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Career readiness, developmental work personality and age of onset in young adult central nervous system survivors
Posted online on August 14, 2012. (doi:10.3109/09638288.2012.703754)
1Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign,
2Children’s Brain Tumor Foundation,
New York, NY
3Department of Educational Psychology, Counseling, and Special Education, Pennsylvania State University,
Correspondence: David Strauser, Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign,
213 A Huff Hall, MC-588, 1206 South Fourth Street, Champaign, IL, 61820
USA. E-mail: firstname.lastname@example.org
Purpose: The primary purpose of this paper is to undertake foundational research in the area of career readiness, work personality and age of onset with young adult central nervous system (CNS) survivors. Method: Participants for this study consisted of 43 individuals whose age range from 18 to 30 (M = 21.64, SD = 3.46), an average age of brain tumor onset of 9.50 years (SD = 4.73) and average years off of treatment of 7.25 years (SD = 5.80). Packets were distributed to survivors who were participating in a psychosocial cancer treatment program. Participants completed multiple career instruments and a demographic form. Differences between groups and among the variables were examined and size effect sizes were analyzed. Results: Young adult CNS survivors had significantly lower levels of work personality and career readiness when compared to young adult non-cancer survivors with CNS cancer with those between the ages of 6 and 12 reported significantly lower levels when compared to individuals diagnosed before age 6 and after the age of 13. Conclusions: Young adult CNS survivors at an increased risk for having lower levels of work personality and career readiness then a norm group comparison. Age of onset (between 6 and 12) may be at significant risk factor for developing poor or dysfunctional work and career behaviors.
Implications for Rehabilitation
· Young adults with central nervous system (CNS) cancer are at particular risk for experiencing difficulties related to career and employment.
· Work personality and career readiness are two constructs that have been found to be related to one’s ability to meet the demands of work.
· Young adult CNS cancer survivors have lower levels of work personality and career readiness.
· Individuals diagnosed between the ages of 6 and 12 may be at particular risk and may need specific vocational rehabilitation interventions.
· The results of this study point to the need for comprehensive career and vocational services for young adult CNS cancer survivors.
Research indicates that adults with a history of cancer diagnosis during childhood experience significant problems related to career development and obtaining employment [1–4]. Recent metaanalysis studies revealed that adult survivors of childhood cancer are nearly twice as likely to be unemployed when compared to their healthy controls [5,6].
Problems related to career development and employment and overall quality of life are a particular concern for young adult survivors of childhood central nervous system (CNS) cancer because previous studies have indicated that this specified group experiences higher levels of unemployment, quitting work, employment in lower-skill jobs, problems identifying appropriate career and educational goals, social isolation, and reduced health and quality of life [5,7–11]. When compared to their peers with other types of cancer and their non-cancer survivor counterparts, CNS cancer survivors demonstrate higher prevalence of functional limitations and participation restrictions that interfere their employment, educational attainment, and other social outcomes [12–16].Specifically, survivors of childhood CNS cancer have been found to be five times more likely to be unemployed then when compared to their non-cancer survivor counterparts . They also have nearly 15 times the risk for not participating in school or work when compared with siblings . Often the treatment for CNS cancer, such as cranial radiation, surgery and chemotherapy, contribute to career development and employment problems by creating a variety of physical disabilities, endocrine or cardiovascular dysfunctions, neurological and neurosensory dysfunctions, cognitive and psychological problems, and increasing the individual’s general level of fatigue [17–22]. In addition, as a result of their age at diagnosis, disease progression, and treatment regime, many of these adult survivors with history of childhood cancer may not have had the opportunity to develop the skills or experiences needed to develop effective career and work behaviors, and find work that is consistent with their residual function capacity . A study of parents with young adult survivors of childhood CNS cancer found that employment concerns and a lack of career development and employment resources for their young adult children are a major concern and are associated with increased levels of parental stress .
