Psychosocial Adjustment

Patients with myelomeningocele are at risk for behavioral problems and psychiatric disorders including poor self-esteem, less positive affect, and high levels of stress (Lavigne et al. 1988; Snow et al. 1994). Patients commonly report more internalizing behaviors, fewer family interactions, less social competence, and less independent behavior (Lavigne et al. 1988). Preadolescents are more likely to experience poor adaptation than older patients and are less likely to initiate social contacts and make independent decisions. This is typically accompanied by a more passive style when interacting with family members, particularly parents. Although inattention is a recurrent issue, these patients are less physically active given their limitations (Holmbeck et al. 2003). These tendencies develop prior to adolescence, indicating that developing mood problems are likely to persist into adolescence. Few of these patients date regularly as teenagers, and the resulting social isolation leads to reduced interactions with peers and delayed social maturation (Hayden et al. 1979). Lower socioeconomic status contributes to lower expectations for school performance in this population and appears to have an additive effect in poor psychosocial adjustment as well (Holmbeck et al. 2003).

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