Oxidative Stress, Motor Abilities, and Behavioral Adjustment in Children Treated for Acute Lymphoblastic Leukemia

PURPOSE/OBJECTIVES: To examine associations among oxidative stress, fine and visual-motor abilities, and behavioral adjustment in children receiving chemotherapy for acute lymphoblastic leukemia (ALL) . DESIGN: A prospective, repeated-measures design . SETTING: Two pediatric oncology settings in the southwestern United States. SAMPLE: 89 children with ALL were followed from diagnosis to the end of chemotherapy. METHODS: Serial cerebrospinal fluid samples were collected during scheduled lumbar punctures and analyzed for oxidative stress biomarkers. Children completed fine motor dexterity, visual processing speed, and visual-motor integration measures at three time points. Parents completed child behavior ratings at the same times. MAIN RESEARCH VARIABLES: Oxidative stress, fine motor dexterity, visual processing, visual-motor integration, and behavioral adjustment . FINDINGS: Children with ALL had below-average fine motor dexterity, visual processing speed, and visual-motor integration following the induction phase of ALL therapy. By end of therapy, visual processing speed normalized, and fine motor dexterity and visual-motor integration remained below average. Oxidative stress measures correlated with fine motor dexterity and visual-motor integration. Decreased motor functioning was associated with increased hyperactivity and anxiety . CONCLUSIONS: Oxidative stress occurs following chemo-therapy for childhood ALL and is related to impaired fine motor skills and visual symptoms . IMPLICATIONS FOR NURSING: Early intervention should be considered to prevent fine motor and visual-spatial deficits, as well as behavioral problems.