Alexa Stern

Training Track: Clinical

Lab:  CHATS Lab

Advisor: Grayson Holmbeck, Ph.D.

Office: Coffey 302

Email:  astern4@.luc.edu

Webpage: http://chatslab.weebly.com/

University of Pennsylvania, BA, Psychology

Alexa is in interested in working with youth with acute and chronic health conditions and their families to promote adjustment and coping. Her work focuses on individual and family factors that impact self-management and adherence among children and adolescents with chronic medical conditions.

Depressive Symptoms, Neuropsychological Functioning, and Self-Management in Youth with Spina Bifida: Direct, Mediating, and Reciprocal Pathways

Although successful self-management of health care responsibilities is critical to meeting the developmental demands associated with the transition to adulthood in youth with spina bifida (SB), research on individual factors impacting self-management in this population is sparse. Given the increased risk for cognitive deficits and development of depressive symptoms in this population, this study aimed to examine two pathways through which depressive symptoms and neuropsychological dysfunction may be associated with self-management in youth with SB. First, it was hypothesized that neuropsychological functioning would mediate the relationship between depression and self-management. Second, an alternative model was tested whereby it was expected that depressive symptoms would mediate the relationship between neuropsychological dysfunction and self-management. Participants included 114 youth with SB (M age = 10.96 at Time 1). Data were collected at three time points, each spaced approximately two years apart. Youth, their parents, and their teachers completed questionnaires on child depressive symptoms, child neuropsychological functioning, and child self-management behaviors. Youth also completed a brief test battery assessing executive functioning. Greater deficits in attention and working memory, and more severe depressive symptoms predicted lower levels of medical responsibility over time. Unique relationships were found among depressive symptoms and individual cognitive deficits. Bootstrapped mediation analyses revealed that teacher-reported depressive symptoms significantly mediated the respective relationships between attention and working memory, and medical responsibility (all p’s < .05), but that neuropsychological dysfunction did not mediate the relationship between depressive symptoms and medical responsibility. It is hoped that this research will inform the development of evidence-based interventions aimed at improving and fostering the development of self-management in youth with SB.

Grayson Holmbeck, Ph.D., Noni Gaylord-Harden, Ph.D.

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.