ABSTRACT

Children with a chronic disease are more likely to do poorly at school, have lower IQ scores, and have more difficulties learning than healthy children. For example, this has been shown for children with diabetes (Ryan, 1990) and epilepsy (Hiemenz, Hynd, & Jimenez, 1999). Children who are younger when they were diagnosed are also at greater risk of subsequent learning difficulties compared with those who are older on diagnosis. Although the situation may be more complex than it first seems, the broad conclusions of this chapter support these general findings for children treated for leukemia. Many children do have learning difficulties in school, and the likelihood of this happening is greater for children who are less than 5 years of age on diagnosis. In this chapter, a number of reasons why children may experience learning difficulties are identified and then currently available empirical work reviewed. Although the first studies suggested that CNS irradiation was the most likely explanation for learning difficulties, later work has challenged this view. Over time there has also been a change in the kind of tests used to assess children’s learning. For a number of reasons, IQ tests are no longer considered entirely appropriate, and need to be supplemented by tests of specific functioning, such as memory, attention, or concentration. Changes in treatment protocols over time, use of different tests in different studies, and difficulties establishing the contribution of treatment over more general social and family variables, has limited the theoretical and clinical rele-

vance of this work. However, in drawing the work together, consideration is given to the implications for remedial help and interventions for the children.