Journal of the International Neuropsychological Society

Research Article

The relationship of neuropsychological functioning to adaptation outcome in adolescents with spina bifida

AMY K. HEFFELFINGERa1 c1, JENNIFER I. KOOPa1, PHILIP S. FASTENAUa2, TIMOTHY J. BREIa3, LISA CONANTa1, JENNIFER KATZENSTEINa2, SUSAN E. CASHINa4 and KATHLEEN J. SAWINa5a6

a1 Department of Neurology, Division of Neuropsychology, Medical College of Wisconsin, Milwaukee, Wisconsin

a2 Department of Psychology, Indiana University, Purdue University, Indianapolis, Indiana

a3 Developmental Pediatrics, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, Indiana

a4 College of Health Sciences, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin

a5 Center Scientist, Self-Management Science Center, College of Nursing, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin

a6 Children's Hospital of Wisconsin, Milwaukee, Wisconsin

Abstract

Adolescents with spina bifida (SB) vary in their ability to adapt to the disease, and it is likely that numerous risk and protective factors affect adaptation outcomes. The primary aim was to test neuropsychological impairment, exemplified herein by executive dysfunction, as a risk factor in the Ecological Model of Adaptation for Adolescents with SB. Specific hypotheses were that: (1) executive functioning predicts the adaptation outcome of functional independence in adolescents with SB; (2) executive functioning mediates the impact of neurological severity on functional independence; and (3) family and adolescent protective factors are related to functional independence and moderate the relationship between executive functioning and functional independence. Forty-three adolescents aged 12–21 years completed neuropsychological measures and an interview that assessed risk, adolescent and family protective factors, and functional independence. Age, level of lesion, executive functioning, and the protective factor adolescent activities were significantly correlated with the functional independence outcome. In hierarchical regression analysis, the model accounted for 61% of the variance in functional independence outcomes. Executive functioning mediated the impact of neurological severity on functional independence. (JINS, 2008, 14, 793–804.)

(Received June 05 2007)

(Revised May 20 2008)

(Accepted May 20 2008)

Correspondence:

c1 Correspondence and reprint requests to: Amy Heffelfinger, MCW Clinics at Froedtert, 9200 W. Wisconsin Avenue, Milwaukee, WI 53226. E-mail: aheffelfinger@mcw.edu

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