| Bone marrow transplantation (BMT) is an effective treatment for many pediatric acquired and genetic conditions. It is an arduous process that poses challenges and manifests stress reactions in patients and their families. Patients are hospitalized and often treated with chemotherapy and radiation, and remain in isolation for weeks to months. Research has been conducted on the psychosocial, quality of life, and neuropsychological effects of BMT on patients and their families. Fewer studies have been conducted on the adaptive behavior changes that take place over time in pediatric BMT patients. This study examines the adaptive behavior and neuropsychological changes that take place in pediatric patients following BMT, using the Vineland Adaptive Behavior Scales and age-appropriate cognitive tests. These changes are considered within the framework of developmental theories and Bronfenbrenner's Social Ecological Theory. Results show a general worsening of adaptive behavior and cognitive functioning from pre- to 1- and 3-years post-BMT, with significant worsening of global intellectual functioning, nonverbal intellectual functioning, and clinically meaningful declines in verbal intellectual abilities, memory, and motor skills. At 3-year follow-up, plateau or improvement was found in socialization, global intellectual functioning, and math computational skills. Compared to normative means, participant means were generally lower, but still in the average range, at pre-BMT, with differences emerging at 1- and 3-years post-BMT in overall adaptive behavior, daily living, motor and visual-motor skills, and academic achievement. Pre-BMT ability, gender, graft-versus-host disease status, paternal education level, and participant survival were associated with longitudinal change in adaptive behavior and cognitive functioning. |
