Longitudinal Associations among Individual Factors, Parenting Behaviors, and Medical Responsibility in Youth With Spina Bifida: Mediation, Moderation, and Growth Analyses

The objective of this research was to examine how youth individual factors (neuropsychological functioning and depressive symptoms) and maternal and paternal acceptance, behavioral control, and psychological control were associated with child medical responsibility among youth with spina bifida (SB). These longitudinal studies examined multimethod, multi-informant data from families of youth with SB, their parents, and teachers. The first study used bootstrapping methods to examine two competing, mediational pathways through which depressive symptoms, executive functioning, and attention were associated with medical responsibility over time. The second study used moderation analyses to examine how parenting behaviors moderated the relationship between these cognitive skills and medical responsibility over time. The third study used mixed methods growth analyses to explore how neuropsychological factors and parenting behaviors were related to trajectories of medical responsibility across adolescence and young adulthood, utilizing a task specific approach. Results are discussed within the context of broader social-ecological frameworks of pediatric self-management. These findings have implications for potential interventions targeted at helping families manage the transition from parent- to self-management of SB medical tasks. Further investigation of the impact that individual, family, and community factors have on the unfolding of medical responsibility among youth with SB is warranted.