Date of Award


Degree Type


Degree Name

Master of Arts (MA)




Spina bifida (SB) is associated with neurologic impairments that increase individuals’ risk for neuropsychological deficits, particularly inattention and executive dysfunction. While extant literature has yet to examine the development of inattention in youth with SB, some research suggests that these youth may not experience the age-related improvements in executive dysfunction seen in the general population. SB is a heterogeneous condition; thus, it is important to consider variability in condition severity when examining outcomes over time in youth with SB. Lesion level and shunt status are commonly used as indicators of SB severity and have been significantly associated with variability in neurocognition and other condition-related outcomes. Shunt revisions, which are also common in these youth and represent additional neurological insult, have also been found to be associated with parent-reported inattention and executive dysfunction in some research. Existing literature highlights a need for additional research on inattention and executive dysfunction and their development across time in youth with SB, as well as careful consideration of condition severity factors, including number of shunt revisions. Thus, this study aimed to characterize the development of inattention and executive dysfunction in youth with SB and examine the relationship between condition severity variables (i.e., lesion level, shunt status, and number of shunt revisions) and inattention and executive dysfunction at age 11.5 years and over time in these youth.

Participants included 140 youth with SB enrolled in a larger study, with data collected over five time points (Holmbeck & Devine, 2010). Medical history, including shunt status, number of lifetime shunt revisions, and lesion level, were collected via parent reports and medical chart review. Parents and teachers reported on youth’s inattention and executive function using informant-based measures across the five time points.

Parents and teachers reported linear decreases in inhibition and working memory problems over time and stability in planning/organizing problems. In contrast, the development of inattention and shifting problems varied by reporter. At age 11.5 years, shunt status predicted worse inattention and executive dysfunction according to parents and teachers, while number of shunt revisions predicted worse parent-reported working memory alone. Surprisingly, lesion level predicted better parent-reported inhibition problems at 11.5 years. Lastly, number of shunt revisions and lesion level predicted worse parent-reported inattention and inhibition over time, respectively.

These findings suggest that inattention and executive dysfunction may significantly change over time in youth with SB, though this is dependent on context and reporter. This study also identified a relationship between condition severity variables and these cognitive constructs at age 11.5 years and over time. Early identification of deficits and implementation of interventions for youth with SB, particularly youth with increased condition severity, may result in better longitudinal outcomes. Results also contribute to the expanding literature on shunting practices and highlight the need for advancements in shunting techniques to improve surgical outcomes and, as a result, later neuropsychological functioning.

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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.