Carol L. Armstrong, PhD, ABPN

Carol L. Armstrong, PhD, ABPN, is a pediatric neuropsychologist in the Department of Child and Adolescent Psychiatry and Behavioral Sciences and director of the Neuropsychology Lab and Neuro-Oncology Program at CHOP.

Areas of Expertise: Diseases of the brain's white matter, neuro-oncology, memory, normal aging
Locations: Main Campus
Appointments and Referrals: 1-800-TRY-CHOP (1-800-879-2467)

  • Background

    Over the past 22 years, my laboratory has investigated the prospective longitudinal findings on the cognitive and neuroimaging outcomes associated with neural responses to radiotherapy (RT), as well as brain tumor effects on developed and developing human brains. These studies sequentially examined the possible cognitive correlates and brain region associations with the effects of tumors and radiotherapy.  We reported a double dissociation of memory systems from before to after RT, which strongly infers that RT affects memory systems differentially.  Independent replication of the memory decrement response was found by another laboratory, and we confirmed the findings in a group controlled study {Armstrong, 2012 #552}. 

    Our goal is to translate a mechanistic investigation of radiation injury effects in adults to investigations in children with brain tumors who receive RT.  A new initiative is proton RT effects in infants, relying on cognitive techniques associated with the pathophysiology of radiosensitive brain cells. Disease-specific cognitive tests, second only to a comprehensive neurocognitive evaluation, are more effective in measuring progression and treatment benefit than brief though sensitive batteries, or global cognitive measures, as shown by the effectiveness of tumor-specific cognitive measurement to predict recurrence {Armstrong, 2003 #306}.  Therefore, we propose to use both a comprehensive battery of cognitive tests for children and a paradigm considered a cognitive biomarker of cerebellar capacity for learning because the cerebellum is involved in almost 40% of brain tumors in children.  The proposed study will demonstrate the feasibility and provide pilot data for a national collaborative effort to investigate the neurodevelopmental effects of proton therapy in very young children.

    We demonstrated that pediatric response to therapeutic irradiation shows a different temporal course of post-treatment change in cognition, suggesting a different response of the neural substrate than in adults (conference papers {Armstrong, 2013 #574}, ms under review and waiting to add historical hippocampal dose reconstructions to analyses). The cognitive response functions, double dissociation of memory systems, and effect size are consistent, which supports the notions that radiation effects can be differentiated from tumor-related injury, and that cognition could be a biomarker.  Neurocognitive and neuroimaging studies of cerebellar and hippocampal responses to radiotherapy must be a part of studies of RT effects, because the cerebellum and hippocampus both 1) rely on long term depression for rapid learning and clearing of memories needed for learning, 2) contain neural stem cells, and 3) are most vulnerable to environmental injury. The prolonged developmental trajectory of the cerebellum contributes to its vulnerability. There is consensus that the hippocampi, which are critical memory structures with capacity for post-natal and adult neurogenesis, are often in the treatment field and thus important to protect in treatment plans. 

    One focus in the Neuropsychology Lab in Neuro-Oncology has been cognitive cerebellar function and neuroimaging changes over time {Armstrong, 2005 #440}. Our pilot studies (conference paper listed, ms. in preparation) show that it is very difficulty to discriminate the cortical (explicit) and cerebellar (implicit) components of neuropsychological tests. My lab is actively testing the validity of new methods to monitor radiotherapy effects that are based in current theory of the role of cerebellum in implicit cognition. The proposed study will investigate a method with greater precision and established validity – eyeblink conditioning – to measure the developmental cognitive response to proton therapy.  We have collected pilot data on eyeblink conditioning in the age group proposed in the current application, and learned that cognitive testing of toddler ages presents particular challenges.  We have learned from these experiences and are in a unique position to achieve longitudinal data acquisition of both established tests of clinical neuropsychological capacities and a more precise method – eyeblink conditioning. 

    I have brought together a team of investigators for pilot studies, and for the current study that integrates the director of infant treatment in our Neuro-Oncology Program (Minturn) with the director of pediatric radiation oncology (Hill-Kayser), and two very experienced specialists in neuroimaging: researchers in DTI and cognitive neuroscience (Ashtari) and functional MRI and cognition (Herrington).  Thus we have exceptional institutional and intellectual resources to accomplish our stated goals.

