Associations between academic and neurocognitive functioning and bowel program management independence in youth and young adults with spina bifida.

BACKGROUND

Youth and young adults with spina bifida (SB) are at risk for neurocognitive challenges and face substantial medical needs, including neurogenic bowel management. Little is known about the relationship between neurocognitive functioning and independently managing a bowel program. Understanding these associations could help tailor interventions that promote independence and long-term quality of life.

OBJECTIVE

To examine whether performance-based measures of intellectual functioning, academic achievement, and executive functioning are associated with bowel management program (BMP) independence in a clinical sample of youth and young adults with SB. We hypothesized that better neurocognitive and academic functioning would be associated with greater BMP independence.

DESIGN

Cross-sectional study using secondary analysis of an institutional clinical registry. Binary logistic regression using weighted least squares mean and variance estimation tested predictors of bowel management independence, including a latent academic functioning factor and observed full-scale IQ, adjusting for age and ambulation status.

SETTING

Outpatient hospital pediatric rehabilitation clinic.

PARTICIPANTS

A total of 79 individuals with SB (ages 10-25 years; 50.6% female) with data on BMP status and neuropsychological testing.

INTERVENTIONS: Not applicable.

MAIN OUTCOME MEASURE: BMP independence, as measured by a parent-reported (if under 18 years) or self-reported (if older than 18 years) questionnaire.

RESULTS

After adjusting for age and ambulation status, higher full-scale IQ (odds ratio [OR] = 1.32 [95% CI, 1.04-1.67], p = .025) and academic functioning (as defined as a latent variable including reading, writing, and math performance) (OR = 1.35 [95% CI, 1.08-1.69], p = .009) were associated with greater BMP independence. Executive functioning (as defined by a latent variable including tasks assessing planning, problem-solving, initiation, and cognitive flexibility) was not a significant predictor. When both full-scale IQ and academic functioning were included in a multivariable model, only full-scale IQ remained a significant independent predictor (OR = 1.45 [95% CI, 1.04-1.68], p = .004), suggesting that overall intellectual ability accounts for much of the variance in self-management.

CONCLUSIONS

Higher intellectual functioning is associated with BMP independence in youth and young adults with SB, indicating that key cognitive abilities support self-management. These findings highlight the importance of considering general intellectual ability when designing individualized treatment plans and emphasize the need to address broader contextual barriers to promote successful self-management.