Returning to work and pursing one’s career development has been identified as a critical part of enhancing the cancer survivorship experience . Individual’s overall identity, self-esteem, self-worth, self-concept have been linked to work. Work is also pivotal in facilitating and maintaining social relationships which provide the individual with psycho-social support which increases levels of community integration and overall health promotion [25–27]. Poor career development and not being employed has been linked to reduced cancer adjustment, general increase in health related medical problems, an overall decrease in quality of life and a decrease in the general welfare of both the individual and family [28–30].
Making career and employment decisions has been identified as a difficult, stressful and time consuming process, and can be negatively impacted by the presence of a chronic health condition or disability . Developing appropriate and functional career and vocational behavior is considered a developmental process with the ages of 6–12 being identified as critical to the overall career development process [32–34]. Research in the area of career development and vocational behavior has indicated that the career vocational constructs of career readiness and work personality are two developmental variables that significantly impact career development, vocational behavior, and ultimately employment [35,36]. Career readiness is a cognitively mediated construct that addresses the individual’s ability to effectively manage the cognitive and affective factors related to making effective career decisions . Career readiness is defined as the capability of an individual to make appropriate career and employment choices taking into account the complexity of the contextual factors (family, SES, gender) that influence an individual’s career development and employment. Capability refers to the cognitive and affective capacity of the individual to engage in effective career and employment problem solving and decision making. Complexity refers to the contextual factors originating in family, society, employing organizations, or the economy that make it more difficult to process the information necessary to solve career and employment problems and make decisions [37,38]. Research has found that individuals who have higher levels of career readiness make better and more effective career decisions and also have less psychological distress [37,38].
Work personality is a developmental construct that has been found to play a critical role in establishing the foundation for effective vocational and career behavior for individuals with disabilities, and has been linked to meeting the contextual demands of the work environment [39,40].The theoretical model of Developmental Work Personality emphasizes the importance of the home and school environments, role models embedded in each individual’s environment, and the learning experiences they provide, as being the primary influences on a child’s developing personality as it pertains to adult work behaviors. According to the developmental work personality model, an individual’s work personality begins to develop during middle childhood, the stage Erikson called Industry versus Inferiority, and is influenced by observed behaviors from parents, teachers, older siblings, and other community role models that are relevant to the child. This model consists of the environmental structure that fosters the foundation of the work personality development, as well as the process of learning behaviors in childhood that relate to adult work behaviors. Both structure and process will influence the overall development of an individual’s work personality. Research has found individuals with disabilities who have higher levels of developmental work personality are better able to meet the contextual demands of the work environment therefore increasing their overall level of employment .
Research related to career development and employment of young adult CNS survivors is needed to gain a better understanding of how CNS cancer and age of tumor onset impacts the development of career readiness and work personality. To date, no research has been conducted that has examined career development in young adult CNS survivors and the impact of age of tumor onset on the career development and vocational behavior. Exploratory foundational research is needed in this area so that potential problem areas or deficits can be indentified and that systematic programmatic intervention research can be undertaken to increase the career development and employment of young adult CNS survivors. The primary purpose of this paper is to undertake foundational research in the area of career readiness, work personality and age of onset with young adult CNS survivors. The first goal of this study is to examine differences in the levels of career readiness and developmental work personality between young adult CNS survivors and an appropriate matched normative group. It is hypothesized that young adult CNS survivors will have significantly lower levels of career readiness and work personality when compared to their age matched normative group. In addition, we are interested in exploring differences in career readiness and developmental work personality based on age of tumor onset. Based on the career development and vocational behavior theory, it is hypothesized that individuals who are diagnosed with CNS cancer between the ages of 6 and 12 (Erikson’s Industry vs. Inferiority Stage) will have lower levels of career readiness and work personality when compared to individuals who are diagnosed before age 6 and after age 13. The following two research questions guided this study:
1. Do young adult CNS survivors have lower levels of career readiness and work personality when compared to an appropriately matched group?
2. For young adult CNS survivors, are there significant differences in levels of career readiness and work personality based on age of tumor onset?
