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Heaven- TX</a></li> <li class="page_item page-item-94"><a href="https://www.acco.org/education-issues/">Education Issues</a></li> <li class="page_item page-item-97"><a href="https://www.acco.org/education-scholarships/">Education Scholarships</a></li> <li class="page_item page-item-13662"><a href="https://www.acco.org/elises-isolation-story/">Elise’s Isolation Story</a></li> <li class="page_item page-item-14070"><a href="https://www.acco.org/emmas-survivor-story/">Emma’s Survivor Story</a></li> <li class="page_item page-item-13463"><a href="https://www.acco.org/emotional-communication-kit-online/">Emotional Communication Kit: Online!</a></li> <li class="page_item page-item-12771"><a href="https://www.acco.org/la-roche-posay/">Emotional Communication Kits</a></li> <li class="page_item page-item-5437"><a href="https://www.acco.org/event-registration/">Event Registration</a></li> <li class="page_item page-item-30880"><a href="https://www.acco.org/ewings-sarcoma/">Ewing’s Sarcoma</a></li> <li class="page_item page-item-34456"><a href="https://www.acco.org/family-resources/">Family Resources</a></li> <li class="page_item page-item-10889"><a href="https://www.acco.org/federal/">Federal</a></li> <li class="page_item page-item-8300 page_item_has_children"><a href="https://www.acco.org/financial/">Financial</a> <ul class='children'> <li class="page_item page-item-6218"><a href="https://www.acco.org/financial/social-security-disability/">Getting Social Security Benefits For a Child with Cancer</a></li> </ul> </li> <li class="page_item page-item-520"><a href="https://www.acco.org/for-families/">For Families</a></li> <li class="page_item page-item-191"><a href="https://www.acco.org/for-kids/">For Kids</a></li> <li class="page_item page-item-196"><a href="https://www.acco.org/for-siblings/">For Siblings</a></li> <li class="page_item page-item-194"><a href="https://www.acco.org/for-teens/">For Teens</a></li> <li class="page_item page-item-14395"><a href="https://www.acco.org/franciscos-survivor-story/">Francisco’s Survivor Story</a></li> <li class="page_item page-item-11647"><a href="https://www.acco.org/gavinfritts/">Gavin Fritts Shining Star – NC</a></li> <li class="page_item page-item-14174"><a href="https://www.acco.org/gavins-survivor-story/">Gavin’s Survivor Story</a></li> <li class="page_item page-item-1982"><a href="https://www.acco.org/genetic-changes-in-cancer-second-of-three-parts/">Genetic Changes in Cancer: Second of Three Parts</a></li> <li class="page_item page-item-1984"><a href="https://www.acco.org/genetics-and-anti-leukemia-therapy-the-tpmt-story/">Genetics and Anti-Leukemia Therapy: The TPMT Story</a></li> <li class="page_item page-item-524"><a href="https://www.acco.org/get-help-from-a-local-division/">Get Help from a Local Division</a></li> <li class="page_item page-item-414"><a href="https://www.acco.org/get-involved/">Get Involved</a></li> <li class="page_item page-item-7728"><a href="https://www.acco.org/maylea/">Giggles of Gold Project</a></li> <li class="page_item page-item-6360"><a href="https://www.acco.org/givingtuesday/">Giving Tuesday</a></li> <li class="page_item page-item-4254"><a href="https://www.acco.org/global-childhood-cancer-event/">Global Childhood Cancer Event</a></li> <li class="page_item page-item-253"><a href="https://www.acco.org/gogold/">Go Gold For Kids With Cancer®</a></li> <li class="page_item page-item-35569"><a href="https://www.acco.org/go-gold-gala/">GO GOLD® Gala</a></li> <li class="page_item page-item-34042"><a href="https://www.acco.org/go-gold-the-run/">GO GOLD® THE RUN</a></li> <li class="page_item page-item-3297"><a href="https://www.acco.org/gold-ribbon-awareness/">Gold Ribbon Awareness</a></li> <li class="page_item page-item-65"><a href="https://www.acco.org/gold-ribbon-heroes/">Gold Ribbon Heroes</a></li> <li class="page_item page-item-13817"><a href="https://www.acco.org/gold-wall-of-gratitude/">Gold Wall of Gratitude</a></li> <li class="page_item page-item-4631"><a href="https://www.acco.org/goldenangels/">Golden Angels – Puerto Rico (PR)</a></li> <li class="page_item page-item-12853"><a href="https://www.acco.org/golden-warriors-of-maine-me/">Golden Warriors of Maine – ME</a></li> <li class="page_item page-item-14066"><a href="https://www.acco.org/graces-survivor-story/">Grace’s Survivor Story</a></li> <li class="page_item page-item-6538"><a href="https://www.acco.org/green-family/">Green Family</a></li> <li class="page_item page-item-23"><a href="https://www.acco.org/groups/">Groups</a></li> <li class="page_item page-item-14098"><a href="https://www.acco.org/hannahs-survivor-story/">Hannah’s Survivor Story</a></li> <li class="page_item page-item-1831"><a href="https://www.acco.org/health-related-outcomes-for-hodgkin-disease-survivors/">Health-Related Outcomes for Hodgkin Disease Survivors</a></li> <li class="page_item page-item-31010"><a href="https://www.acco.org/hepatoblastoma-cancer-de-higado/">Hepatoblastoma (Cáncer de Hígado)</a></li> <li class="page_item page-item-1339"><a href="https://www.acco.org/hepatoblastoma/">Hepatoblastoma (Liver Cancer)</a></li> <li class="page_item page-item-170"><a href="https://www.acco.org/hero-beads/">Hero Beads®</a></li> <li class="page_item page-item-37"><a href="https://www.acco.org/history/">History of ACCO</a></li> <li class="page_item page-item-551"><a href="https://www.acco.org/history-timeline/">History Timeline</a></li> <li class="page_item page-item-2"><a href="https://www.acco.org/">Home</a></li> <li class="page_item page-item-1407"><a href="https://www.acco.org/home-2/">Home</a></li> <li class="page_item page-item-3235"><a href="https://www.acco.org/hope4heroes/">Hope 4 Heroes – CO</a></li> <li class="page_item page-item-34438"><a href="https://www.acco.org/hope-amidst-sorrow/">Hope Amidst Sorrow: A Seminar for Bereaved Parents</a></li> <li class="page_item page-item-5188"><a href="https://www.acco.org/hope4ccf/">Hope4CCF – LA</a></li> <li class="page_item page-item-34720"><a href="https://www.acco.org/hospital-organization-resources/">Hospital & Organization Resources</a></li> <li class="page_item page-item-11769"><a href="https://www.acco.org/hospitalnetwork/">Hospital Network Program</a></li> <li class="page_item page-item-1760"><a href="https://www.acco.org/hydrocephalus-shunts-and-gamma-knife/">Hydrocephalus, Shunts, and Gamma Knife</a></li> <li class="page_item page-item-13521"><a href="https://www.acco.org/i-feel-afraid/">I feel afraid.