Social Interactions Between Children With Cancer and Their Peers: Teacher Ratings

Journal of Pediatric Psychology, Vol. IS, No. 1, 1990, pp. 43-56

Social Interactions Between Children With Cancerand Their Peers: Teacher Ratings1

Robert B. Noll2

Michigan State University

William M. BukowskiUniversity of Maine

Fred A. RogoschArizona State University

Sarah LeRoyWayne State University

Roshni KulkarniMichigan State University

Received July 11, 1988; accepted January 6, 1989

Compared children (ages 8-18) with cancer (n = 24) and matched classroomcontrol children (n = 24) using a modified version of the Revised Class Play(RCP). A wide variety of malignancies were represented, except brain tumors.Childrens' classroom teachers completed the RCP, an instrument modifiedto obtain teachers' impressions of three fundamental dimensions of inter-personal style: sociability-leadership, aggressive-disruptive, sensitive-isolated.Relative to the matched controls, children with cancer were perceived byteachers as (a) less sociable and prone towards leadership and (b) more so-cially isolated and withdrawn. These findings suggest a need for long-term

1 Preparation of this article was supported in part by a Biomedical Research Support Grant fromMichigan State University to Robert B. Noll. We gratefully acknowledge the assistance of WilliamWeil, David Kallen, two anonymous reviewers, and the editor on earlier drafts of this manuscript.

2 All correspondence should be sent to Robert B. Noll, Children's Hospital Medical Center,Elland and Bethesda Aves., Cincinnati, Ohio 45229.

43

0I46-8693/90/0200-OO43SO6.00/0 © 1990 Plenum Publishing Corporation

at Mem

orial University of N

ewfoundland on A

ugust 3, 2014http://jpepsy.oxfordjournals.org/

Dow

nloaded from

http://jpepsy.oxfordjournals.org/

44 Noll et al.

psychosocial interventions oriented towards peer relationships of childrenwith cancer.

KEY WORDS: cancer; social roles; teacher ratings.

The prognosis for children diagnosed with cancer has imporved dramaticallyduring the past decade. Recent statistics show that 60% of children diag-nosed with cancer survive at least 5 years (Young, Ries, Silverberg, Horm,& Miller, 1985). Nevertheless, although disease mortality has decreasedmarkedly, considerable evidence indicates that psychosocial morbidity hasincreased significantly. Numerous studies have demonstrated that childrenand families who must deal with the stress of cancer and the side effects ofits lengthy and intensive treatment experience many social and emotionalproblems (Van Dongen-Melman & Sanders-Woudstra, 1986). These childrenand their families are chronically exposed to numerous stressful experiencesincluding surgery, hospitalizations, chemotherapy, and exposure to death.In addition, cancer treatment frequently causes changes in (a) physical ap-pearance such as hair loss, facial distortions, weight gains, or amputations,(b) intellectual abilities (Fletcher & Copeland, 1988), and (c) behavioral andemotional adaptations. Pertinent to their behavioral competence, these chil-dren have been described as depressed, angry, anxious, and withdrawn (Hil-gard & LeBaron, 1982; Kashani & Hakami, 1982; Koocher & O'Malley, 1981;Lansky, 1974; Spinetta, 1974; Susman et al., 1981). In addition, there is evi-dence that children with cancer fear rejection from peers (Koocher, O'Mal-ley, Gogan, & Foster, 1980; Zwartjes, 1979), feel less socially competent(Deasy-Spinetta, 1981; Futterman & Hoffman, 1970; Klopovich, Vats, But-terfield, Cairns, & Lansky, 1981; Sawyer, Crettenden, & Toogood, 1986),and have poor school attendance that may continue 2 to 3 years after theinitial diagnosis (Cairns, Klopovich, Hearne, & Lansky, 1982; Lansky &Cairns, 1979).

Although these tendencies are not in themselves indices of psychopathol-ogy, they are factors that place children at risk for maladaptive relations withage-mates. Peer relationships have particular significance because positivepeer relationships during childhood are associated with prosocial behavior,academic achievement, and stress resistance (Green, Forehand, Beck, & Vosk,1980; Kurdek & Krile, 1982; Masten, Morison, & Pellegrini, 1985; Morison& Masten, 1987; Werner & Smith, 1982). Conversely, problematic peer rela-tionships are related to academic failure, aggressive behavior, and generalpsychopathology in children (Masten et al., 1985; Pelham & Milich, 1984;Serbin, Lyons, Marchessault, Schwartzman, &Ledingham, 1987; Younger,Schwartzman, & Ledingham, 1985) that may continue through adolescenceand into adulthood (see Parker & Asher, 1987).