  • Education and Training


    Neuropsychology - Western Reserve Psychiatric Habilitation Center, Northfield, OH
    Neuropsychology - Ohio Industrial Commission, Rehabilitation Division, Dept. of Health Psychology, Columbus, OH

    Undergraduate Degree

    BA in Psychology - Vassar College, New York, NY

    Graduate Degree

    MA, PhD in Clinical Psychology) - Wright Institute, School in Berkeley, Berkeley, CA

  • Titles and Academic Titles

    Director of Neuropsychology Lab, Neuro-Oncology Program, The Children's Hospital of Philadelphia

    Adjunct Associate Professor of Pediatrics, Perelman School of Medicine at the University of Pennsylvania

  • Departments and Services
  • Research Interests

    Cognitive neuroscience (cognitive outcomes, neuroimaging).

  • Publications


    Armstrong CL, Morrow L. Neuropsychologia medyczna. Warsaw: Wydawnictwo Lakarskie PZWL, 2014. Polish translation from English language edition, Handbook of Medical Neuropsychology, Springer, 2011.

    Armstrong CL. Handbook of Medical Neuropsychology: Applications of Cognitive Neuroscience. C. L. Armstrong (Ed.), and L. Morrow (Assoc. Ed.). New York, NY: Springer, 2011.

    Armstrong CL. Cancer. C. L. Armstrong (Assoc. Ed.) In J. Kreutzer, B. Caplan, J. DeLuca (Eds), Encyclopedia of Clinical Neuropsychology. New York, NY: Springer, 2011.



    Armstrong CL. Early-delayed radiotherapy effects; Endothelial proliferation; Involved field radiotherapy; Late effects of radiotherapy; Late-delayed effects of radiotherapy; Metastasis; Neurofibromatosis 1; Neurofibromatosis 2; Pleomorphism; Plexiform neurofibromas; Proton beam therapy; Radiation injury; Radiation necrosis; Tuberous sclerosis; Tumor grading. In J. Kreutzer, B. Caplan, J. DeLuca (Eds), Encyclopedia of Clinical Neuropsychology. New York: Springer, 2011.


    Armstrong, CL, Schmus, CJ, Belasco, JB. Neuropsychological Problems in Neuro-Oncology. In: Armstrong CL, editor. Handbook of Medical Neuropsychology: Applications of Cognitive Neuroscience. New York: Springer; 2010.


    Armstrong, CL, Cunningham, J. Functional and Developmental Effects of Environmental CO Toxicity in Children. In Penney D, editor. Carbon Monoxide Toxicity. CRC Press; 2007.


    Armstrong, CL. The Neuropsychology of Treatments for Individuals with Brain Tumors. In: Zillmer EA, Spiers MV, editors. Principles of Neuropsychology. Belmont, CA: Wadsworth/Thomson Learning; 2001.

    Armstrong, CL, Hayes, KM, Martin, R. Neurocognitive Problems in Attention Deficit Disorder: Alternative Concepts and Evidence for Impairment in Inhibition of Selective Attention. In: Wasserstein J, Wolf LE, LeFever FF, editors. Adult Attention Deficit Disorder: Brain Mechanisms and Life Outcomes. Annals of the New York Academy of Sciences. New York: New York Academy of Sciences; 2001. Vol. 931, p. 196-215.



    Avery S, Tannazi F, Hill-Kayser C, Ashtari M, Armstrong C. Longitudinal diffusion tensor imaging study of brain development in infants treated with proton therapy. Particle Therapy Co-Operative Group, 53rd Annual Conference, Shanghai, China, June 8-14, 2014.

    Hill-Kayser CE, Lustig RA, Minturn JE, Both S, Waanders A, Belasco J, Armstrong C, Phillips P, Fisher MJ. Proton radiation for treatment of infratentorial brain tumors in infants and very young children. Journal of Clinical Oncology Annual Meeting Edition, 2014. American Society of Clinical Oncology Annual Conference, Chicago, IL. 2014.


    Knight, S, Palmer, S, Conklin, H, Schreiber, J, Armstrong, C, et al. Working memory development following treatment for childhood medulloblastoma: A 5-year longitudinal study. Australasian Society for the Study of Brain Impairment, Sydney, Australia, 2013.