</a></li> <li class="page_item page-item-13503"><a href="https://www.acco.org/i-feel-angry/">I feel angry.</a></li> <li class="page_item page-item-13509"><a href="https://www.acco.org/i-feel-bored/">I feel bored.</a></li> <li class="page_item page-item-13525"><a href="https://www.acco.org/i-feel-disgusted/">I feel disgusted.</a></li> <li class="page_item page-item-13490"><a href="https://www.acco.org/i-feel-happy/">I feel happy.</a></li> <li class="page_item page-item-13494"><a href="https://www.acco.org/i-feel-proud/">I feel proud.</a></li> <li class="page_item page-item-13472"><a href="https://www.acco.org/i-feel-sad/">I feel sad.</a></li> <li class="page_item page-item-13498"><a href="https://www.acco.org/i-feel-surprised/">I feel surprised.</a></li> <li class="page_item page-item-13519"><a href="https://www.acco.org/i-feel-tired/">I feel tired.</a></li> <li class="page_item page-item-1986"><a href="https://www.acco.org/improving-informed-consent-in-childhood-cancer-trials/">Improving Informed Consent in Childhood Cancer Trials</a></li> <li class="page_item page-item-10881"><a href="https://www.acco.org/international/">International Advocacy</a></li> <li class="page_item page-item-33565"><a href="https://www.acco.org/iccd-2024/">International Childhood Cancer Day – 2024</a></li> <li class="page_item page-item-4711"><a href="https://www.acco.org/international-statistics/">International Statistics</a></li> <li class="page_item page-item-14265"><a href="https://www.acco.org/irenes-survivor-story/">Irene’s Survivor Story</a></li> <li class="page_item page-item-1977"><a href="https://www.acco.org/its-only-a-phase-clinical-trials-part-ii/">It’s only a Phase! Clinical Trials Part II</a></li> <li class="page_item page-item-10615"><a href="https://www.acco.org/jake/">Jake’s Dragon Foundation – PA</a></li> <li class="page_item page-item-14329"><a href="https://www.acco.org/jeffs-survivor-story/">Jeff’s Survivor Story</a></li> <li class="page_item page-item-241"><a href="https://www.acco.org/jelsert/">Jel Sert</a></li> <li class="page_item page-item-14399"><a href="https://www.acco.org/jennifers-survivor-story/">Jennifer’s Survivor Story</a></li> <li class="page_item page-item-14176"><a href="https://www.acco.org/jensens-survivor-story/">Jensen’s Survivor Story</a></li> <li class="page_item page-item-14283"><a href="https://www.acco.org/jillians-survivor-story/">Jillian’s Survivor Story</a></li> <li class="page_item page-item-14286"><a href="https://www.acco.org/juanitas-survivor-story/">Juanita’s Survivor Story</a></li> <li class="page_item page-item-2370"><a href="https://www.acco.org/karis-cause/">Karis’ Cause – OH</a></li> <li class="page_item page-item-13446"><a href="https://www.acco.org/kartersisolation/">Karter’s Isolation Story</a></li> <li class="page_item page-item-14109"><a href="https://www.acco.org/karters-survivor-story/">Karter’s Survivor Story</a></li> <li class="page_item page-item-14178"><a href="https://www.acco.org/kaydences-survivor-story/">Kaydence’s Survivor Story</a></li> <li class="page_item page-item-554"><a href="https://www.acco.org/kemper/">Kemper Foods International</a></li> <li class="page_item page-item-36077"><a href="https://www.acco.org/ks-acco/">Kendra Scott Supports Kids with Cancer</a></li> <li class="page_item page-item-6560"><a href="https://www.acco.org/kovach-family/">Kovach Family</a></li> <li class="page_item page-item-11687"><a href="https://www.acco.org/laborinlovebuildinginhope/">Labor in Love: Building in Hope – OR</a></li> <li class="page_item page-item-99"><a href="https://www.acco.org/late-effects/">Late Effects</a></li> <li class="page_item page-item-30421"><a href="https://www.acco.org/leucemias-infantiles/">Leucemias Infantiles</a></li> <li class="page_item page-item-14427"><a href="https://www.acco.org/lilys-survivor-story/">Lily’s Survivor Story</a></li> <li class="page_item page-item-31268"><a href="https://www.acco.org/linfomas-infantiles/">Linfomas Infantiles</a></li> <li class="page_item page-item-4490"><a href="https://www.acco.org/live-newsfeed/">Live Newsfeed</a></li> <li class="page_item page-item-36912"><a href="https://www.acco.org/lived-experience-of-cancer-a-who-study/">Lived Experience of Cancer: A WHO Study</a></li> <li class="page_item page-item-290"><a href="https://www.acco.org/local-groups/">Local Groups</a></li> <li class="page_item page-item-14401"><a href="https://www.acco.org/logans-survivor-story/">Logan’s Survivor Story</a></li> <li class="page_item page-item-2408"><a href="https://www.acco.org/love-for-zac/">Love for Zac – CA</a></li> <li class="page_item page-item-36370"><a href="https://www.acco.org/make-it-cute/">Make It Cute</a></li> <li class="page_item page-item-13433"><a href="https://www.acco.org/masonsisolation/">Mason’s Isolation Story</a></li> <li class="page_item page-item-24088"><a href="https://www.acco.org/matilda-jane/">Matilda Jane</a></li> <li class="page_item page-item-518"><a href="https://www.acco.org/medical-play-kit/">Medical Play Kit</a></li> <li class="page_item page-item-14243"><a href="https://www.acco.org/mias-isolation-story/">Mia’s Isolation Story</a></li> <li class="page_item page-item-7021"><a href="https://www.acco.org/microsoft/">Microsoft</a></li> <li class="page_item page-item-7085"><a href="https://www.acco.org/mission-of-hope/">Mission of Hope – Sean Swarner Cancer Climber</a></li> <li class="page_item page-item-32"><a href="https://www.acco.org/mission-statement-2/">Mission Statement</a></li> <li class="page_item page-item-14383"><a href="https://www.acco.org/mollys-survivor-story/">Molly’s Survivor Story</a></li> <li class="page_item page-item-36393"><a href="https://www.acco.org/name-shirts-are-back-in-2024/">Name Shirts are Back in 2024!