Chemobrain in children and teens

Chemotherapy and radiation therapy can cause problems with cognitive (mental) functions, such as concentration, memory and the ability to multitask. Most children who receive chemotherapy experience these effects, sometimes referred to as “chemobrain” or brain fog, to some degree, although doctors are unable to predict who might be affected.

The cognitive effects of chemotherapy for some are long-lasting. A small percentage of people have long-term effects known as "chemotherapy-induced cognitive impairment." The symptoms include a mental fogginess and effects on:

• Memory
• Word retrieval
• Concentration
• Processing numbers
• Following instructions
• Multitasking
• Setting priorities

Effects of childhood cancer on learning

Learning difficulties can begin either during treatment or may become evident months or even years after treatment. Mathematics, spatial relationships, problem solving, attention span, reading and spelling, processing of information, planning and organizing, and concentration skills are all areas of learning that may be affected. Problems with fine motor coordination, which might cause poor handwriting, can also develop.

Children with blood cancer may receive therapy that affects the central nervous system (CNS). The CNS includes the brain and spinal cord. Therapies that affect the CNS increase the risk for cognitive effects, including educational issues. Examples of these therapies include:

• Methotrexate or cytarabine, if given in high doses intravenously (IV) or injected into the spinal fluid (intrathecal [IT])
• Total body irradiation (TBI), prior to a stem cell transplantation

Receiving cancer treatment at a younger age also increases risk. Significant cognitive effects are more often associated with treatment plans that include radiation to the brain or brain surgery, neither of which are routinely used to treat childhood blood cancer.

Talk to your child’s healthcare team about any educational or learning issues that cause concern. A pediatric psychologist can perform neuropsychological testing to evaluate your child for any signs of these potential late effects.

Learn more about long-term or late effects of cancer treatment in children and teens.

Managing learning problems at school

Going to school is a big part of feeling normal for children and adolescents, but going back to school after cancer treatment can also bring new challenges for your family. It is important to identify the areas of learning where your child may struggle. Then you can work together with the healthcare team, teachers and school staff to provide support and resources to help your child be successful in school.

Neuropsychological testing: Children who are at risk for cognitive effects or who are having difficulty in school should have neuropsychological testing done by a licensed pediatric neuropsychologist (an expert in the way the brain works ) to check for possible learning challenges. Discuss the need for neuropsychological testing with your child’s healthcare team, who can refer you to a pediatric neuropsychologist.

School psychological assessment: Neuropsychological testing is often not covered by insurance and can be expensive. A school-based assessment may also be an option (or may be a requirement of the school) to help determine your child’s educational needs. These assessments are usually performed to determine if your child is eligible for special education programs. Generally, school-based assessments are less effective than neuropsychological testing at linking cancer treatment with learning or behavior problems. Ask your child’s school administrators for more information.

Meeting your child’s educational needs: With the help of the healthcare team, inform teachers and school staff about your child's educational needs before he or she returns to school. Work together with the healthcare team, teachers and school staff to develop a program tailored to your child's specific needs. The program may include:

• Special accommodations—accommodations can be made to meet a child's educational needs, such as allowing for additional time to complete class work or take exams. Children may qualify for special help under federal laws.
• Long-term planning—plans can be developed to help a child through school transitions from middle school to high school and into adult life.
• Cognitive behavioral therapy—certain cognitive therapies can help children develop strategies to address learning problems. For example, one strategy may be breaking down complex problems into smaller tasks.

All childhood cancer survivors may be at risk for behavioral, emotional or social problems regardless of cognitive effects. If you notice changes in your child’s behavior, speak to your child’s healthcare team and ask for a referral to a mental health professional.

Managing learning problems at home

The following are some things you can do at home to help your child manage cognitive side effects: 

• Get organized by making sure everything has a place in your home and get rid of clutter.
• Stick to a schedule. Children need structure to feel a sense of control. Be patient with your child and allow extra time to accomplish tasks.
  Minimize distractions when your child is working on homework. For example, put away phones and electronics.
• Encourage your child to exercise his or her brain by reading, playing educational or memory games, or by doing something creative such as drawing or playing music.
• Encourage your child to be physically active. Ask the healthcare team for an exercise program.
• Provide foods that promote healthy brain function, such as fish, dark leafy greens, fresh fruits and vegetables and whole grains.
• Maintain a regular sleep schedule so your child can get the recommended amount of sleep for their age.
• Teach your child to avoid alcohol, smoking or “vaping,” and other drugs, which can alter his or her mental state.

Questions to ask your child's healthcare team

• What are the possible cognitive effects of my child’s treatment(s)?
• When are cognitive effects likely to happen?
• Are there any changes, signs or symptoms I should tell my child’s pediatrician about right away?
• What can I do to ease the symptoms of my child’s cognitive effects?
• Will my child have difficulties in school because of the cognitive effects?
• Can my child be referred for neuropsychological testing?
• Will insurance cover the cost of testing by a neuropsycologist? If so, under what conditions?
• When would it be appropriate for my child to be re-tested for cognitive effects?
• What accommodations at school do you recommend for my child?