For children with acute lymphoblastic leukemia (ALL), the type/dose of steroid seems not to be related to adverse psychological reactions (APRs) but may be associated with sleep problems, according to a review published in Psycho-Oncology. Investigators conducted a systematic review in six databases to identify risk factors for steroidinduced APRs and sleep problems in children with ALL. Data were included from 24 articles. The quality of evidence was low overall. The type/ dose of steroid was not related to APRs based on current evidence but was possibly related to sleep problems. Younger and older patients appeared to be at risk for behavioral problems and sleep problems, respectively. No studies were found describing parental stress or medical history. The associations of genetic susceptibility need to be replicated. “Overall, these conclusions should be interpreted with caution,” the authors wrote. “One important recommendation is to implement a standardized prospective registration of both steroid-induced APRs and sleep problems and risk factors in future studies in children with ALL, since identifying children at risk and determining effective care can improve health-related quality of life during treatment.”