    Armstrong, CL, Lustig R, Minturn J, Fisher M, Tochner Z, Hill-Kayser C, Phillips, P. Similarities and differences in adult and child responses to irradiation and implications for neural recovery. Cognitive Neuroscience Society Annual Meeting, April, 2013. Supplement of the Journal of Cognitive Neuroscience, Annual Meeting Abstracts, 2013.



    Knight SJ, Conklin HM, Palmer SL, Schreiber JE, Armstrong CL, Wallace D, Bonner M, Swain MA, Evankovich KD, Mabbott DJ, Boyle R, Huang Q, Zhang H, Anderson VA, Gajjar A. Working memory abilities among children treated for medulloblastoma: Parent report and child performance. Journal of Pediatric Psychology, 2014; doi: 10.1093/jpepsy/jsu009.

    Schreiber JE, Gurney JG, Palmer SL, Bass JK, Wang M, Chen S, Zhang H, Swain M, Chapieski ML, Bonner MJ, Mabbott DJ, Knight SJ, Armstrong CL, Boyle R, Gajjar A. Examination of Risk Factors for Intellectual and Academic Outcomes following Treatment for Pediatric Medulloblastoma. Neuro-Oncology, 2014, 16(8), 1129-1136; doi: 10.1093/neuonc/nou006.


    Palmer SL, Armstrong C, Onar-Thomas A, Wu S, Wallace D, Bonner MJ, Schreiber J, Swain M, Chapieski L, Mabbott D, Knight S, Boyle R, Gajjar A. Processing speed, attention and working memory after treatment for medulloblastoma: An international, prospective and longitudinal study. Journal of Clinical Oncology, 2013, 31(28), 3494-3500.

    Moitra E and Armstrong CL. Neural substrates for heightened anxiety in children with brain tumors. Developmental Neuropsychology, 2013, 38(5), 337-351.

    Posters and Presentations

    Invited Lectures


    Positive Outcomes: Translational Studies to Identify Phasic Injury and Recovery of Cognitive Function after Irradiation of Pediatric Brain Tumors. The Children’s Hospital of Philadelphia Research Institute Scientific Symposium, May 5, 2015.

    Quality of Life and Neurocognitive Function in Brain Tumor Survivors: Long-term cognitive outcomes across the lifespan, depression, rehabilitation. Penn Oncology Neurosurgery Symposium – Brain Tumors 2015: Bridging Precision Science and Personalized Medicine, April 10, 2015.


    Quality of Life and Neurocognitive Function in Brain Tumor Survivors. Penn Oncology Neurosurgery Symposium, June 6, 2014.


    Specificity of the Cognitive Response to Irradiation: Longitudinal Patterns. Children’s Hospital of Philadelphia, Brain Tumor Program Research Seminar, 3/1/13.

    The Nature of Attention. Children’s Hospital of Philadelphia, Neuropsychology Seminar (CE workshop), 1/23/13.

  • Awards and Honors

    2014, Fellow, American Psychological Association
    2004, International Liaison Committee of the International
    Neuropsychology Society, Research Editing Consulting Program
    2002, Diplomate, American Board of Professional Neuropsychology
    2001-2006, National Institutes of Health Scientific Review Section, Psychopathology, Developmental Disabilities, Stress and Aging
    1999, Fellow, National Academy of Neuropsychology
    1980-1981, Vassar College Graduate Research Scholar
    1971-1975, New York State Regents Scholar
    1970-1971, National Merit Scholar

  • Editorial and Academic Positions

    Editorial Positions

    2011-present, Neuropsychology Review, editorial board

    Ad hoc editor

    British Journal of Medicine and Medical Research
    Child Neuropsychology
    Cognitive and Behavioral Neurology
    Journal of the International Neuropsychology Society
    Journal of Rheumatology
    Neuropsychiatry, Neuropsychology, and Behavioral Neurology
    Pediatric Psychology
    Perceptual and Motor Skills
    Rehabilitation Psychology

  • Leaderships

    Memberships in Professional Organizations


    International Neuropsychology Society
    International Liaison Committee of the INS, Research Editing Consulting Program


    American Board of Neuropsychology: Work Sample Reviewer
    American Psychological Association, Div. 40 (Society of Clinical Neuropsychology)
    Children’s Oncology Group
    National Academy of Neuropsychology, Fellow
    Society for Neuroscience