Intrathecal and intravenous methotrexate and/or radiation to the brain can sometimes cause damage to the central nervous system. Some children develop learning disabilities which can start immediately or several years after treatment. Typically, poor performance is noted in mathematics, spatial relationships, problem solving, attention span, and concentration skills.
My daughter is a year off treatment and three years past radiation and seems to have no cognitive problems at all. She is doing well in kindergarten. She reads and writes, and has taught herself to add and subtract all of the combinations up to twenty. I was worried while she was on chemotherapy that her comprehension was slow. She continually asked me to reread portions of books and didn't seem to understand without constant repetition. But that faded away after the chemotherapy ended, and now she's quick to understand stories read aloud. She does, however, have significant social problems which may be related to the radiation.
My son turned 3 years old while receiving his cranial radiation. He is now 5 years old and has major cognitive problems. He can't count, and so far he hasn't been able to learn the alphabet. He is in a preschool for the developmentally disabled, and the teacher feels that he has just hit a brick wall. I gave her the Candlelighters book, "Educating the Child with Cancer," and several articles. She is trying different techniques with him. He is a super kid, though, with a great attitude, and we hope for the best.
Rachel received 1,800 rads of cranial radiation when she was 17 months old. She's 6 now, in kindergarten. She has multiple cognitive problems, including problems with letter and number recognition and short-term memory. She is a child who will need extra help in school, including phonics and drilling while learning to read. It is challenging for her to sit quietly in class and listen to the teacher. After much observation, I truly think that these kids have a quirky organizational system for their brain. They seem to have a different way of inputting and outputting information. She will frequently say something completely out of the blue during a conversation that is totally unrelated to what is being discussed. My husband and I both realize that school may be a struggle for her, but we intend to get her all of the help available to persons who are traumatically brain injured. Her self-esteem is high, she is a very bright, verbal child, and we will work with each of her teachers to ensure that she gets the best education possible.
It is important to remember that doctors cannot predict which children will develop cognitive problems. Children at greatest risk for cognitive problems are those treated when less than 5 years of age, with those under 2 at the highest risk. Chapter 15, School, discusses in detail the types of educational problems some children face and how to deal with them.
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Although nobody gets a parenting manual or bible in the delivery room, it is our duty as parents to try to make our kids as well rounded, happy and confident as possible. It is a lot easier to bring up great kids than it is to try and fix problems caused by bad parenting, when our kids have become adults. Our children are all individuals - they are not our property but people in their own right.