Self-care independence in children with neurological disorders: An interactional model of adaptive demands and executive dysfunction.

Abstract

Objective: To describe a neuropsychological assessment model that proposes executive functioning as a key moderator in the development of self-care independence. Setting: Inpatient and outpatient rehabilitation facilities. Participants: Transition-age youths with congenital and acquired neurological disorders. Intervention: Transition to the adaptive roles and expectations of adulthood can be challenging for adolescents with neurological disorders and other chronic medical conditions. These individuals frequently encounter functional problems related to additional time requirements, new life skill demands, and increased need for organization and planning. In addition, the neuropsychological consequences of these disorders often include deficits in motor speed and coordination as well as executive control (including planning, organization, and working memory). Consideration of the integrity of executive function skills and the presence of atypical adaptive demands is crucial during planning for transition of individuals into self-care independence and development of an approach to assessment and intervention. Conclusions: Rehabilitation psychologists have the potential to improve the quality of life of adolescents with neurological disorders as they transition into adulthood by considering the "executive burden" posed to the individuals by various combinations of executive dysfunction and atypical adaptive demands.

Age-related Differences in Executive Function Among Children with Spina Bifida/Hydrocephalus Based on Parent Behavior Ratings

“…Children with MMH are vulnerable to difficulties as they "age into" expectations for independence in daily living, self-care, vocational, social, and community integration skills (Tarazi et al, 2007). Results suggest a role for screening of executive function throughout development in this population, as functional difficulties may arise over time.…”

“…Although interpretation of the current results is limited by the cross-sectional nature of the study, our findings suggest that the functional implications of problems with maturation of executive abilities in children with MMH may not be apparent until adolescence. That is, although frequency of symptomatology appears consistent across age groups in children with MMH, we propose that the relative level of dysfunction associated with these behaviors may become more evident as these children do not meet age-appropriate expectations in areas such as independent initiation of goal-directed activity, self-monitoring, planning, and flexibility (Tarazi, Mahone, & Zabel, 2007). This observation is consistent with a qualitative description of youngsters with MMH, in which young children are often described as being hyperactive and distractible, while adolescents reportedly have difficulty with initiation of tasks, skill application, self-monitoring, and flexibility (Mahone et al, 2002c).…”

“…However, in addition to impeded maturation of executive functions, children and adolescents with MMH have additional life skills demands as compared to typically developing children (Tarazi et al, 2007). Due to the nature of the disorder, children and adolescents with MMH are typically required to manage and prevent urological, neurological, orthopedic, skin, and elimination problems, and are responsible for learning how to self-catheterize, reposition, and perform skin checks at specific times (Wolraich & Hesz, 1988).…”

Interrelationships of sex, level of lesion, and transition outcomes among young adults with myelomeningocele

“…However, a significant multivariate result was observed for LOL (Roy's largest root=0.32, F (4,40) =3.18, p=0.02). A series of one-way analyses of variance revealed differences on the social relationships domain only (F (2,42) =5.94, p=0.005).…”

“…2 However, a range of medical (e.g. muscle weakness and paralysis, bladder and bowel dysfunction, orthopedic abnormalities), 3 neurocognitive, 4 and social deficits present challenges to completing the developmental outcomes associated with early adulthood including self-management and community integration. 5 These health and social difficulties also place them at risk for psychological distress 6 and poor quality of life (QOL).…”