Participants for this study consisted of 43 individuals whose ages range from 18 to 30 (M = 21.64, SD = 3.46) who were young adult CNS cancer survivors and agreed to voluntarily participate in the study. Subjects were recruited from a psychosocial program that typically serves 50 individuals at one time. The majority of the participants were Caucasian making up 80.0% of the sample, followed by 7.5% African–American, 5.0% Asian/Pacific Islanders and 5.0% Hispanic. All of the participants identified themselves as single never married. Most participants were female, making up 58.1% of the sample, with 41.9% male. The majority of the participants (34.9%) completed some college, followed by 30.2% completing school through the 12th grade, 20.9% completing community college, 9.3% acquiring a 4-year college degree, and 4.7% completing a graduate program. Participants’ reported an average age of brain tumor onset of 9.50 years (SD = 4.73) and average years off of treatment of 7.25 years (SD = 5.80) (Table I).
Developmental Work Personality Scale (DWPS) [39,40] consists of 26 items addressing behaviors, role models and tasks that individuals encounter during middle childhood and which are consistent with Erikson’s developmental stage of Industry versus Inferiority [41,42]. Individuals rate DWPS item responses on a scale ranging from 0 (not at all like me) to 5 (very much like me). Example items include “In school I completed my work on time” and “I felt good when I completed my homework”. One additional item asks individuals to report their highest completed grade from 5 to 12+. A factor analysis found three distinct constructs of developmental work personality that aligned with subscales of the DWPS: Work Tasks, Social Skills, and Role Model, all with good internal consistencies . The DWPS was found to positively and significantly correlate with NEO-FFI subscales of conscientiousness and agreeableness and the subscales of the Work Personality Profile . The internal consistency for the total scale for this sample is α = 0.66, which is expected considering three distinct but related factors are contained in the scale.
Career Thoughts Inventory (CTI)  is based on the cognitive information processing theoretical approach to career development and career services  and a cognitive therapy approach to mental health and mental health services [45,46]. For the purposes of the instrument, career thoughts are defined as outcomes of one’s thinking about assumptions, attitudes, behaviors, beliefs, feelings, plans, and/or strategies related to career problem solving and decision making. The CTI consists of 48 items and produces a total score and three construct scales: (a) the Decision Making Confusion (DMC) scale, consisting of 14 items, measures the extent to which an individual’s emotions or lack of decision making skill knowledge interferes with his or her ability to make a career decision; (b) the Commitment Anxiety scale (CA), consisting of 10 items, examines the impact anxiety has on a person’s ability to commit to a career decision and (c) the External Conflict scale (EC), consisting of five items, examines how well the person utilizes input from others and his or her self-perception in decision making. Respondents use a 4-point rating scale with responses ranging from 0 (Strongly Disagree) to 3 (Strongly Agree). Examples of items are: (a) No field of study or occupation interests me at this time (Decision Making Confusion); (b) The views of important people in my life interfere with choosing a field of study or occupation (External Conflict); (c) I’m afraid of overlooking an occupation (Commitment Anxiety). CTI – total scores and three subscale scores were derived by summing the items.
Packets containing the research materials were distributed to individual young adult CNS survivors who were participating in a psychosocial cancer treatment program. All of the participants were informed that their participation in the research study was voluntary, no incentives were associated with participation, and that all data collected would be confidential. Only individuals that signed the informed consent statement were included in the study. All participants were free to withdraw from the study without penalty at any time. This study was reviewed and approved by the appropriate Institutional Review boards. All participants completed the survey packet without assistance and returned them to the researchers.
To investigate the differences between the cancer survivors and the normative group on career readiness, raw scores for CTI Total, DMC, CA, and EC were converted into T-scores based on the CTI normative data which was collected for adults from the community (n = 571) [35,44]. Sample T-tests were then conducted by entering all these converted T-scores as the manipulated variables. The boxplot presenting the converted T-scores of cancer survivor group was also presented.