</a></li> <li class="page_item page-item-13167"><a href="https://www.acco.org/national-pajama-day/">National Pajama Day</a></li> <li class="page_item page-item-1349"><a href="https://www.acco.org/neuroblastoma/">Neuroblastoma</a></li> <li class="page_item page-item-32359"><a href="https://www.acco.org/neuroblastoma-2/">Neuroblastoma</a></li> <li class="page_item page-item-1988 current_page_item"><a href="https://www.acco.org/neuropsychological-testing-an-excerpt-from-educating-the-child/" aria-current="page">Neuropsychological Testing: An Excerpt from Educating the Child</a></li> <li class="page_item page-item-1990"><a href="https://www.acco.org/new-approaches-for-resistant-brain-tumors/">New Approaches for Resistant Brain Tumors</a></li> <li class="page_item page-item-40"><a href="https://www.acco.org/news-and-press/">News and Press</a></li> <li class="page_item page-item-4365"><a href="https://www.acco.org/newsfeed-test/">Newsfeed Test</a></li> <li class="page_item page-item-11391"><a href="https://www.acco.org/nickys-heart-of-gold-pa/">Nicky’s Heart of Gold – PA</a></li> <li class="page_item page-item-13438"><a href="https://www.acco.org/noahsisolation/">Noah’s Isolation Story</a></li> <li class="page_item page-item-11076"><a href="https://www.acco.org/orangeribbon/">Orange Ribbon Foundation</a></li> <li class="page_item page-item-1746"><a href="https://www.acco.org/osteonecrosis-a-source-of-bone-pain-and-loss-of-function/">Osteonecrosis: A Source of Bone Pain and Loss of Function</a></li> <li class="page_item page-item-7340"><a href="https://www.acco.org/goodwillchill/">Otter Pop Vibes Tour #GoodWillChill</a></li> <li class="page_item page-item-186"><a href="https://www.acco.org/outside-resources/">Outside Resources</a></li> <li class="page_item page-item-1992"><a href="https://www.acco.org/palliative-or-hospice-care-does-my-child-need-this-service/">Palliative or Hospice Care: Does my child need this service?</a></li> <li class="page_item page-item-246"><a href="https://www.acco.org/palmco/">Palmco</a></li> <li class="page_item page-item-10142"><a href="https://www.acco.org/pwap/">Paranormal With a Purpose – FL</a></li> <li class="page_item page-item-2438"><a href="https://www.acco.org/paulandthedragon/">Paul and the Dragon</a></li> <li class="page_item page-item-166"><a href="https://www.acco.org/paul-and-the-dragon-dvd/">Paul and the Dragon Video</a></li> <li class="page_item page-item-13424"><a href="https://www.acco.org/paxtonsisolation/">Paxton’s Isolation Story</a></li> <li class="page_item page-item-34857"><a href="https://www.acco.org/pediatric-cancer-teaching-resources-for-professionals-educators/">Pediatric Cancer Teaching Resources For Professionals & Educators</a></li> <li class="page_item page-item-396"><a href="https://www.acco.org/pjammin/">PJammin® For Kids with Cancer</a></li> <li class="page_item page-item-7315"><a href="https://www.acco.org/pjamminfaq/">PJammin® Frequently Asked Questions</a></li> <li class="page_item page-item-1764"><a href="https://www.acco.org/ports-and-central-lines/">Ports and Central Lines</a></li> <li class="page_item page-item-1994"><a href="https://www.acco.org/practical-genetics-in-cancer-the-human-genetic-code/">Practical Genetics in Cancer: The Human Genetic Code</a></li> <li class="page_item page-item-35046"><a href="https://www.acco.org/preventing-hearing-loss-from-chemo/">Preventing Hearing Loss from Chemo</a></li> <li class="page_item page-item-13222"><a href="https://www.acco.org/print-at-home-coloring-pages/">Print-at-Home Coloring Pages</a></li> <li class="page_item page-item-10883"><a href="https://www.acco.org/proclamations/">Proclamation Language</a></li> <li class="page_item page-item-14447"><a href="https://www.acco.org/quick-links/">Quick Links</a></li> <li class="page_item page-item-404"><a href="https://www.acco.org/raise-awareness-2/">Raise Awareness</a></li> <li class="page_item page-item-1141"><a href="https://www.acco.org/raise-awareness/">Raise Awareness</a></li> <li class="page_item page-item-530"><a href="https://www.acco.org/read-about-it-acco-publications/">Read About It: ACCO Publications</a></li> <li class="page_item page-item-13870"><a href="https://www.acco.org/read-alongs-with-acco/">Read Alongs with ACCO</a></li> <li class="page_item page-item-1996"><a href="https://www.acco.org/relapsed-all-chemotherapy-vs-transplant/">Relapsed ALL: Chemotherapy vs Transplant</a></li> <li class="page_item page-item-1998"><a href="https://www.acco.org/relapsed-all-questions-for-parents-to-ask/">Relapsed ALL: Questions for Parents to Ask</a></li> <li class="page_item page-item-10"><a href="https://www.acco.org/research/">Research</a></li> <li class="page_item page-item-208"><a href="https://www.acco.org/research-articles/">Research Articles</a></li> <li class="page_item page-item-1766"><a href="https://www.acco.org/researching-the-medical-literature/">Researching the Medical Literature</a></li> <li class="page_item page-item-1352"><a href="https://www.acco.org/retinoblastoma/">Retinoblastoma</a></li> <li