Abstract
BACKGROUND: Surveillance of neurocognitive late effects has typically focused on the pediatric survivor alone and rarely has focused on the potential family burden. We investigated the impact of child neurocognitive effects on parenting stress and hypothesized that parents of childhood cancer survivors with greater executive difficulties experience higher stress relative to parents of children with less adverse impact. METHODS: Parents of 44 children who survived cancer involving central nervous system-directed treatments and who had documented neurocognitive deficits completed standardized questionnaires assessing their perceived level of stress and perception of their child's executive functioning abilities in daily life. Data from performance-based cognitive tests were obtained on the children. Multiple regression models examined socio-demographic, clinical, and child's executive functioning as predictors of parent stress. Differences in parenting stress based on child's level of executive functioning were evaluated. RESULTS: Parent stress was significantly associated with both performance-based and parent report measures of child executive functioning. Child executive functioning significantly predicted parent stress even after controlling for socio-demographic and clinical factors, and the final model accounted for 42% of the variance in parent stress levels. Significant differences in parent stress were found when comparing higher versus lower levels of child executive functioning. The nature of the executive difficulties, however, appears important, as we found increased parenting stress among children with behavioral regulation problems rather than metacognitive difficulties. CONCLUSIONS: The associations between parenting stress and neurocognitive problems found in this study suggest the need for further research, along with professional monitoring and appropriate intervention.