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Degree Type


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Doctor of Philosophy (PhD)




The purpose of this study was to test a mediated effects model in which youth with spina bifida who have greater pain, are more overweight, or have worse motor control were expected to have fewer friends and to display worse social performance in part because their higher degree of condition severity interferes with their involvement in developmentally-appropriate activities.

Data for the current study were drawn from the first wave of a larger, longitudinal study of psychosocial adjustment of children and adolescents with spina bifida. The sample was comprised of 108 children and adolescents with spina bifida and shunted hydrocephalus, ages 8-15 years (M = 11.5, SD=2.5), their parents, and a peer chosen by youth with spina bifida to participate in the study with them. Data were collected through youth- and parent-report on questionnaires, neuropsychological testing with youth, and video-recorded standardized interaction tasks involving participants with spina bifida and their nominated peers.

Children and adolescents reported their current pain as moderately intense (M = 3.48, SD = 3.22; using a 0 - 10 visual analog scale) and 60% were overweight or obese according to BMI-percentile (i.e., > 85th percentile body mass index-for-age; M = 75.77, SD = 28.47). Child motor function was rated on a 1 - 5 scale, with "5" representing greatest motor limitations. The sample modal motor function was Level 4, which represents a functional level characterized by transportation in a manual wheelchair across most settings. Median number of friends reported by parents was "2 or 3" friends (ranging from "none", "1", "2 or 3", or "4 or more") and social performance was observed to be generally adaptive (M = 3.39, SD = .58, mean item score as coded on 1 - 4 scale). Average overall IQ among participants was within the low average range (WASI FSIQ M= 82.09, SD=19.55).

Multiple regression analyses were conducted to test the mediated effects model, with IQ included as a covariate in all analyses. Findings supported several direct and indirect associations between condition severity and social competence, rather than the hypothesized mediated effects model. First, pain intensity was indirectly associated with social functioning in that children with greater pain were reported to exhibit less activity involvement â= -.29, F (2, 48) = 10.98, p < .001, which was, in turn, related to less adaptive social performance with peers. However, weight status had a direct impact on social outcomes; a higher degree of overweight was associated with having fewer friends â= -.29, F (2, 48) = 10.98, p < .001.

Pain intensity and weight status affect the social competence of children and adolescents with spina bifida through different pathways. Pediatric psychologists can work to enhance the social functioning of these youth by routinely assessing these frequently overlooked condition-related factors, providing behaviorally-based interventions to directly treat the youth's pain or overweight, and encouraging youth involvement in developmentally-appropriate activities.

Creative Commons License

Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 License.