class="page_item page-item-1355"><a href="https://www.acco.org/rhabdoid-tumors/">Rhabdoid Tumors</a></li> <li class="page_item page-item-5985"><a href="https://www.acco.org/ribbons-of-gold/">Ribbons of Gold – WI</a></li> <li class="page_item page-item-6423"><a href="https://www.acco.org/rock-bottom/">Rock Bottom</a></li> <li class="page_item page-item-6566"><a href="https://www.acco.org/rbfamilies2016/">Rock Bottom Holiday Families</a></li> <li class="page_item page-item-1406"><a href="https://www.acco.org/sample-page-2/">Sample Page</a></li> <li class="page_item page-item-14530"><a href="https://www.acco.org/sarcoma-awareness-month/">Sarcoma Awareness Month</a></li> <li class="page_item page-item-1358"><a href="https://www.acco.org/sarcomas/">Sarcomas</a></li> <li class="page_item page-item-32674"><a href="https://www.acco.org/sarcomas-2/">Sarcomas</a></li> <li class="page_item page-item-6585"><a href="https://www.acco.org/scherff-family/">Scherff Family</a></li> <li class="page_item page-item-13384"><a href="https://www.acco.org/sew-to-save-lives/">Sew to Save Lives</a></li> <li class="page_item page-item-14250"><a href="https://www.acco.org/sing-along-with-acco/">Sing Along with ACCO</a></li> <li class="page_item page-item-391"><a href="https://www.acco.org/sitemap/">Sitemap</a></li> <li class="page_item page-item-13309"><a href="https://www.acco.org/social-isolation-stories/">Social Isolation Stories</a></li> <li class="page_item page-item-13045"><a href="https://www.acco.org/stamp/">Stamp Out Childhood Cancer</a></li> <li class="page_item page-item-123"><a href="https://www.acco.org/start-a-division/">Start a Division or Group</a></li> <li class="page_item page-item-7261"><a href="https://www.acco.org/state/">State</a></li> <li class="page_item page-item-12073"><a href="https://www.acco.org/state-comprehensive-cancer-control-plan/">State Comprehensive Cancer Control Plan</a></li> <li class="page_item page-item-13667"><a href="https://www.acco.org/stevens-isolation-story/">Steven’s Isolation Story</a></li> <li class="page_item page-item-1730"><a href="https://www.acco.org/stories-from-adult-and-child-survivors/">Stories from Adult and Child Survivors</a></li> <li class="page_item page-item-7210"><a href="https://www.acco.org/kobie/">Strength to Survive Childhood Cancer Foundation – HI</a></li> <li class="page_item page-item-1725"><a href="https://www.acco.org/suicidal-thoughts-and-attempts-in-adult-survivors/">Suicidal Thoughts and Attempts in Adult Survivors</a></li> <li class="page_item page-item-6552"><a href="https://www.acco.org/sullivan-family/">Sullivan Family</a></li> <li class="page_item page-item-13972"><a href="https://www.acco.org/survivor-stories/">Survivor Stories</a></li> <li class="page_item page-item-30176"><a href="https://www.acco.org/survivor-stories-alec/">Survivor Stories: Alec</a></li> <li class="page_item page-item-30156"><a href="https://www.acco.org/survivor-stories-alex/">Survivor Stories: Alex</a></li> <li class="page_item page-item-30124"><a href="https://www.acco.org/survivor-stories-ashley/">Survivor Stories: Ashley</a></li> <li class="page_item page-item-30164"><a href="https://www.acco.org/survivor-stories-cara/">Survivor Stories: Cara</a></li> <li class="page_item page-item-30168"><a href="https://www.acco.org/survivor-stories-jordan/">Survivor Stories: Jordan</a></li> <li class="page_item page-item-30239"><a href="https://www.acco.org/survivor-stories-meg/">Survivor Stories: Meg</a></li> <li class="page_item page-item-30679"><a href="https://www.acco.org/survivor-stories-payal/">Survivor Stories: Payal</a></li> <li class="page_item page-item-30161"><a href="https://www.acco.org/survivor-stories-ronald/">Survivor Stories: Ronald</a></li> <li class="page_item page-item-30174"><a href="https://www.acco.org/survivor-stories-taylor/">Survivor Stories: Taylor</a></li> <li class="page_item page-item-30127"><a href="https://www.acco.org/survivor-stories-tj/">Survivor Stories: TJ</a></li> <li class="page_item page-item-30171"><a href="https://www.acco.org/survivor-stories-victoria/">Survivor Stories: Victoria</a></li> <li class="page_item page-item-198"><a href="https://www.acco.org/targeted-therapeutics/">Targeted Therapeutics</a></li> <li class="page_item page-item-2000"><a href="https://www.acco.org/targeted-therapeutics-workshop-at-international-cancer-congress/">Targeted Therapeutics Workshop at International Cancer Congress</a></li> <li class="page_item page-item-2002"><a href="https://www.acco.org/targeting-cancer-in-the-21st-century/">Targeting Cancer In The 21st Century</a></li> <li class="page_item page-item-5405"><a href="https://www.acco.org/team-go-gold/">Team Go Gold</a></li> <li class="page_item page-item-526"><a href="https://www.acco.org/teen-journal/">Teen Journal</a></li> <li class="page_item page-item-6357"><a href="https://www.acco.org/thank-you/">Thank you</a></li> <li class="page_item page-item-1852"><a href="https://www.acco.org/thank-you-for-ordering/">Thank You For Ordering</a></li> <li class="page_item page-item-16373"><a href="https://www.acco.org/brain-tumor-charter-of-rights/">The Brain Tumour Patients’ Charter of Rights</a></li> <li class="page_item page-item-4129"><a href="https://www.acco.org/madison/">The Miracle of Madison – MD</a></li> <li class="page_item page-item-1732"><a href="https://www.acco.org/the-problem-of-pain-in-childhood-cancer-survivors/">The Problem of Pain in Childhood Cancer Survivors</a></li> <li class="page_item page-item-5922"><a href="https://www.acco.org/xen/">Through Xen – CT</a></li> <li class="page_item page-item-1582"><a href="https://www.acco.org/timeline/">Timeline</a></li> <li class="page_item page-item-27985"><a href="https://www.acco.org/tipos-de-cancer-infantil/">Tipos de Cáncer Infantil</a></li> <li class="page_item page-item-2004"><a href="https://www.acco.org/treating-high-risk-neuroblastoma-at-the-turn-of-the-century/">Treating High-Risk Neuroblastoma at the Turn of the Century</a></li> <li class="page_item page-item-1770"><a href="https://www.acco.org/treatment-centers-for-childhood-cancers/">Treatment Centers for Childhood Cancers</a></li> <li class="page_item page-item-86"><a href="https://www.acco.org/treatment-2/">Treatment Options</a></li> <li class="page_item page-item-2745"><a href="https://www.acco.org/triderma/">TriDerma Supports ACCO!