Journal of Pediatric Psychiatry, Vol 24, 499-509, Copyright © 1999 by Society of Pediatric Psychology
JS Hommeyer, GN Holmbeck, KE Wills and S Coers
OBJECTIVE: To examine relations between condition severity and psychosocial
functioning in 70 8- and 9-year-old pre-adolescents with spina bifida by
testing several direct, indirect, and mediated effects models for proximal
functional status and distal adjustment outcomes. METHODS: Proximal
functional status outcomes (e.g., degree of involvement in activities,
scholastic competence, athletic competence, attentional problems) and
distal adjustment outcomes (e.g., behavior problems, social competence)
were assessed with mother, father, and teacher report. Severity variables
included spinal lesion level, spina bifida classification, shunt status,
ambulation status, number of shunt surgeries, and two severity composites.
RESULTS: Condition severity was associated with the proximal functional
status outcomes across parent and teacher report. In contrast, no
significant relationships were found between the severity parameters and
distal adjustment outcomes. Findings supported a proximal effects model of
condition severity as well as an indirect effects model (e.g., presence of
a shunt-->less scholastic competence-->less social competence) and
were consistent with recent theoretical formulations (e.g., Wallander &
Varni, 1995). CONCLUSIONS: Disentangling proximal functional status
outcomes and distal adjustment outcomes is critical in studies of condition
severity and psychosocial functioning. We discuss clinical implications.
ARTICLE
Condition severity and psychosocial functioning in pre-adolescents with spina bifida: disentangling proximal functional status and distal adjustment outcomes
Loyola University of Chicago, Department of Psychology, Illinois 60626, USA.
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