To examine differences in developmental work personality, the mean scores of DWPS for the young adult CNS survivors were compared to the comparison group. The comparison group consisted of 295 college students who were at least 18 years of age, enrolled in classes at a large Midwestern University, voluntarily agreed to participate, and indicated that they did not have a disability or diagnosis of cancer. Participants ranged in age from 18 to 23 (mean=20.76, SD = 1.33), 26.7% were females, and 73.3% were Caucasian, followed by Asian (15.6%) and Hispanic (11.1%). Because our comparison group consisted of college students who were younger and had higher education level, participants’ age and education level were entered as covariates. A multivariate analysis of covariance (MANCOVA) was computed by entering the entering the total and subscale scores of DWPS (i.e. Total, Work Task, Social Skill, and Role Model) as the dependent variables and the group (i.e. cancer survivors vs. comparison group) as the independent variable. In addition, to maximize the statistical analysis nearly equal amounts of college students (n = 45) were randomly chosen from the larger original sample for comparison purposes . No significant differences were identified on any of the key demographic variables for the small group randomly chosen. Univariate F-statistics were conducted to examine mean differences for the DWPS total and subscale scores between the two groups.
To examine research question two the sample of young adult CNS survivors were divided into three age groups. Because theoretically the age of 6–12 was of interest in this study, groups were divided into the following three groups based on age of tumor onset: (1) birth to five, (2) 6–12, and (3) 13–18. To examine the differences between the three age of onset groups for the DWPS total and three subscales, four separate univariate ANOVAs were conducted by entering the total and subscale scores of DWPS (i.e. Total, Work Task, Social Skill, and Role Model) as the dependent variables and the age of onset group as the independent variable. Similar procedures were used to examine the differences between the three ages of the onset groups on the scores of CTI by entering the total and subscale scores of CTI (i.e. Total, Decision Making Confusion, Commitment Anxiety, and External Conflict) as the dependent variables.
Due to the small sample size and the desire to increase statistical power, all of the research questions were tested at 10 . In addition, the primary focus of analysis for the present study was effect size to inform the magnitude of effects and enhance the judgment regarding the “practical significance” of study results [49–51]. Confidence Intervals (CIs) for effect size were calculated using the SPSS macro provided by Michael Smithson  and reported to increase the precision of our estimates [50,53].
For research question one, results of the one sample T-tests (Table II) indicated that young adult CNS survivors had significantly higher scores (i.e. lower level of vocational identity) on the CTI total [t(40) = 0.3.35, p < 0.002, d = 0.52], and the three subscales [DMC t(40) = 2.61, p < 0.013, d = 0.41; CA t(40) = 3.52, p < 0.001, d = 0.55; EC t(40)=3.52, p < 0.002, d = 0.50] than the age-based normative sample, in which the effect of all score comparisons were medium, except the DMC comparison which was small to medium. The boxplot on T-scores of CTI scores were presented in Figure 1. The descriptive statistics for the total and three subscale scores of DWPS between the two groups are reported in Table III. Results from MANCOVA indicated that the overall model was significant [Wilks’ Lambda: F (4, 80) = 2.488, p = 0.050, η2 = 0.111], in which both covariates were not significant [F (4, 80) = 0.302, p = 0.876, η2 = 0.015 and F (4, 80) = 1.847, p = 0.128, η2 = 0.085 for age and education, respectively]. After adjusting for the covariates, follow-up univariate ANOVAs indicated that both the Total and three subscale scores of DWPS, when examined alone, were significantly different between the two groups [F (1, 83) = 4.106–8.355, ps < 0.05] with medium effects, with CNS survivors reporting lower levels on the total and all subscale scores.