</a></li> <li class="page_item page-item-32712"><a href="https://www.acco.org/tumor-de-wilms-y-otros-tumores-renales-infantiles/">Tumor de Wilms y Otros Tumores Renales Infantiles</a></li> <li class="page_item page-item-32701"><a href="https://www.acco.org/tumores-de-la-medula-espinal/">Tumores de la Médula Espinal</a></li> <li class="page_item page-item-32667"><a href="https://www.acco.org/tumores-rabdoides/">Tumores Rabdoides</a></li> <li class="page_item page-item-73"><a href="https://www.acco.org/types-of-childhood-cancer/">Types of Childhood Cancer</a></li> <li class="page_item page-item-77"><a href="https://www.acco.org/us-childhood-cancer-statistics/">US Childhood Cancer Statistics</a></li> <li class="page_item page-item-14635"><a href="https://www.acco.org/virtual-advocacy/">Virtual Advocacy</a></li> <li class="page_item page-item-36325"><a href="https://www.acco.org/voyageur-outward-bound-school/">Voyageur Outward Bound School</a></li> <li class="page_item page-item-21662"><a href="https://www.acco.org/wacco/">WACCO</a></li> <li class="page_item page-item-6544"><a href="https://www.acco.org/walsh-family/">Walsh Family</a></li> <li class="page_item page-item-27552"><a 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class="col col-6 links"> <div id="flex-item" class="w-100 d-block"> <a href="https://www.acco.org">Current Specials </a> <a href="https://www.acco.org">Get Directions </a> <a href="https://www.acco.org/photo-gallery/">Photo Gallery </a> </div> </div>  </div> </div>  <div class="container-fluid"> <div class="row"> <div class="bg-container" style="background-image: url(https://www.acco.org/wp-content/themes/acco-new/img/bg-slider.png)"><div class="bg-overlay"><div class="container"><h1 class="entry-title">Neuropsychological Testing: An Excerpt from Educating the Child</h1></div></div></div> </div> </div> <div id="one-column"> <div class="container"> <div class="row"> <div id="primary" class="col-md-12"> <div class="content-wrapper"> <article id="post-1988" class="post-1988 page type-page status-publish hentry"> <div class="entry-content"> <p><strong>NEUROPSYCHOLOGICAL TESTING: AN EXCERPT FROM EDUCATING THE CHILD WITH CANCER</strong></p> <p>Source: Fall 2004 CCCF Newsletter</p> <p>Over the past 20 years, we have learned a great deal about how children treated for cancer learn and perform in school. Perhaps the most important thing we have learned is that there are patterns of abilities that occur after successful treatment that are different from those seen with more common learning problems that are often call “learning disabilities.” This difference is important, since the understanding of learning, and the approach to evaluating learning in children treated for cancer, needs to be different as well. For this reason, some of the standard approaches to testing children with cancer that occur in the school and other private settings may not be adequate for identifying problems and planning ways to help.</p> <p><strong>COMMON APPROACHES TO EVALUATION OF LEARNING PROBLEMS</strong></p> <p>In the public schools, and in many private settings, a child’s ability to obtain special education services for learning problems is based on his or her performance on a group of tests of intellectual ability and academic achievement. Commonly, children are administered a standardized IQ test, along with tests of school-based skills, and often a measure of adaptive function.</p> <p><strong>IQ TESTS</strong></p> <p>IQ tests are individually administered to the child and are made up of a number of subtests of specific abilities. A child’s score is based on his/her performance compared to other children of the same age. Three scores from an IQ test are considered:</p> <ul> <li>A verbal IQ score, which is an index of 5 to 6 different tests of verbal or language-based skills.</li> <li>A Performance IQ score, which is an index of 5 to 6 tests of visual, motor, speed, and perceptual abilities, and</li> <li>A Full Scale IQ score, which is a combination of all the tests included in the Verbal and Performance IQ scores.</li> </ul> <p><strong>ACADEMIC ACHIEVEMENT TESTS</strong></p> <p>The academic achievement tests are also individually administered, and may involve tests of Reading (word recognition and comprehension), Arithmetic (math calculations and applied math abilities), Spelling, and Writing. The child’s scores on these tests are based on his or her performance compared to other children of the same age or in the same grade.</p> <p><strong>TESTS OF ADAPTIVE FUNCTION</strong></p> <p>Tests of adaptive function are usually administered in the form of an interview with the parent or caregiver. These tests typically provide information about a child’s communication, daily living, socialization, and motor skills compared to other children the same age, as observed by the parent or primary caregiver.