Abstract：
Objective: Survivors of pediatric brain tumors are at increased risk of executive function (EF) and adaptive behavior difficulties. While previous research suggests that executive dysfunction impacts suboptimal adaptive outcomes, the specific elements of EF influencing this relationship remain unexplored. This study examines the relationship between cognitive flexibility and adaptive behavior in survivors compared to healthy controls. Methods: 86 survivors (Mage(SD)=23.41(4.24), 44 females) and 86 controls (Mage(SD)=23.09(4.50), 44 females) completed the Delis-Kaplan Executive Function System Trail Making Test (TMT) and Verbal Fluency Test (VFT). The Letter-Number Sequencing (LNS) and Category Switching (CS) conditions were isolated as measures of cognitive flexibility. Informants provided responses to obtain adaptive behavior ratings using the Scales of Independent Behavior-Revised (SIB-R). Linear regressions explored relationships between cognitive flexibility and SIB-R scores in survivors compared to controls. Results: For both TMT and VFT, the relationship between cognitive flexibility and adaptive behavior was significantly different between survivors and controls for SIB-R scores in Social Communication, Community Living, and Personal Living Skills (p<.0125). Survivors\' better LNS performance predicted greater SIB-R scores across the same 3 domains (all p= <.001, r2semipartial=.08). Similarly, survivors\' better CS performance predicted greater SIB-R scores across the same 3 domains (p = 0.002 to .02, r2semipartial =.03 to .04). No significant relationships were found in controls (all p >.05). After adjusting for working memory and inhibitory control, most relationships remained significant in survivors (p= <.001 to .046, r2semipartial=.02 to .08). Conclusion: These findings reveal a robust, positive relationship between cognitive flexibility performance and adaptive behaviors specific to survivors.
摘要：
目的：小儿脑肿瘤幸存者的执行功能（EF）和适应性行为困难的风险增加。虽然先前的研究表明执行功能障碍会影响次优的适应性结果，EF影响这种关系的具体因素仍未被探索。这项研究考察了与健康对照组相比，幸存者的认知灵活性与适应性行为之间的关系。方法：86名幸存者（Mage（SD）=23.41（4.24），44名女性）和86名对照（法师（SD）=23.09（4.50），44名女性）完成了Delis-Kaplan执行功能系统跟踪测试（TMT）和言语流利度测试（VFT）。字母数字排序（LNS）和类别转换（CS）条件被隔离为认知灵活性的量度。告密者使用独立行为量表（SIB-R）提供了响应以获得自适应行为评级。线性回归分析了与对照组相比，幸存者的认知灵活性与SIB-R得分之间的关系。结果：对于TMT和VFT，认知灵活性和适应行为之间的关系显着不同的幸存者和对照组的SIB-R得分在社会交往，社区生活,和个人生活技能（p<.0125）。幸存者表现更好的LNS预测相同3个领域的SIB-R得分更高(所有p=<.001，r2半部分=.08)。同样，幸存者更好的CS表现预测相同3个领域的SIB-R得分更高(p=0.002至.02，r2半部分=.03至.04)。在对照中没有发现显著的关系(所有p>.05)。调整工作记忆和抑制控制后，在幸存者中，大多数关系仍然显着（p=<.001至.046，r2半部分=.02至.08）。结论：这些发现揭示了一个强有力的，认知灵活性表现与幸存者特有的适应性行为之间存在正相关关系。