at Mem


ewfoundland on A


Dow

nloaded from


Peer Relationships of Children with Cancer 45

Clearly, children with cancer are at particularly high risk for problemswith peers. Although a systematic evaluation of the social interactions ofchildren with cancer would permit an assessment of the competencies anddeficits of children utilizing standardized measures that do not focus on psy-chopathology, this work has not been done. In addition, nearly all of thework focusing on behavioral and emotional adaptations in children withcancer has lacked adequate controls (Breslau, 1983; Van Dongen-Melman,& Sanders-Woudstra, 1986) as well as standardized measures developed toevaluate competence and/or vulnerability.

The current study differs from prior investigations in several impor-tant ways. First, as our index of social functioning, we modified a widelyused instrument that taps individual differences within a broadly defined nor-mal range of vulnerabilities and competencies. We used a technique knownas the Revised Class Play (RCP; Masten et al., 1985) that was developedas a peer assessment procedure to measure children's interactions with peersaccording to three dimensions of behavior: (a) sociability-leadership, (b)aggressive-disruptive, and (c) social isolation. This technique, which has beenused in several studies of children's peer relations (e.g., Carroll, 1988; Mastenet al., 1985; Morison & Masten, 1987; Rubin & Mills, 1988), was modifiedfor the purposes of this study to be used to collect teachers' impressions ofchildren's social behavior. Previous studies (Coie & Dodge, 1988; Connolly& Doyle, 1981; Rubin & Mills, 1988; Vosk, Forehand, Parker, & Rickard,1982) have shown that there is considerable overlap between teachers andchildren's impressions of children's social interactions, although this workdid not use the RCP. This measure requires peers or teachers to imagine theyare the director of a play starring the members of the classroom. They areasked to select from a roster of children in the room the child who couldbest play a series of roles in a play. The play has roles that permit assess-ment of positive aspects of peer reputation (good leader, many friends, senseof humor, etc.) as well as negative aspects of peer reputation related to ag-gression (bossy, fights, loses temper easily, etc.) and social isolation (left out,sad, shy, etc.). The class play methodology allowed data to be collected ina manner that did not focus on the child with cancer and also permitted as-sessment of competencies along with vulnerabilities. Previous research withthis methodology (Masten et al., 1985) suggested it is very sensitive to subtledifficulties that have been reported by previous investigators regarding the adap-tations of children with cancer in the classroom (Deasy-Spinetta & Spinetta,1980), since it is not oriented to identification of psychopathology but rather to arange of interpersonal adaptations.

Second, we made direct comparisons between children with cancer andspecific classmates with whom they were matched on the basis of gender,age, and race. Previous studies of children with cancer in the classroom have

at Mem


ewfoundland on A


Dow

nloaded from


46 Noll et al.

failed to utilize control groups or have relied upon hypothetical comparisonpoints. Third, most of our informants were completely unaware of the par-ticular purpose of the study, thus reducing the possibility of bias in theirjudgments (Spirito et al., 1988).

This research had two purposes: (a) to assess teachers' impressions ofthe peer behavior of children with cancer by asking their teachers to completea modified version of a well-established inventory of social behavior, and(b) to explore the utility of the class play methodology with teachers for study-ing children with cancer (i.e., to evaluate the applicability of this approachto the study of social development in populations of children with chronicchildhood illness). Insofar as findings for children with cancer regarding be-havioral competencies and vulnerabilities are applicable to the larger popu-lation of children with chronic physical illness (Drotar, 1981; Hobbs, Perrin,Ireys, Moynihan, & Shayne, 1984), findings from this work would permita greater understanding of the adaptations and needs of these children andwould suggest an appropriate methodology for studying these children.

