Medical responsibility growth in youth with spina bifida: Neuropsychological and parenting predictors

Development of inattention and executive dysfunction in youth with spina bifida: condition severity variables as predictors

Youth with spina bifida (SB) are at increased risk for inattention and executive dysfunction challenges. This study aimed to characterize the development of inattention and executive dysfunction in SB and examine the relationship between condition severity (i.e. lesion level, shunt status, and shunt revisions) and inattention and executive dysfunction at age 11.5 and longitudinally. Participants included 140 youth with SB. Condition severity was collected via parent reports and chart review. Parents and teachers reported on youth's inattention and executive dysfunction using informant-based measures across five time points. Parents and teachers both reported linear decreases in inhibition and working memory problems. Development of inattention and shifting problems varied by reporter. At 11.5 years, shunt status predicted worse parent- and teacher-reported inattention and executive dysfunction, while shunt revisions predicted worse parent-reported working memory alone. Higher lesion level predicted fewer parent-reported inhibition problems at 11.5 years. Over time, more shunt revisions and higher lesion level predicted worse parent-reported inattention and inhibition, respectively. Findings suggest that inattention and executive dysfunction may significantly change over time in youth with SB, related to condition severity and reporter. Early deficit identification and intervention implementation, particularly for youth with greater SB severity, may result in better longitudinal outcomes.

Contextual predictors of self-management and independence trajectories in adolescents and young adults with spina bifida

AIM

To examine socioeconomic, condition-related, and neuropsychological predictors of self-management trajectories in adolescents and young adults with spina bifida.

METHOD

In this longitudinal study, participants completed the Adolescent/Young Adult Self-Management and Independence Scale interview. Socioeconomic status (SES), shunt status, lesion level, and executive functioning were assessed. Growth in self-management was estimated using linear mixed-effects models.

RESULTS

Participants (n = 99) were aged 18 to 27 years. Approximately half (52.5%) were female and White; 15.2% were Black; and 32.3% Hispanic or Latino. Although none of the predictors were associated with growth in self-management from ages 18 to 27 years (p > 0.05), several factors were associated with the intercept at age 18 years for total self-management. Higher SES at baseline predicted a higher total self-management score at age 18 years (b = 0.03, standard error [SE] = 0.01; p < 0.001). On average, participants at age 18 years with a shunt scored lower than those without a shunt (b = -0.90, SE = 0.32; p = 0.01); those with a thoracic lesion scored lower than those with lower lesion levels (lumbar: b = -1.22, SE = 0.34; sacral: b = -1.20, SE = 0.36; p = 0.001 for both). Better parent-reported and teacher-reported executive functions predicted higher total self-management (metacognitive: b = -0.03, SE = 0.01; behavioral regulation: b = -0.04, SE = 0.01; p < 0.05 for both).

INTERPRETATION

On average, all participants improved in self-management over time. Additionally, baseline superiority in self-management for adolescents and young adults without a shunt, less severe lesions, better executive functions, and higher SES persisted over time.

WHAT THIS PAPER ADDS

Higher socioeconomic status at baseline predicted higher self-management scores at age 18 years. Participants with a shunt scored lower than those without a shunt. Participants with a thoracic lesion scored lower than those with other, less severe lesions. Better parent-reported and teacher-reported executive functions predicted higher self-management scores at age 18 years. Growth in self-management was not moderated by socioeconomic, condition-related, or neuropsychological variables.

"Crafting a 'TransitionOmeter': A Proposed Framework for Developing and Honing Capabilities of Young People Transitioning to Adult Healthcare Services."

This paper focuses on an innovative approach to preparing children and young people, with Spina Bifida, to move from child-centered to adult-oriented healthcare systems. Reflecting on our role in delivering a national nurse led service, we set to identify and critique international transition tools in use for this population. Specifically, we aimed to identify the core capabilities and indicators of progression to successful transition, so that holistic interventions could be planned to match the needs of individuals and their carers. There were two phases to the study, initially focusing on a systematic literature review on transition tools and the specific items that these tools captured, including skills, abilities and behaviors. Phase two culminated in the articulation of a segmented and incremental "road map", aligned with facets deemed essential for a successful healthcare transition. The reporting of the literature review (phase one) followed the PRISMA guidelines and shaped the qualitative element of the study (phase two) through the use of semi-structured interviews and thematic analysis. The search strategy yielded 11 studies, which were then manually searched for other relevant literature, adding a further 14 articles. The review analyzed 7 specific tools for spina bifida and 8 generic tools, which were deemed appropriate for this group of patients. A comprehensive list of core capabilities was then articulated and framed to fit a progression timeline. Specific interventions were formulated to explore ways to co-produce resources that could enhance and support a planned transition to adult-focused services. Our proposed mapping of capabilities and progression could shape other transition programs, where nurses work collaboratively with young people, carers and other members of a team. More work is needed to further explore and embed the framework that, as we did, could be digitized and shared with all stakeholders involved in the transition process.

Neurodevelopmental Outcomes for Individuals With Congenital Heart Disease: Updates in Neuroprotection, Risk-Stratification, Evaluation, and Management: A Scientific Statement From the American Heart Association

Over the past decade, new research has advanced scientific knowledge of neurodevelopmental trajectories, factors that increase neurodevelopmental risk, and neuroprotective strategies for individuals with congenital heart disease. In addition, best practices for evaluation and management of developmental delays and disorders in this high-risk patient population have been formulated based on literature review and expert consensus. This American Heart Association scientific statement serves as an update to the 2012 statement on the evaluation and management of neurodevelopmental outcomes in children with congenital heart disease. It includes revised risk categories for developmental delay or disorder and an updated list of factors that increase neurodevelopmental risk in individuals with congenital heart disease according to current evidence, including genetic predisposition, fetal and perinatal factors, surgical and perioperative factors, socioeconomic disadvantage, and parental psychological distress. It also includes an updated algorithm for referral, evaluation, and management of individuals at high risk. Risk stratification of individuals with congenital heart disease with the updated categories and risk factors will identify a large and growing population of survivors at high risk for developmental delay or disorder and associated impacts across the life span. Critical next steps must include efforts to prevent and mitigate developmental delays and disorders. The goal of this scientific statement is to inform health care professionals caring for patients with congenital heart disease and other key stakeholders about the current state of knowledge of neurodevelopmental outcomes for individuals with congenital heart disease and best practices for neuroprotection, risk stratification, evaluation, and management.