The assessment of executive functioning in pediatric patients with posterior fossa tumors: A recommendation to combine caregiver-based ratings and performance-based tests.

Objective: This study addresses the issue of drawing valid conclusions about the assessment of executive functioning (EF) in long-term survivors of pediatric posterior fossa tumors (PPFT).

Method: All 44 patients (females = 18, mean age = 11 years) were treated consecutively at our department for PPFTs (medulloblastomas, ependymomas, low-grade-gliomas). Four years after diagnosis, their EF was investigated, considering age at diagnosis and treatment type. The validity, sensitivity, and specificity of different EF measures (TMT-B, Number Repetition, WCST, BRIEF) were compared and Strengths-and-Difficulties-Questionnaire was incorporated as a potential screening for EF issues.

Results: EF impairments were found, especially in patients with chemo-/radiotherapy. Caregiver-ratings and performance-based-EF-tests identified different patients as below average. Sensitivity was highest in TMT-B. Strengths-and-Difficulties-Questionnaire was not an adequate screening for EF.

Conclusion: It is essential to assess patients with PPFT with performance-based-tests as well as caregiver-questionnaires, since EF impairments are not always visible at the behavioral level but may still influence everyday life.