METHOD

Subjects

The study sample of children with cancer was recruited from two pedi-atric oncology clinics in the Midwest. From these services, children betweenthe ages of 8 and 18 who were currently attending regular school and receiv-ing chemotherapy or had stopped treatment within the past 12 months wereinformed of our interest in children's friendships and they were asked to par-ticipate in this study. These children were in the maintenance phase of treat-ment, were stabilized sufficiently medically to be attending school regularly,or had ended treatment within the past 12 months (Table I).3 Twenty-sevenfamilies were approached and 25 consented. One school did not want to par-ticipate in the work. Based upon staff consensus, 15 of the schools were con-sidered rural and 9 urban. Because children with known central nervoussystem malignancies reportedly have significant behavioral and emotionalproblems that are uniquely related to tumor location (Aram & Ekelman, 1986;

'Children who are no longer being treated for cancer were included in the study as findingsregarding the behavioral and emotional impact of cancer suggest that psychosocial effects per-sist well beyond 1 year after the completion of therapy (Koocher & CMalley, 1981). Moreover,given that studies have demonstrated that peer reputation is a stable phenomenon (Bukowski& Newcomb, 1984; Masten et al., 1985; Morison & Masten, 1987), it is conceivable that chil-dren who had recently ended chemotherapy would continue to present a stable reputation profile.

at Mem


ewfoundland on A


Dow

nloaded from



Kun, Mulhern, & Crisco, 1983; Sollee & Kindlon, 1987), extent of surgicalresection (Danoff, Cowchock, Marquette, Mulgrew, & Kramer, 1982), ageof child (Danoff et al., 1982; Duffner, Cohen, & Parker, 1988; Mulhern &Kun, 1985), and the use of whole brain radiation therapy (Duffner, Cohen,Thomas, & Lansky, 1985; Duffner et al., 1988; Ellenberg, McComb, Siegel,& Stowe, 1987; Kun et al., 1983), these children were excluded from this study.

The current study was the initial phase of a larger project focused onchildren's friendships. In the first phase of this project, the study was ex-plained to all of the children with cancer and their parents. They were toldthat the purpose of the project was to study children's friendships; no men-tion was made of our interest in children with cancer. After obtaining per-mission from the parents and children to contact the child's school, the schoolprincipal was contacted and informed of our interest in studying the peerrelationships of children with cancer. With the principal's permission, wecontacted the teachers of children with cancer and initially told them of ourinterest in children's friendships but not of our specific interest in childrenwith cancer so as to minimize the potential effects of bias of the teacher'sjudgments. After collecting data from teachers, a structured interview wasconducted to determine whether the teacher knew of the study's specific fo-cus. Subsequently, consent forms were sent home with all of the childrenin the classrooms (N = 575). These consents asked for permission to involvechildren in a study of children's friendships. No mention was made of cancer.Permission was obtained from 90% of these parents allowing 515 children,including all of the target children, to participate in the remainder of thisproject. From this pool of participating children, the children with cancerwere then matched with another child in the same room on the basis of gender,date of birth, and race (by observation). A phone call was made to the par-ents of potential control subjects asking them to participate in a researchproject that was investigating the impact of chronic illness on children. Con-trols were selected on the basis of closest birthday to the child with cancerand gender. They were told that we need to work with families with sick chil-dren as well as families with healthy children to understand the impact ofchronic illness in children on families. Seventy percent of potential controlfamilies agreed to participate in the second study. During the second study,control subjects were screened (parent and child report) to insure they hadno chronic illness. Because of their participation in the larger study, RevisedDuncan Socioeconomic scores (TSEI2; Stevens & Featherman, 1981) wereavailable for all participants (Table I). The Revised Duncan was selected asan index of socioeconomic status (SES) as a result of recent work by sociol-ogists suggesting that occupation-based measures represent a more contem-porary indicator of SES that is sensitive to changes in occupational attainment(Featherman & Hauser, 1977; Mueller & Parcel, 1981; Nock & Rossi, 1979).

at Mem


ewfoundland on A


Dow

nloaded from


48 Noll et al.

Table I. Background Characteristics of Children WithCancer {n = 24) and Matched Control Children (n = 24)°

Children with cancer Matched control children

Type16 leukemia (ALL)* No severe chronic illness5 solid tumors3 lymphomas

Chemotherapy18 on6 off

Demographic characteristics of children

AgeRange: 8-18 years 8-17 yearsM 12.3 years 12.5 years

Race23 Caucasian 23 Caucasian

1 Black 1 Black

Family Duncan Socioeconomic Index' (Stevens &Featherman, 1981)

39.00 42.57

"14 males, 10 females, in each group.'ALL, acute lymphoblastic leukemia, the most commontype of childhood leukemia.

cThis measure is a widely used indicator of occupationranking based upon education and income data from the1970 census.