</p> <p><strong>USE OF TESTS FOR CLASSIFICATION</strong></p> <p>Determination of a learning problem is usually based on several criteria. Children may be classified because their scores fall within a certain range, or because there are discrepancies between test scores in identified areas. Some of these classifications include:</p> <p><span style="text-decoration: underline">Impaired Cognitive Abilities (Mental Retardation)</span>: Children who score below 70 on an IQ test, have academic achievement scores in this same range, and have scores on a standardized measure of adaptive function (e.g., a parent report of the child’s communication, daily living, socialization, and motor skills) that are also below 70 may meet criteria for diagnosis of impaired cognitive abilities or mental retardation.</p> <p><span style="text-decoration: underline">Specific Learning Disability</span>. Children who score above 70 on an IQ test, but have a significant discrepancy (usually more than 15 points) between their IQ score and measures of academic achievement (Reading or Math) may qualify for services for the learning disabled. Usually some indication of a processing deficit (e.g., visual-motor or auditory processing) is also necessary for this classification.</p> <p><span style="text-decoration: underline">Varying Exceptionalities</span>. Children whose test scores indicate learning problems, but who also have other sensory deficits (e.g, hearing, vision), physical movement problems, or speech difficulties, may be classified in the category of varying exceptionalities, and may receive a range of both educational and therapeutic services.</p> <p><span style="text-decoration: underline">Other Health Impaired</span>. Children who experience problems in school that can be attributed to a chronic health condition (including cancer) may fall under the 504 regulations that permit services for children who do not otherwise meet special education categorization. However, many may also be eligible for Individual Education Plans (IEPs) and access to a full range of special education services.</p> <p><strong>NEUROPSYCHOLOGICAL TESTING</strong></p> <p>The late effects of treatment of cancer in children often involve very specific disabilities, including visual perception, memory, processing speed, and sequencing. Problems in these areas are not commonly seen in children not treated for cancer. Over the past 20 years, investigators and parents have observed that the types of testing done for school problems do not include tests that identify the kinds of problems faced by children with cancer and are not helpful in determining the kinds of assistance that is needed. For these reasons, clinicians and parent advocacy groups are increasingly recommending that children treated for cancer receive a battery of tests that focus specifically on the patterns of difficulties that may be experienced. This kind of testing is commonly referred to as neuropsychological testing.</p> <p><strong>WHAT IS NEUROPSYCHOLOGICAL TESTING?</strong></p> <p>Neuropsychological testing involves giving a child a number of tests that provide information about how the brain works in the areas of memory, speed, language, visual processing, auditory processing, integration of information, emotional and behavioral regulation, and planning and organization. The tests are administered by a trained professional (either a licensed psychologist or someone supervised by the psychologist). The purpose is to provide a comprehensive, detailed assessment of a person’s ability to encode, process, store and express information. Interpretation of the various test results allows strengths and weakness to be uncovered. From this evaluation, recommendations can be made for accommodations to assist learning and functioning.</p> <p>The tests that are used are developed for children, and the tests that are given are selected to match the skills expected for children of specific age ranges. The child’s scores are based on how he or she performs compared to other children of the same age. Neuropsychological tests of specific abilities may vary, depending on the age of the child at the time of diagnosis and treatment, the age at the time he or she is tested, and what kind of treatment he or she received.</p> <p><strong>WHAT IS A NEUROPSYCHOLOGIST?</strong></p> <p>A neuropsychologist is a licensed psychologist (Ph.D. or Psy.D.) who has special and advanced training in evaluating the relationship between the brain and behavior in a number of areas. A pediatric neuropsychologist is a licensed psychologist who has training and experience in understanding the relationship between the brain and behavior in children. This requires the additional skill of understanding how this relationship changes over time as the child’s brain grows and develops.</p> <p>Most states do not specifically license neuropsychologists, although the American Board of Professional Psychology does provide a board certification for advanced skills in the area. There is not a separate certification for pediatric neuropsychology. For these reasons, parents and referring physicians should determine whether the psychologist has obtained training in brain-behavior relationships, neuropsychological testing, neuro-rehabilitation, or other similar area, and whether he or she has experience evaluating children with complex medical problems that affect the brain. Knowledge about the disease process and the effects of chemotherapy and radiation may be critical to evaluations that are helpful. If parents are unsure of the qualifications of a psychologist to perform this type of evaluation, they should discuss this with their child’s oncologist to be sure that a knowledgeable person is available to perform the evaluation. Most pediatric oncology programs that participate in the Children’s Oncology Group have identified a qualified professional in this area.</p> <p>The neuropsychologist can help parents and teachers:</p> <ul> <li>Understand how treatment has affected thinking, learning, and behavior.