For research question two, the descriptive statistics for the total and three subscale scores of DWPS and that of CTI across three age of onset groups are reported in Table IV. Results from ANOVA analyses indicated that, regarding the DWPS, the Work Task subscale score was significantly different across the three age of onset groups, [F (2, 40) = 2.805, p = 0.072, η2 = 0.123, respectively). Examination of effect size index indicated that the Work Task subscale score has the medium to large effect on the variability which was explained by memberships in the group defining the onset age of CNS. However, no significant group effect was observed in the total score and subscale scores of Social Skill and Role Model across the three groups. Further pair-wise analyses indicated that the young adult CNS survivors with their onset age of CNS 6–12-year-old scored lower on Work Tasks of the DWPS than the other two groups. Regarding the CTI, no significant difference were found for the total and three subscale scores across the three groups (all ps > 0.1) (Table V). Nevertheless, a medium effect was observed for the External Conflict subscale of CTI, suggesting that the young adult CNS survivors with their onset age of CNS 6–12-year-old tended to report higher levels of external conflict when compared to the other two groups.
Results for research question one indicate that young adult cancer survivors reported significantly lower levels of developmental work personality when compared to a sample group of young adult collage students. Examination of effect sizes indicated medium effect sizes across all subscales approaching or exceeding η2 = 0.04, the recommended minimum effect size representing practically significant effects . The results are consistent with the hypothesis and prior research with individuals with disabilities suggesting that young adult cancer survivor may experience limitations in both the structure and process that may limit their acquisition of the interpersonal skills needed to meet the contextual demands of the work environment . Study findings would also indicate the need for the development and implementation of initiatives aimed at strengthening work personality so that CNS survivors can better meet the contextual demands of the work environment.The overall results of this study indicate that young adult CNS survivors have significantly lower levels of work personality and career readiness when compared to young adult non-cancer survivors. This finding is consistent with prior research which has found that individuals with chronic health conditions and who have disabilities report lower levels of developmental work personality and career readiness compared to their non-disabled counterparts [54,55]. The most interesting finding of this study was that individual CNS survivors diagnosed with CNS cancer between the ages of 6–12 reported significantly lower levels on the Work Task subscale when compared to those survivors diagnosed before the age of 6 and after the age of 13. This finding supports the theoretical foundation regarding developmental work personality that the age group of 6–12 (Industry vs. Inferiority) is an important developmental period in the development of effective career and vocational behavior. Results also indicate that individuals who are diagnosed with CNS cancer between the ages of 6 and 12 may be at increased risk of developing lower levels of work personality which may lead to increased problems meeting the contextual demands of the work environment. When age of onset and career readiness was examined no significant differences were found. However, examination of effect sizes indicated a medium effect for the 6–12 age group for the External Conflict subscale indicating that this group scored higher on this subscale when compared to individuals with an age of onset before 6 and after age 13. The specific results for each of the two research questions are discussed below.
Study results also indicated that young adult CNS survivors reported significantly lower levels of readiness with all effect sizes exceeding the recommended minimum effect for practical significance for social science research when compared to an age based norm group. Findings suggest that young adult CNS survivors experience problems related to both the capability (cognitive and affective capacity to engage in effective career and employment problem solving and decision making) and complexity (managing family, societal, employing organizations, and cultural factors) necessary to solve career and employment problems and decisions. This finding is consistent with prior research in the area of disability that has found the individuals with disabilities have significantly lower levels of readiness for both capability and complexity . The initial findings also highlight the need for comprehensive career counseling services for young adult CNS survivors to increase knowledge regarding career decisions making and to help increase the management of environmental factors that may negatively impact the career development process.
Results for research question two indicate that individuals diagnosed with CNS cancer between the ages of 6 and 12 reported significantly lower levels of developmental work personality, specifically in the area of Work Tasks when compared to individuals diagnosed before age 6 and after the age of 13. This finding is consistent with the theory of developmental work personality and is the first study to examine age of onset and work personality development. This important finding indicates that individuals diagnosed between the age of 6 and 12 may be at particular risk for an underdeveloped work personality resulting in difficulty meeting the contextual demands of the work environment. Factors that could be contributing to the potentially underdeveloped work personality, especially in the area of work tasks, may be process related factors such as cognitive difficulties related to attention, concentration, memory, and processing speed and structural factors such as missing school for lengthy periods due to treatment and environments that do not provide adequate opportunity to develop work personality. The findings indicating no significant differences in the developmental work personality areas of social skills and role models in consistent with prior research in the area of disability .
