Effect of Extrinsic Motivation on Academic Fluency Outcomes in Survivors of Pediatric Medulloblastoma
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Medulloblastoma is the most commonly diagnosed malignant pediatric brain tumor. While deficits in processing speed, memory, attention, and IQ are well documented in childhood medulloblastoma survivors, impairments in academic functioning have not been adequately studied in this population, despite the fact that most survivors require long-term special education services and are significantly less likely than their healthy peers to finish high school. The present study is the first to identify fluent academic performance as a significant weakness relative to academic skill development in childhood medulloblastoma survivors-thereby isolating fluency as a major contributing factor to survivors' academic difficulties. The present study is also the first to investigate the effects of enhanced extrinsic motivation on fluent academic performance in pediatric medulloblastoma survivors. As such, this study represents a new direction for research in this population, moving beyond basic documentation of deficits toward intervention-focused research. A previous study indicated that extrinsic motivation enables survivors of childhood medulloblastoma to improve their performance to the normal range on tasks related to processing speed and attention (Riva, Pantaleoni, Milani, & Belani, 1989). However, prior to the present study, there had been no further investigations of this isolated finding. Present results suggest that a performance-based incentive used to enhance extrinsic motivation predicted statistically significant improvement, but not normalization of function, in performance on measures of academic fluency relative to baseline. No demographic, medical, or neuropsychological variables predicted response to incentive. Findings suggest that academic performance of survivors can significantly improve under highly motivating conditions. Recognition of this potential for improvement in light of persisting limitations in fluency, suggesting deficits that cannot be fully overcome, may inform academic supports. Additionally, the findings of this study may provide a rationale for investigations of the effect of varying levels of motivation in other pediatric medical populations and with respect to other areas of neurocognitive functioning. The findings of this study also represent a significant and novel contribution to the debate regarding level of effort and the effect of motivational states on neuropsychological performance.