Family factors as moderators of the association between specific cognitive domains and psychosocial, academic, and adaptive functioning outcomes in youth with spina bifida.

OBJECTIVE

The aim of this study was to examine the direct and interactive effects of cognitive and family factors on psychosocial, academic, and adaptive functioning outcomes in youth with spina bifida (SB).

METHODS

Participants included 41 families of youth with SB (ages 3-16 years old). Caregivers reported on child functioning (i.e., executive, psychosocial, and adaptive functioning), as well as family factors, such as family environment, marital adjustment, caregiver distress, and parenting stress. Youth completed performance-based assessments of vocabulary and academic functioning. Direct effects of cognitive and family factors on youth psychosocial, academic, and adaptive outcomes were examined using hierarchical multiple regression analyses, whereas interactive effects were examined using moderation models in PROCESS.

RESULTS

Regression analyses revealed that both cognitive (i.e., executive dysfunction, vocabulary) and family (i.e., parenting stress) factors accounted for variability in youth outcomes. Interactive effects between cognitive and family factors were also revealed when predicting youth emotional and behavioral problems, as well as adaptive skills. Specifically, greater executive dysfunction was associated with greater emotional and behavioral problems in low and moderate, but not high, quality family environments. Additionally, analyses revealed that youth with higher levels of executive dysfunction generally demonstrated poorer adaptive skills, regardless of caregiver distress. However, those with low levels of executive dysfunction demonstrated poorer adaptive skills only in the presence of more caregiver distress.

CONCLUSIONS

Both cognitive and family factors may contribute to adjustment outcomes in children with SB. Findings highlight the importance of developing comprehensive family-based interventions in the context of SB.