Results for research question two also indicated that there were no significant differences for the CTI Total and across the three subscales based on age of tumor onset. However, examination of effect sizes indicated a medium effect for the 6–12 age of tumor onset group on the External Conflict scale indicating that this group had higher levels of external conflict when compared to the other two groups. Findings suggest that individuals diagnosed between the ages of 6–12 may be at more risk for experiencing problems managing family, societal, employer, and cultural factors related to engaging in career and employment problem solving. Some prior studies related to individuals with disabilities has revealed increased difficulty with issues related to external conflict but no conclusive findings have been documented . Issues related to age of onset and career readiness have not been examined in prior research so it will be important to replicate this study with a larger sample to determine if differences external conflict can be replicated and the magnitude of the differences examined.
Conclusions regarding the results of this study are limited by the following considerations. First, this study utilized a cross-sectional exploratory approach which limits the ability to determine any causal link between the variables. Second, for this exploratory study the sample size was relatively small consisting of only 43 young adult CNS survivors. As a result, our findings may not be truly representative and generalizable to the young adult CNS survivor population as a whole. Limited sample size also restricted the scope and analysis and eliminated the ability to develop more in-depth models and to examine any impact of the specific lesion location. Third, our comparison group of non- cancer survivors is limited by the fact that it is disproportionately male college students which may indicate potential differences related to cultural and socio-economic background and educational competency. Finally, limitations of self-report measures are well documented in the research and social science/medical literature.
Several important findings have been identified in this exploratory study. Study results found that young adult CNS survivors have significantly lower levels of career readiness when compared to an age based norm group. Despite no significant differences being found, young adults age 6–12 also reported elevated scores related to managing external and contextual factors related to career problem solving and decision making. Findings related to developmental work personality also found significant differences with young adult CNS survivors reporting lower levels developmental work personality when compared to norm standards with individuals diagnosed between the age of 6 and 12 reporting significantly lower levels of work personality compared to individuals diagnosed before age 6 and after age 13. All of the findings taken together provide some initial evidence for the need of comprehensive career and vocational counseling services for young adult CNS survivors in psycho-social cancer treatment programs. Findings also suggest that individuals diagnosed between the age of 6 and 12 may be at particular risk for poor career development and employment outcomes. Future studies should also extend the research examining age of onset and career development and employment outcomes and address the potential development of appropriate career and vocational interventions to increase levels of career readiness and work personality.
Declaration of Interest: The authors report no declaration of interest.
2. Kirchhoff AC, Leisenring W, Krull KR, Ness KK, Friedman DL, Armstrong GT, Stovall M, et al. Unemployment among adult survivors of childhood cancer: a report from the childhood cancer survivor study. Med Care 2010;48:1015–1025.
3. Stern M, Krivoy E, Foster RH, Bitsko M, Toren A, Ben-Arush M. Psychosocial functioning and career decision-making in Israeli adolescent and young adult cancer survivors. Pediatr Blood Cancer 2010;55:708–713.
8. Zebrack BJ, Donohue JE, Gurney JG, Chesler MA, Bhatia S, Landier W. Psychometric evaluation of the Impact of Cancer (IOC-CS) scale for young adult survivors of childhood cancer. Qual Life Res 2010;19:207–218.
9. Zebrack BJ, Gurney JG, Oeffinger K, Whitton J, Packer RJ, Mertens A, Turk N, et al. Psychological outcomes in long-term survivors of childhood brain cancer: a report from the childhood cancer survivor study. J Clin Oncol 2004;22:999–1006.
10. Zeltzer LK, Lu Q, Leisenring W, Tsao JC, Recklitis C, Armstrong G, Mertens AC, et al. Psychosocial outcomes and health-related quality of life in adult childhood cancer survivors: a report from the childhood cancer survivor study. Cancer Epidemiol Biomarkers Prev 2008;17:435–446.
