Profiles of Neuropsychological Functioning in Children and Adolescents with Spina Bifida: Associations with Biopsychosocial Predictors and Functional Outcomes

Abstract

Objectives: The current study examined neuropsychological performance among children with spina bifida (SB) to determine biological and functional correlates of distinct "profiles" of cognitive functioning. Methods: A total of 95 children with SB myelomeningocele (ages, 8-15 years) completed a neuropsychological assessment battery. Hierarchical and non-hierarchical cluster analyses were used to identify and confirm a cluster solution. Hypothesized predictors of cluster membership included lesion level, number of shunt surgeries, history of seizures, age, ethnicity, socio-economic status, and family stress. Outcomes included independence, academic success, expectations for the future, and quality of life. Results: Ward's cluster method indicated a three-cluster solution, and was replicated with two other cluster analytic methods. The following labels were applied to the clusters: "average to low average" (n = 39), "extremely low to borderline" (n = 27), and "broadly average with verbal strength" (n = 29). Socio-econimc status, lesion level, and seizure history significantly predicted group membership. Cluster membership significantly predicted independence, academic success, parent expectations for the future, and child reported physical quality of life. Conclusions: Findings from this study suggest qualitatively different cognitive profiles exist among children with SB, and the relevance of neuropsychological functioning for day-to-day adaptive functioning and quality of life. Clinical implications and future research are discussed. (JINS, 2016, 22, 804-815)

Language and Latino immigrants living with spina bifida: Social determinants of health – the missing dimension in quality of life research

“…Whereas researchers utilized supplementary assessment measures to investigate additional dimensions (e.g., stress, anxiety, depression, cognitive function) that theoretically could impact QOL [36,41,42,45], in our US-based review where an estimated 55 million Hispanics/Latinos live, we found no study that probed cultural aspects (e.g., language, acculturation, immigration, etc.) as potential modifiers on QOL.…”

“…Lastly, two studies reported on cognitive function outcomes with regard to QOL. In a study by Wasserman and Holmbeck [41], cognitive ability was assessed using the Wechsler Abbreviated Scale of Intelligence (WASI) and subtests from the Wide Range Achievement Tests 3 (WRAT3), the Cognitive Assessment System (CAS), the Delis Kaplan Executive Function System (D-KEFS), the Test of Everyday Attention for Children (TEA-Ch), the Diagnostic Analysis of Nonverbal Accuracy 2 (DANVA2), and the Comprehensive Assessment of Spoken Language (CASL). The results from this study revealed qualitatively different cognitive profiles among children with SB, which ultimately related to physical QOL.…”

“…, were also used, but less frequently. Although the majority of studies used solely generic assessments of QOL (n = 13/18; 72%) [30][31][32][33][34][35][36][37][38][39][40][41][42], two articles reported the use of both a generic and a SB-specific QOL measure (i.e., PedsQL 4.0 and SB-HRQOL, n = 2/18; 11%) [43,44], and three studies (n = 3/18; 17%) documented QOL entirely utilizing validated instruments specific to SB (SB-HRQOL, FICQOL, and QUALAS) [13,45,46]. Regarding risk of bias, incomplete outcomes data were noted in eight of the 18 studies [33,34,[37][38][39][40]42,45].…”

A cross sectional single institution study of quality of life in adult patients with spina bifida

“…Wasserman and Holmbeck describe different clusters of cognitive functioning in children with SB based off of lesion level, shunt procedures, seizure history, age, ethnicity, socioeconomic status, and family stress. 19 These clusters are thought to impact independence and quality of life. The children who undergo reconstruction may begin in a different cognitive clustering group than those who do not require this throughout their lifetime.…”

“…Wasserman and Holmbeck describe different clusters of cognitive functioning in children with SB based off of lesion level, shunt procedures, seizure history, age, ethnicity, socio‐economic status, and family stress . These clusters are thought to impact independence and quality of life.…”