A Systematic Review and Meta-Analysis of Executive Function Outcomes in Pediatric Central Nervous System Tumor Survivors

Abstract

Background: This review aimed to determine whether executive dysfunction is a characteristic of survivors of central nervous system tumors in children and adolescents, including Astrocytoma, Neurofibromatosis-1, Medulloblastoma, and Pilocytic Astrocytoma.

Methods: A review and meta-analysis of executive function assessed with Behavior Rating Inventory of Executive Function (BRIEF) in individuals with these tumor types.

Results: The main findings of the meta-analyses can be summarized as follows: (i) Neurofibromatosis type 1 (NF1) – BRIEF (parents): Children with NF1 show significant deficits in executive functions according to the parent-rated BRIEF, with an overall model effect size of d = 0.81 (p < 0.001). The most affected areas are working memory, monitoring, and metacognition, indicating that these deficits are consistent and clinically relevant. (ii) NF1 – BRIEF-P (parents and teachers): In this meta-analysis, the overall model effect size was d = 0.37 (p < 0.001), showing moderate but significant difficulties in executive functions. Both parents and teachers report problems in working memory and emerging metacognition, reflecting a consistent pattern across different observational contexts. (iii) Medulloblastoma vs. other tumors: Patients with medulloblastoma exhibit marked deficits in executive functions compared to other brain tumors, with an overall model effect size of d = –0.74 (p < 0.001). The most affected areas include inhibition, initiation, regulation, and metacognition, with consistent findings across the included studies.

 Conclusions: Executive deficits are observed in individuals with brain tumors or survivors, significantly affecting their academic, social, and emotional lives. Early identification, along with educational and neuropsychological support, is essential to preventing these deficits from interfering with academic, personal, and professional functioning.