Instrument

The Revised Class Play (RCP; Masten et al., 1985) is a descriptivematching instrument that asks children to "cast" classmates or students into30 different roles (example: a good leader, someone who picks on other kids,someone who is shy, etc.) Although the RCP has only been used by peers,we gave this instrument to teachers to complete. Factor analysis of the 30RCP roles revealed three dimensions: Sociability-Leadership, Aggressive-Disruptive, and Sensitive-Isolated (Masten et al., 1985; Morison & Masten,1987). Children high on the Sociability-Leadership dimension are more like-ly to exhibit higher academic achievement and to be seen by teachers as be-ing more cooperative and initiating. The Aggressive-Disruptive dimensionis associated with academic difficulties along with teacher reports of disrup-tive and oppositional behavior. High scores on this dimension are associat-ed with the most maladaptive behavioral patterns and demonstrate highstability over time, especially for boys (Parker & Asher, 1987). High scoreson the Sensitive-Isolated dimension are associated with difficulties with com-

at Mem


ewfoundland on A


Dow

nloaded from



prehension and attention and children high on this dimension are perceivedas being withdrawn. These dimensions have been shown to be both internal-ly consistent (alphas range from .81 to .95) and stable across time. Correla-tions across 17 months ranged from .63 to .65 (Masten et al., 1985). Finally,a 7-year follow-up of peer reputation in middle childhood based upon RCPscores demonstrated the predictive validity of the RCP. Positive scores ob-tained in middle childhood correlated with competence in adolescence whilenegative aspects of peer reputation in middle childhood correlated with psy-chopathology and behavioral problems in adolescence (Morison & Masten,1987).

Since this investigation utilized the RCP with a special population ofchildren, nine additional roles were added to the end of the play. Three ofthese roles were related to illness in children and were included as a validitycheck. The remaining six roles related to difficulties with academic work,physical appearance, and athletic abilities, and were included as exploratoryitems.

Procedure

After permission from the child with cancer and his or her family hadbeen obtained, the principal and then the child's teacher were contacted andinformed of the study's broad focus on children's friendships. For childrenin grade school, the child's regular teacher was asked to complete the RCP;the English teacher was asked for children in middle or high school. Theywere asked to complete the RCP with a class roster in front of them andto select one child from the roster who could best play each role in the play.Instructions to the teachers followed the procedures of Masten et al. (1985).After completing the RCP, a semistructured interview was completed withthe teacher to determine whether the teacher knew the specific purpose ofthe study. While all of the teachers knew that one of the children in theirclass had cancer, 16 did not know about our specific interest in children withcancer when they completed the RCP. No data were collected until childrenhad been in their classroom for at least 3 months. If the child with cancerwas experiencing medical difficulties that affected school attendance, datacollection was postponed until regular attendance occurred, to increase theaccuracy of teacher ratings.

The RCP was scored according to previously developed procedures(Masten et al., 1985). Briefly, raw summary scores were obtained for eachexperimental and control child. These scores were then standardized throughz -score transformations within each classroom to adjust for unequal class-room sizes. Data were initially analyzed separately for boys and girls, butno differences were found. Findings reported are collapsed across gender.

at Mem


ewfoundland on A


Dow

nloaded from


SO Noll et al.

RESULTS

Measurement Model

Prior to conducting any data analyses, Cronbach's alpha was used toassess the internal consistency (i.e., reliability) of the three RCP scores. Theobserved values revealed adequate levels of reliability (see Table II).

Children With Cancer Versus Matched Controls

Initial data analysis examined whether the ratings from the 8 teacherswho knew the purpose of the study were significantly different from the 16teachers who did not know of the study's interest in children with cancer.Using an ANOVA in which teacher knowledge was a between-subjects vari-able and the cancer/control variable was a within-subjects factor, no sig-nificant differences were found either on the three factor scores or on anyof the 39 class play roles.

Subsequently, a three-stage process was adopted to compare childrenwith cancer with the matched controls. First, a multivariate analysis of vari-ance was conducted to examine differences between the children with cancerwith the controls on the three factor scores. This analysis revealed a signifi-cant multivariate effect for type of child, cancer or control; F(3, 20) = 2.89,p < .05.

Second, univariate analysis of variance were used to examine differ-ences between the children with cancer and the controls on each of the RCPdimension scores. Significant effects for the type of child variable were foundwith the Sociability-Leadership score and the Sensitive-Isolated score (TableII). That is, children with cancer were selected significantly less often forroles on the Sociability-Leadership dimension, and significantly more oftenfor roles on the Sensitive-Isolated dimension.

Third, to determine which of the 15 roles within the Sociability-Leadership dimension and which of the 7 roles within the Sensitive-Isolated

Table II. Reputation Scores for Children With Cancer (n = 24) and Matched Control(n = 24)

Cluster

Sociability-leadershipAggressive-disruptiveSensitive-isolated

°p < .05, two-tailed

Cronbach alpha

.70

.76

.58

tests.