</li> </ul> <ul> <li>Identify what services and accommodations may be needed in the educational setting.</li> <li>Recommend interventions.</li> <li>Advise on potential or likely improvements, problems and changes.</li> </ul> <p><strong>WHO NEEDS NEUROPSYCHOLOGICAL TESTING?</strong></p> <p>Neuropsychological testing is usually indicated for children with:</p> <ul> <li>Tumors of the central nervous system (CNS), especially those requiring cranial radiation, but including those who were treated with surgery only.</li> <li>Acute lymphoblastic leukemia, particularly those treated with cranial radiation and those on more recent protocols that involved triple intrathecal chemotherapy and higher dose methotrexate during consolidation.</li> <li>Diseases requiring radiation to the head, including those receiving total body irradiation prior to bone marrow or stem cell transplantation.</li> <li>Very young children who receive intensive chemotherapy and require prolonged hospitalizations because of treatment and side effects.</li> <li>Other children who are identified by the pediatric oncologists because of specific concerns about that child’s school performance, learning, or development.</li> </ul> <p>Because the effects of cancer treatment appear to emerge over time, a single testing will usually not be adequate to address the child’s needs as he or she develops. Obtaining an evaluation during the first year after diagnosis will help address immediate difficulties that may occur because of medication side effects or school absences, and will also provide a “baseline” for determining whether there are “late effects” when the child is a survivor. Re-evaluations every 18 months to 3-years (shorter intervals during the elementary years, with longer intervals in adolescence and young adulthood) are usually recommended to assess changes due to treatment and revise recommendations for intervention.</p> <p><strong>PREPARING THE CHILD FOR TESTING</strong></p> <p>When the word “test” is used with a child treated for cancer, it inevitably brings up thoughts of needles, painful procedures, or confining spaces. For this reason, special care should be taken when talking with a child about neuropsychological testing. Both parents and the psychologist should be sensitive to this issue. There are several strategies that may be helpful:</p> <ul> <li>Explain to the child that no needles or painful procedures are involved in this kind of testing. Neuropsychological testing is a “no stick zone.”</li> <li>Explain that these are not tests that you pass or fail. They are tests that help the psychologist, parents, and child understand how the child’s brain works and how he or she best learns. The tests will hopefully identify areas where learning is difficult, but will also identify areas where the child does well.</li> <li>Explain that some of the tests may be really easy, some may be very hard, and some may be in-between. No one is expected to be able to know or do everything perfectly, but each child should do his or her very best. However, if there is something that is too hard, after giving a good try, or there is something that the child has never heard before, then the best answer may be “I don’t know.”</li> <li>Give the child a chance to ask questions, both of his/her parents before the testing session, and of the psychologist before and at appropriate points during testing.</li> <li>Explain that the results of the test will be used to find ways to help make learning and doing well in school a bit easier and more successful.</li> </ul> <p>Parents should also prepare the child and themselves for the fact that neuropsychological testing requires time, a positive relationship between the child and the person administering the tests, and sensitivity on the part of the psychologist about special issues for the child with cancer (e.g., increased fatigue). In some cases, the psychologist may recommend conducting the evaluation over several sessions to be sure that the child’s performance is the best possible, and not influenced by fatigue. This kind of evaluation is not something that can be rushed, so parents and children should approach the testing session with patience.</p> <p><strong>PARTS OF A NEUROPSYCHOLOGICAL TESTING</strong></p> <p>The neuropsychological evaluation involves more than just giving a few tests. It is designed to provide a comprehensive picture of the way the child learns and develops, and therefore includes a number of important parts. Most neuropsychological evaluations include:</p> <ul> <li>A detailed interview with the parents about the child’s medical, developmental, learning, behavioral, and social history, with specific attention to the type of disease, treatment involved, and results of any hearing, vision, and neuroimaging evaluations that have been done. A review of past and current medications should be included in this interview.</li> <li>A brief family interview about family history of learning, attention, emotional, or behavioral problems.</li> <li>Tests of IQ, academic achievement, and adaptive behavior.</li> <li>Specific tests of visual and verbal memory, sequential memory, attention and concentration, visual-spatial-motor integration, processing speed, language ability (expressive and receptive), social perception, and executive function (planning, organization).</li> <li>Other special tests may be included if there are sensory deficits (e.g., vision or hearing), motor impairments, or a history of learning problems prior to diagnosis of cancer.</li> <li>Screening for social, behavioral, or emotional difficulties.</li> </ul> <p>Many of the tests used in neuropsychological testing are not included in the typical evaluation provided in the school system, although there may be some overlap on some tests.