Measures
Social Adjustment. Social adjustment was measured using the
Withdrawal subscale of the Behavioral Assessment System for
Children, Third Edition, Parent Rating Scales
(BASC-3).29 The BASC-3 is a standardized
parent-report measure of behavioral and emotional functioning in
children and adolescents. The Withdrawal subscale is comprised of 10
items scored on a 5-point scale (1=never, 5=almost always) which are
summed to provide a total subscale score. Higher scores reflect higher
social withdrawal. The BASC-3 has evidence of validity for use with
pediatric cancer survivors and is a reliable measure to detect
differences between survivors and healthy controls.30BASC-3 scores are standardised for age. During statistical analyses, we
used the standard t-scores of participants for analyses which have a
mean of 50 and a standard deviation of 10. In addition, we considered
the frequency of participants who scored above the clinical cut-off
(>60) on the BASC-3 Social Withdrawal scale as a measure of
those experiencing clinically significant social
difficulties.29 Alpha was .87 for the child scale
(participants age 8-11) and .84 for the adolescent scale (participants
age 12-18) in the current sample.Executive Functioning. Executive functioning was measured using
the total score of the Behavior Rating Inventory of Executive
Functions, Second Edition (BRIEF-2) Parent Form.31The BRIEF-2 is a 59-item parent-report measure of executive function.
Items are scored on a 5-point scale (1=never, 5=almost always) which are
summed to provide a total score. Higher scores indicate greater deficits
in executive function. BRIEF-2 scores are standardised for age. During
statistical analyses, we used the standard t- scores of
participants for analyses which have a mean of 50 and a standard
deviation of 10. Alpha was .97 in the current sample.Demographic information. Participating parents completed a
demographic questionnaire which collected the following information:
child(s) sex, age, and ethnicity, annual household income, and highest
level of parental and maternal education. Clinical information was
collected for all survivors of ALL from their medical records including:
age at diagnosis, time since diagnosis, time off treatment, and
diagnostic risk level (low, standard, intermediate).Statistical AnalysesThe sample for this analysis (N =96) was comprised of 38
survivors, 20 survivor siblings, and 38 age- and sex-matched controls.
Data were analyzed using SPSS 26 using a familywise alpha rate of .05.
Descriptive statistics were calculated for the full sample.
For aim 1, multilevel modeling was used to evaluate group differences
(survivor, survivor sibling, control) in BASC-3 Social Withdrawal. The
repeated measures formulation within SPSS Mixed Models was used to
handle potential systematic variation (i.e., dependence) within survivor
families.32 This dependence was considered ‘nuisance’
variability to be disentangled from the fixed parameters (i.e., mean
BASC-3 differences between groups), which were of substantive interest.
This method models nonindependence at the level of the family as a
covariance by allowing for error terms from each child within the same
family to be correlated. For aim 2, a main effects regression model was
tested with age at diagnosis, time off treatment, and BRIEF-2 score as
predictors of BASC-3 Social Withdrawal in survivors only. For aim 3, a
mediation model was tested with the significant group pairwise
comparisons from aim 1 as the antecedent variable, BRIEF-2 score as the
mediator, and BASC-3 Social Withdrawal as the outcome. See Fig. 1 for a
description of the tested model. For aim 4 a mediation model was tested
with the significant disease-related predictor(s) from aim 2 as the
antecedent variable(s), BRIEF-2 score as the mediator, and BASC-3 Social
Withdrawal as the outcome in survivors only. The PROCESS
macro33 for SPSS was used to test the mediation
models; the statistical significance of the indirect effect was tested
using 5,000 bootstrapped samples.