Children with cancer

.26

.10

.37

Control children

.64

.44- .08

Children

F(\, 22)

5.29°1.006.33°

at Mem


ewfoundland on A


Dow

nloaded from



dimension would account for the overall differences on these dimensions,univariate ANOVAs were performed with individual role scores. To protectagainst obtaining findings that were due primarily to chance, the criterionfor significance was set at .01. Significant differences between the childrenwith cancer and the matched control were found on two roles from theSociability-Leadership dimension ("someone who has good ideas" and "some-one everyone listens to") and three roles from the Sensitive-Isolated dimen-sion ("someone who can't get things going," "someone who can't get othersto listen," and "someone who plays alone").

The multivariate analysis reported above was reconducted with age,gender, school location (urban vs. rural), current chemotherapy status, andwhether the child had received cranial radiation included as additional in-dependent variables. No significant effects were found for any of thesevariables.

Validity Assessments

Three validity assessments were performed. First, differences betweenthe children with cancer and the matched controls on the nine roles addedto the RCP were examined. Since predictions were made a priori regardingnominations on the three illness roles, the criterion for significance was setat .05. The comparisons demonstrate that this methodology was sensitiveto the presence of illness in the child with cancer (Figure 1). Children withcancer were nominated significantly more often for roles indicative of ill-ness such as sick a lot, missing school, and tired. The six additional rolesrelated to academic success, appearance, and athletic abilities were addedto the play to explore the adjustment of children with cancer in these areas.No predictions were made on these roles. Teachers' nominated children withcancer as having less academic success and less athletic competence, althoughthese differences were nonsignificant trends in the data.

Second, further evidence of the concurrent validity of the RCP was ob-tained by making Appearance Ratings of the child with cancer during a class-room visit. Abnormalities in physical appearance were rated from noabnormalities (1) to major distortions (5) on a 5-point Likert scale. During10 of 24 classroom visits, two raters went to the classroom. The correlationsbetween their ratings was .93. Children with cancer were rated 1.97 (slightabnormalities). These observational data correspond to appearance role nomi-nations by teachers on the class play; children with cancer were not nomi-nated significantly more often as having less optimal appearance (see Figure 1).

Third, a final validity check was made by obtaining absentee recordsat the end of the school year from 18 of 24 schools. Children with cancer

at Mem


ewfoundland on A


Dow

nloaded from


52 NoU et al.

had missed an average of 25.6 days, controls had missed 6.5 days. In fiveof the classrooms, the child with cancer missed school less often than theirmatched control. None of these five children with cancer were nominatedby their teacher for the role "misses a lot of school."

DISCUSSION

Children with cancer differed on two dimensions of teacher's percep-tions of peer reputation: sociability-leadership and sensitive-isolated. The pro-totypical pattern for children with cancer was low-Positive, lowaverage-Disruptive, and high-Isolated scores. The picture that emerges fromthe reports by teachers suggests these children have fewer leadership and posi-tive social skills. They tended to be disengaged from peers and have difficul-ties coping with daily academic and/or interpersonal classroom demands ina positive manner. No significant differences were reported by teachers onthe aggressive-disruptive dimension. Validity checks supported the sensitivi-ty of the RCP measure to the presence of severe chronic illness in the child.The findings did not vary for gender, age, school location (urban vs. rural),on or off chemotherapy, or whether the child received cranial radiation.

Our findings are congruent with data reported from other centers onthe adaptations of children with cancer. Although children with cancer arenot reported to have significant psychopathology (Kellerman, Zeltzer, Ellen-berg, Dash, & Rigler, 1980; Zeltzer, Kellerman, Ellenberg, Dash, & Rigler,1980), they do have real problems adjusting to the social, behavioral, andacademic demands of the classroom and are at risk for current and futuredifficulties. The presence of cancer is not related to the presence of severepsychopathology, and notably these children are not perceived as being moreaggressive and disruptive, but they do appear to have difficulties with day-to-day functioning and are less competent.

