's mobility)-seem to aggravate the possibility of adverse psychological repercussions.'2 13 For those with leukaemia there is the additional'risk factor'of their treatment regimens. Both radiotherapy and chemotherapy have been implicated as potential sources of damage to the developing central nervous system. Sometime after the introduction of this treatment protocol parents began to report difficulties for their children at school.'4 Typically, poor performance was noted especially in mathematics, problem solving, attention, and concentration skills.