Pre-existing neurodevelopmental and neuropsychiatric difficulties in children with brain tumours: implications for future outcome studies Daniel E Lumsden 1 , Claire Woodthorpe 1 , Darren Hargrave 2 , Tammy J Hedderly 1 1 Paediatric Neurosciences, King's College Hospital NHS Foundation Trust, London, UK. 2 Paediatric Oncology Unit, The Royal Marsden NHS Foundation Trust, London, UK. Correspondence to: daniel.lumsden@nhs.net doi: 10.1111/j.1469-8749.2010.03822.x SIR–In recent months there has been renewed interest in pro- moting the early detection of brain tumours in children. Delay in the diagnosis of brain tumours causes distress to the patient, their family, and the clinician. Studies into the presenting fea- tures of children with newly diagnosed brain tumours have tended to concentrate on identifying discriminatory signs or symptoms in the child which would prompt earlier referral for further investigation. 1–3 We would like to highlight our own observations about the importance of careful screening in these newly diagnosed patients for neurodevelopmental prob- lems. Outcome studies in children with brain tumours have tended to concentrate on survival rates and on cognitive and developmental measures post treatment. There is cur- rently a relative paucity of information regarding neurode- velopmental and neuropsychiatric disorders in children presenting with brain tumours prior to the commencement of treatment. Our paediatric Neuro-oncology Multidisci- plinary Team thinks that there is a high prevalence of pre-existing neurodevelopmental and neuropsychiatric prob- lems in children with brain tumours before treatment is started. We would suggest that the early identification of these problems has important implications both for the management of the individual child and for future outcome studies. We reviewed the clinical notes and neurodevelopmental histories of all children with newly diagnosed brain tumours presenting to our service between July 2006 and November 2009. During this period 131 children with newly diag- nosed brain tumours were identified. In 13 out of 131 (9.9%) of these patients a pre-existing neurodevelopmental problem was documented (Table SI published online only). In all cases children had been under follow up by local Paediatric and Community Paediatric services. Diagnoses of speech and developmental delay had been made following assessment by these services, including use of the Griffiths Mental Development Scales. Particularly striking was the 6 out of 131 (4.6%) children with documented autistic spec- trum disorders (ASDs), well above the 1% prevalence expected in the general population. 4 These diagnoses were made following comprehensive patient multidisciplinary assessment, including either the 3Di computer assessment, the Autism Diagnostic Interview or the Diagnostic Inter- view for Social and Communication Disorders. In a number of children longstanding psychiatric comorbidity was also documented. As might be expected, a number of these children had con- firmed diagnosis of tuberous sclerosis (n=4) or neurofibro- matosis (n=2), conditions pre-disposing to both tumour development and neurodevelopmental problems. In a number of children no such predisposition could be found. It is uncer- tain to what extents direct tumour effects contributed to the neurodevelopmental problems for each individual child. There may be an as yet unrecognised genetic predisposition to both tumour and developmental problem. We believe that our case series demonstrates a high preva- lence of neurodevelopmental problems, particularly ASDs, in children presenting with newly diagnosed brain tumours. We welcome ongoing work to promote the early identification of children with brain tumours and would like to take the oppor- tunity to encourage clinicians involved in the management of these patients to consider routine screening for neurodevelop- mental problems and psychiatric comorbidity in order to help determine the true prevalence of these problems in this impor- tant patient group. ONLINE MATERIAL/SUPPORTING INFORMATION Additional material for this article may be found online. REFERENCES 1. Wilne S, Collier J, Kennedy C, Koller K, Grundy R, Walker D. Presentation of childhood CNS tumours: a systematic review and meta-analysis. Lancet Oncol 2007; 8: 685–95. 2. Wilne SH, Ferris RC, Nathwani A, Kennedy CR. The pre- senting features of brain tumours: a review of 200 cases. Arch Dis Child 2006; 91: 502–6. 3. Wilne S, Koller K, Collier J, Kennedy C, Grundy R, Walker D. The diagnosis of brain tumours in children: a guideline to assist healthcare professionals in the assessment of children who may have a brain tumour. Arch Dis Child 2010; 95: 534–9. 4. Levy SE, Mandell DS, Schultz RT. Autism. Lancet 2009; 7: 1627–38. ª The Authors. Journal compilation ª Mac Keith Press 2010 93 DEVELOPMENTAL MEDICINE & CHILD NEUROLOGY CLINICAL LETTER