The current findings show that teachers perceive children with canceras less socially competent and more socially isolated. While this study hasnumerous methodological and design advantages over previously reportedwork, these data have several limitations. First, the findings reported hereare for only 24 children with cancer, made by 24 teachers. They representa broad age range as well as a variety of childhood malignancies. While wefound no gender effects, considerable literature suggests that the impact ofstress might be expected to be different for boys than girls (Block, Block,& Gjerde, 1986; Rutter, 1980), although some authors suggest that thedifferential impact of stress on boys is merely a measurement artifact as aresult of greater externalizing symptomatology in boys (Emery, 1982). If ourfindings are replicated, they would tend to support this position for childrenwith cancer.

at Mem


ewfoundland on A


Dow

nloaded from


Peer Relationships of Children with Cancer S3

Second, our findings are based solely on teacher reports and not actualpeer nominations. Although the RCP had demonstrated considerable relia-bility and validity when used with peers, similar data do not exist when themeasure is used with teachers only. Our findings suggest that the reliabilityand validity of the measure are adequate when used with teachers, but thesefindings must be considered tentative. Relatively low reliability was obtainedfor the social-isolation factor, although the reliability observed here does notappear to differ from the reliability observed for similar factors in otherstudies (Newcomb & Bukowski, 1983). Additionally, it is important to pointout that in spite of the relatively low reliability of this factor, significant ef-fects were still obtained. Further work might compare teacher nominationswith actual peer nominations on the RCP to determine the comparabilityof the data sources or could require teachers to complete the instrument attwo points in time.

Given the reported stability of peer reputation for populations of nor-mal children, especially social withdrawal and shyness (Caspi, Elder, & Bern,1988; Kagan, Reznick, Snidman, Gibbons, & Johnson, 1988; Rubin & Mills,1988), and the ability of the RCP to predict future competence or vulnera-bility, our findings are troublesome for children with cancer. Although mor-tality rates are declining, psychosocial morbidity has become a significantissue that calls for greater comprehensive care of these children and theirneeds. Work currently underway at this center has already begun to inves-tigate the stability of peer reputation for children with cancer, and whetherproblems continue after the termination of active treatment.

REFERENCES

Aram, D. M., & Ekelman, B. L. (1986). Cognitive profiles of children with early onset of unilaterallesions. Developmental Neuropsychology, 2, 155-172.

Block, J. H., Block, J., & Gjerde, P. F. (1986). The personality of children prior to divorce:A prospective study. Child Development, 57, 827-840.

Breslau, N. (1983). The psychological study of chronically ill and disabled children: Are healthysiblings appropriate controls? Journal of Abnormal Child Psychology, 11, 379-391.

Bukowski, W. M., & Newcomb, A. F. (1984). Stability and determinants of sociometric statusand friendship choice: A longitudinal perspective. Developmental Psychology, 20, 941-952.

Cairns, N. U., Klopovich, P. , Hearne, E., & Lansky, S. B. (1982). School attendance of chil-dren with cancer. Journal of School health, 52, 152-155.

Carroll, K. G. (1988, August). Revised Class Play and sociometric classifications: Comparabil-ity and gender differences. Paper presented at the meeting of the American Psychologi-cal Association, Atlanta.

Caspi, V., Elder, G. H., & Bern, D. J. (1988). Moving away from the world: Life course pat-terns of shy children. Developmental Psychology, 24, 824-831.

Coie, J. D., & Dodge, K. A. (1988). Multiple sources of data on social behavior and socialstatus in the school. A cross-age comparison. Child Development, 59, 815-829.

Connolly, J., & Doyle, A. B. (1981). Assessment of social competence in preschoolers: Teachersversus peers. Developmental Psychology, 17, 454-462.

at Mem


ewfoundland on A


Dow

nloaded from


54 Noll et al.

Danoff, B. F., Cowchock, F. S., Marquette, C , Mulgrew, L., & Kramer, S. (1982). Assess-ment of the long-term effects of primary radiation therapy for brain tumors in children.Cancer, 49, 1580-1586.

Deasy-Spinetta, P. (1981). The school and the child with cancer. In J. J. Spinetta & P. Deasy-Spinetta (Eds.), Living with childhood cancer (pp. 153-168). St. Louis: C. V. Mosby.

Deasy-Spinetta, P., & Spinetta, J. J. (1980). The child with cancer in school: Teacher's appraisal.American Journal of Pediatric Hematology/Oncology, 2, 89-94.

Drotar, D. (1981). Psychological perspectives in chronic childhood illness. Journal of PediatricPsychology, 6, 211-228.

Duffner, P. K., Cohen, M. E., & Parker, M. S. (1988). Prospective intellectual testing in chil-dren with brain tumors. Annals of Neurology, 23, 575-579.

