77 Development of Parent- and Teacher-Reported Executive Dysfunction and Inattention in Youth with Spina Bifida

Abstract

Objective:Youth with spina bifida (SB) are at increased risk of neuropsychological deficits, including executive dysfunction and inattention. While these deficits are well-documented cross-sectionally, little research has considered the development of these difficulties longitudinally. The limited research on executive dysfunction over time in youth with SB has been mixed, with some studies suggesting stable, elevated executive dysfunction (Tarazi et al., 2008) and others demonstrating improvements in inhibition and shifting in particular (Zabel et al., 2011). In contrast, no research has examined inattention over time in SB. Understanding the development of these constructs is critical for early identification of dysfunction and intervention development. This study thus aims to characterize the development of executive dysfunction and inattention in youth with SB.Participants and Methods:One hundred forty youth with SB were recruited as part of a larger, longitudinal study. Mothers, fathers, and teachers of participants (Time 1: Myouth age = 11.4 years, 53.6% female) completed questionnaire-based measures of executive dysfunction (Behavior Rating Inventory of Executive Function, BRIEF; inhibit, shift, working memory, plan/organize subscales) and inattention (Swanson, Nolan, and Pehlam Teacher and Parent Rating Scale - Fourth Edition, SNAP-IV). Data were collected over five time points occurring at two-year intervals. Growth curves were estimated using linear mixed effects models to estimate development over time.Results:Difficulties with inhibition decreased across age in youth with SB according to mother, father, and teacher reports (p=.000-.007). Mother and father reports of shifting problems decreased across age (p=.009), while teacher reports showed no significant change (p=.799). Working memory problems also significantly decreased over time, but only according to fathers and teachers (p=.004-.005). Difficulties with planning/organizing remained stable across age for all reporters (p=.076-.935). With regards to inattention, symptoms decreased across age according to mothers and teachers (p=.000-.017), but not fathers.Conclusions:Overall, inhibition, shifting, and inattention improved across age in this sample of youth with SB according to at least two reporters. Contrary to existing literature, working memory also improved over time in this sample. Planning/organizing was the only area of executive functioning that remained stable over time across reporters. These results support previous findings of improvements in behavioral regulation (i.e., inhibition, shifting), and stable, elevated planning/organizing difficulties. These findings also highlight the importance of considering different contexts and reporters’ perspectives when examining change over time. Predictors of the development of executive dysfunction and inattention should be considered, as this information may aid with increased understanding of neuropsychological function in SB and identifying which individuals may be most likely to benefit from early intervention. Examining predictors may also help explain differences in working memory development demonstrated in the current study compared to extant literature.