11. Zeltzer LK, Recklitis C, Buchbinder D, Zebrack B, Casillas J, Tsao JC, Lu Q, Krull K. Psychological status in childhood cancer survivors: a report from the Childhood Cancer Survivor Study. J Clin Oncol 2009;27:2396–2404.
12. Ness KK, Mertens AC, Hudson MM, Wall MM, Leisenring WM, Oeffinger KC, Sklar CA, et al. Limitations on physical performance and daily activities among long-term survivors of childhood cancer. Ann Intern Med 2005;143:639–647.
14. Ness KK, Gurney JG, Zeltzer LK, Leisenring W, Mulrooney DA, Nathan PC, Robison LL, Mertens AC. The impact of limitations in physical, executive, and emotional function on health-related quality of life among adult survivors of childhood cancer: a report from the Childhood Cancer Survivor Study. Arch Phys Med Rehabil 2008;89:128–136.
18. Packer RJ, Gurney JG, Punyko JA, Donaldson SS, Inskip PD, Stovall M, Yasui Y, et al. Long-term neurologic and neurosensory sequelae in adult survivors of a childhood brain tumor: childhood cancer survivor study. J Clin Oncol 2003;21:3255–3261.
19. Gurney JG, Kadan-Lottick NS, Packer RJ, Neglia JP, Sklar CA, Punyko JA, Stovall M, et al.; Childhood Cancer Survivor Study. Endocrine and cardiovascular late effects among adult survivors of childhood brain tumors: Childhood Cancer Survivor Study. Cancer 2003;97:663–673.
20. Rønning C, Sundet K, Due-Tønnessen B, Lundar T, Helseth E. Persistent cognitive dysfunction secondary to cerebellar injury in patients treated for posterior fossa tumors in childhood. Pediatr Neurosurg 2005;41:15–21.
23. Strauser D, Feuerstein M, Chan F, Arango J, da Silva Cardoso E, Chiu CY. Vocational services associated with competitive employment in 18-25 year old cancer survivors. J Cancer Surviv 2010;4:179–186.
25. Hoffman B. Cancer survivors at work: a generation of progress. CA Cancer J Clin 2005;55:271–280.
32. Gottfredson L. Gottfredson’s theory of circumscription, compromise, and self-creation. In: Brown D, Associates, editors.Career choice and development. San Francisco, CA: Jossey-Bass; 2002. pp 85–148.
33. Super DE. The psychology of careers: An introduction to vocational development. New York: Harper & Brothers; 1957.
35. Sampson JP, Peterson GW, Lenz JG, Reardon RC, Saunders DE. The design and use of a measure of dysfunctional career thoughts among adults, college students, and high school students: the career thoughts inventory. J Career Assess 1998;6:115–134.
37. Sampson JP. Career counseling and services: A cognitive information processing approach. Belmont, CA: Thomson/Brooks/Cole; 2004.
41. Erikson EH. Identity and the life cycle. psychological issues (monograph 1). New York: InternationalUniversities; 1959.
42. Erikson EH. Childhood and society. New York: W. W. Norton & Co., Inc.; 1963.
43. Bolton B. Manual for the work personality profile: Self report version. Fayetteville, AR: ArkansasTraining and Research Center for Rehabilitation Studies; 1992.
44. Sampson JP. Manual for the career thoughts inventory: professional manual. Odessa, FL: Psychological Assessment Resources; 1996.
45. Beck AT. Cognitive therapy and the emotional disorders. Oxford, England: International Universities Press; 1976.
49. Ferguson CJ. An effect size primer: A guide for clinicians and researchers. Prof Psychol: Res Pract 2009;40:532–538.
50. Thompson B. “ Statistical,”“ practical,” and” linical”: How many kinds of significance do counselors need to consider? J Couns Dev 2002;80:64–71.
52. Smithson M. Correct confidence intervals for various regression effect sizes and parameters: The importance of noncentral distributions in computing intervals. Educ Psychol Meas 2001;61:605–632.
53. Thompson B. Effect sizes, confidence intervals, and confidence intervals for effect sizes. Psychol Sch 2007;44:423–432.