Duffner, P. K., Michael, M. E. Thomas, P. R. M., & Lansky, S. B. (1985). The long-termeffects of cranial irradiation on the central nervous system. Cancer, 56, 1841-1846.

Ellenberg, L., McComb, J. G., Siegel, S. E., & Stowe, S. (1987). Factors affecting intellectualoutcome in pediatric brain tumor patients. Neurosurgery, 21, 638-644.

Emery, R. E. (1982). Interparental conflict and the children of discord and divorce. Psycholog-ical Bulletin, 92, 310-330.

Featherman, D. L., & Hauser, R. M. (1977). Commonalities in social stratification and assump-tions about status mobility in the United States. In R. M. Hauser & D. L. Featherman(Eds.), The process of stratification. Trends and analysis (pp. 3-50). New York: Aca-demic Press.

Fletcher, J. M., & Copeland, D. R. (1988). Neurobehavioral effects of central nervous systemprophylactic treatment of cancer in children. Journal of Clinical and Experimental Neu-ropsychology, 10, 495-537.

Futterman, E. H., & Hoffman, I. (1970). Transient school phobia in a leukemic child. Journalof the American Academy of Child Psychiatry, 9, 477-494.

Green, K. D., Forehand, R., beck, S. J., & Vosk, B. (1980). An assessment of the relationshipamong measures of children's social competence and children's academic achievement.Child Development, 51, 1149-1156.

Hilgard, J., & LeBaron, S. (1982). Relief of anxiety and pain in children and adolescents withcancer: Quantitative measures and clinical observations. International Journal of Clini-cal and Experimental Hypnosis, 30, 417-442.

Hobbs, N., Perrin, J. M., Ireys, H. T., Moynihan, L. C , & Shayne, M. W. (1984). Chronical-ly ill children in America. Rehabilitation Literature, 45, 206-213.

Kagan, J., Reznick, S. J., Snidman, N., Gibbons, J., & Johnson, M. O. (1988). Childhoodderivative of inhibition and lack of inhibition to the unfamiliar. Child Development,59, 1580-1589.

Kashani, J., & Hakami, N. (1982). Depression in children and adolescents with malignancy.Canadian Journal of Psychiatry, 27, 474-477.

Kellerman, J., Zeltzer, L., Ellenberg, L., Dash, J., & Rigler, D. (1980). Psychological effectsof illness in adolescence. I. Anxiety, self-esteem and perception of control. Journal ofPediatrics, 97, 126-131.

Klopovich, P., Vats, T. S., Butterfield, G., Cairns, N. U., & Lansky, S. B. (1981). School pho-bia: Interventions in childhood cancer. Journal of Kansas Medical Society, 82, 125-127.

Koocher, G. P., & O'Malley, J. E. (1981). The Damocles syndrome. New York: McGraw-Hill.Koocher, G. P., O'Malley, J. E., Gogan, J. L., & Foster, D. J. (1980). Psychological adjust-

ment among pediatric cancer survivors. Journal of Child Psychology and Psychiatry,21, 163-173.

Kun, L. E., Mulhern, R. K., & Crisco, J. J. (1983). Quality of life in children treated for braintumors. Intellectual, emotional, and academic function. Journal of Neurosurgery, 58, 1-6.

Kurdek, L. A., & Krile, D. (1982). A developmental analysis of the relation between peer ac-ceptance and both interpersonal understanding and perceived social self-competence. ChildDevelopment, 53, 1485-1491.

Lansky, S. B. (1974). Childhood leukemia. The child psychiatrist as a member of the oncologyteam. Journal of American Academy of Child Psychiatry, 13, 499-508.

at Mem


ewfoundland on A


Dow

nloaded from



Lansky, S. B., & Cairns, N. U. (1979). The family of the child with cancer. Proceedings ofthe American Cancer Society National Conference on the Care of the Child with Cancer(pp. 156-162) held in Boston. New York: American Cancer Society.

Masten, A. S., Morison, P. , & Pellegrini, D. S. (1985). A revised class play method of peerassessment. Developmental Psychology, 21, 523-533.

Morison, P., & Masten, A. S. (1987, April). Peer reputation in middle childhood as a predictorof adaptation in adolescence: A seven year follow-up. Paper presented at the meetingof the Society for Research in Child Development, Baltimore.

Mueller, C. W., & Parcell, T. L. (1981). Measures of socioeconomic status: Alternatives andrecommendations.. Child Development, 52, 13-30.