</p> <p><strong>INTERPRETATION OF RESULTS: THE REPORT</strong></p> <p>Often, parents and teachers view the neuropsychological evaluation as being primarily focused on what tests are given. However, the real benefit of a neuropsychological evaluation is the interpretation of the patterns of test scores, which leads to recommendations that may be helpful. The interpretation and recommendations rely on the knowledge and experience of the psychologist related to normal brain development, an understanding of the effects of disease and treatment on the developing brain, and an awareness of the multitude of complex educational, developmental, medication, and therapeutic interventions available. There are two common types of interpretations that usually come from a neuropsychological evaluation:</p> <ul> <li>Current functioning. This type of interpretation provides information about how the child is performing at the time of testing compared to other children his or her same age. The psychologist also examines the patterns of these scores to determine if there are any inconsistencies between abilities, or if there are obvious delays. This point is important. What has been learned about late effects in childhood cancer is that IQ does not tell the story. Some areas of brain function do not seem to be at as great a risk for problems as others. For this reason, the absolute scores on any given test are not the major concern. Instead, the neuropsychologist examines patterns of abilities (e.g., visual vs. verbal memory, language vs. non-verbal problem solving). The neuropsychological evaluation often detects patterns of clearly defined strengths, as well as weaknesses. The IQ score may seem okay to parents, but the pattern of difficulties may represent a significant set of problems that need to be addressed, and may help parents and teachers anticipate problems that may be encountered in the future. This interpretation of the pattern is a major focus of the evaluation.</li> <li>Functioning over time. This is a more complex interpretation, but one that can provide major benefit. This interpretation examines how scores on the various tests have changed over time. Functioning over time can only be done if there are previous neuropsych results for comparison. Based on knowledge about normal brain development, the type of treatment, and the age of the child at treatment, this type of interpretation may permit some limited predictions about future functioning. More importantly, it may also allow the development of interventions that can prevent or lessen new problems down the line.</li> </ul> <p>Parents should expect that the report and personal feedback session with the psychologist will provide them with a clear summary of the test results, an interpretation of what these results mean, and specific recommendations about how to address any problems that testing may have identified. Sometimes recommendations involve:</p> <ul> <li>Additional testing by developmental specialists (e.g., speech and language, audiology).</li> <li>Specific suggestions for how a child can be taught to read, do math, or write.</li> <li>Suggestions for “accommodations” in the school setting (e.g., extra time to complete work, use of books on tape, use of calculators).</li> <li>Consideration of evaluation for medications that may be helpful (e.g., stimulant medications for attention problems).</li> <li>Referrals for counseling, therapy, or behavioral management to address behavior or emotional problems that were identified during the evaluation.</li> <li>Suggestions about special school programs for the child with complex difficulties.</li> </ul> <p>If these recommendations are not provided, or if they are provided but don’t make sense, parents should always feel free to ask the psychologist to provide more information and explanation so that the information can be understood.</p> <h4><strong>KEY POINTS</strong></h4> <ul> <li>Neuropsychological testing can be expensive and time consuming, but it offers information that is typically not obtained in a standard school evaluation.</li> <li>The results of the evaluation should be interpreted by a professional who has extensive training in interpreting complex test results.</li> <li>Parents of children whose cancer or treatment involved the brain should be aware of the potential risk to their child’s learning and discuss neuropsychological testing with their child’s oncologist. Repeated evaluations (conducted every 2 to 3 years or if there are new, specific concerns) may be needed through high school, and perhaps into college.</li> <li>The reason for the neuropsychological evaluation is to obtain information that can be used to have each child reach his or her maximum potential.</li> </ul> <p>Dr. Armstrong is Professor & Associate Chair of the Department of Pediatrics and Director of the Mailman Center for Child Development at the University of Miami School of Medicine.</p> <p> </p> </div> <footer class="entry-meta"> </footer> </article> <div id="comments"> </div> </div> </div> </div> </div> </div> </div> <footer id="footer"> <div id="footer-info"> <div class="bottom"> <div class="container wow fadeIn" data-wow-duration="1.75s" data-wow-offset="100"> <div class="row py-4"> <div id="footer-1" class="col-12 my-1 d-none d-md-block"> <div class="row"> <div class="col-md-2"> <img class="img-fluid d-block mx-auto" src="https://www.acco.org/wp-content/themes/acco-new/img/logo-footer.png" /> </div> <div class="col-md-10"> <p class="mt-4">The American Childhood Cancer Organization is a 501(c)(3) public charity, whose programs and services are funded entirely by private donations, foundation grants, and corporate contributions. 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