Mulhern, R. K., & Kun, L. E. (1985). Neuropsychologic function in children with brain tumors:III. Interval changes in the six months following treatment. Medical and Pediatric On-cology, 13, 318-324.

Newcomb, A. F. , & Bukowski, W. M. (1983). Social impact and social preference as deter-minants of children's peer group status. Developmental Psychology, 19, 856-867.

Nock, S. L., & Rossi, P. H. (1979). Household types and social standing. Social Forces, 58,1325-1345.

Parker, J. G., & Asher, S. R. (1987). Peer relations and later personal adjustments: Are lowaccepted children at risk? Psychological Bulletin, 102, 357-389.

Pelham, W. E., & Milich, R. (1984). Peer relations in children with hyperactivity/attention deficitdisorder. Journal of Learning Disabilities, 17, 560-565.

Rubin, K. H., & Mills, R. S. (1988). The many faces of social isolation in childhood. Journalof Consulting and Clinical Psychology, 56, 916-924.

Rutter, M. (1980). Protective factors in children's responses to stress and disadvantage. In M.Kent & J. Rolf (Eds.), Primary prevention of psychopathology: Vol. 3. Promoting so-cial competence and coping in children (pp. 49-74). Hanover, NH: University Press ofEngland.

Sawyer, M., Crettenden, A., & Toogood, I. (1986). Psychological adjustment of families ofchildren and adolescents treated for leukemia. American Journal of Pediatric Hematol-ogyi'Oncology, 8, 200-207.

Serbin, L. A., Lyons, J. A., Marchessault, K., Schwartzman, A. E. & Ledingham, J. E. (1987).Observational validation of a peer nomination technique for identifying aggressive,withdrawn, and aggressive/withdrawn children. Journal of Consulting and Clinical Psy-chology, 55, 109-110.

Sollee, N. D., & Kindlon, D. J. (1987). Lateralized brain injury and behavior problems in chil-dren. Journal of Abnormal Child Psychology, 15, 479-490.

Spinetta, J. J. (1974). The dying child's awareness of death: A review. Psychological Bulletin,81, 256-260.

Spirito, A., Stark, L. J., Williams, C , Hewett, K., Drigan, R., & Andrakites, A. (1988, April).Psychosocial sequelae of survivorhood: Social adjustment of successfully treated child-hood cancer patients. Paper presented at the annual meeting of the Society of BehavioralMedicine, Boston.

Stevens, G., & Featherman, D. L. (1981). A revised socioeconomic index of occupational sta-tus. Social Science Research, 210. 364-395.

Susman, E. J., Hollenbeck, A. R. Nannis, E. D., Strope, B. E., Hersh, S. P. , & Levine, A.S. (1981). A prospective naturalistic study of the impact of an intensive medical treat-ment on the social behavior of child and adolescent cancer patients. Journal of AppliedDevelopmental Psychology, 2, 29-47.

Van Dongen-Melman, J. E. W. M., & Sanders-Woudstra, J. A. R. (1986). Psychosocial aspectsof childhood cancer: A review of the literature. Journal of Child Psychology and Psy-chiatry, 27, 145-180.

Vosk, B., Forehand, R., Parker, J. B., & Rickard, K. (1982). A multimethod comparison ofpopular and unpopular children. Developmental Psychology, 18, 571-575.

Werner, M. E., & Smith, R. (1982). Kami's children come of age. Hawaii: University of Hawaii Press.

at Mem


ewfoundland on A


Dow

nloaded from


56 Noll et al.

Young, J., Ries, L., Silverberg, E., Horm, J., & Miller, R. (1985, June). Cancer incidence,survival, and mortality for children under 15 years of age. Paper presented at the Na-tional Conference on Advances in Care of the Child with Cancer, New York.

Younger, A. J., Schwartzman, A. E., & Ledingham, J. E. (1985). Age-related changes in chil-dren's perceptions of aggression and withdrawal in their peers. Developmental Psychol-ogy, 21, 70-75.

Zeltzer, L., Kellerman, J., Ellenberg, L., Dash, J., & Rigler, D. (1980). Psychologic effectsof illness in adolescence. II. Impact of illness in adolescents. Crucial issues and copingstyles. Journal of Pediatrics, 97, 132-138.

Zwartjes, W. I. (1979). Education of the child with cancer. Proceedings of the American CancerSociety National Conference on the Care of the Child with Cancer held in Boston. NewYork: American Cancer Society.

at Mem


ewfoundland on A


Dow

nloaded from


Documents

Social Interactions Between Children With Cancer and Their Peers: Teacher Ratings