Spina bifida (SB) is a neural tube defect affecting the central nervous system (CNS). Most individuals with SB have primary brain dysmorphology, often along with secondary CNS disturbances resulting from hydrocephalus. Thus, SB has a multi-systemic impact on physical functioning, social competence, emotional health, coping, and several cognitive abilities such as executive functioning (EF).
Executive functioning refers to aspects of complex human behaviour that are involved in the control and direction of self-regulating behaviour. The resulting complexity of the EF domain forges its tremendous impact on everyday functioning and correlative importance to human adaptation. However, here have been relatively few validated rehabilitative interventions addressing executive dysfunction. Nevertheless, accumulating evidence shows that structured group-based training in awareness and compensatory strategy application, such as Goal Management Training (GMT)™, can produce significant benefits. GMT is a promising compensatory EF intervention that relies on verbally mediated, metacognitive strategies for improving attention and problem solving.
Despite the documented high prevalence of EF deficits in persons with SB, there are no published studies that have addressed the treatment of EF dysfunction in individuals with SB. Hence, the main aim of this randomized controlled trial was to determine the efficacy of GMT as a group-based treatment programme for adults with SB and EF deficits, employing one treatment group (GMT) and one wait-list control group (WL). The study utilized a repeated-measures design across three time points (baseline, post intervention, and at six-month follow-up). A battery of neuropsychological tests, along with questionnaires covering EF, emotional health and coping, was administered to participants at all three time points. Informant ratings on EF were included in addition to the self-reports.
The results in Paper I demonstrated that, compared to participants in a wait-list condition, participants who had received GMT showed significant improvement on neuropsychological measures of attentional control. GMT was also associated with improved performance on a desktop model of a real-life multitasking situation, suggesting generalization of intervention effects to functional performance in complex real-life settings. Gains associated with GMT were maintained at six-month follow-up.
In Paper II, significant changes were found on self-report measures pertaining to daily-life EF for the treatment group compared with the control group, lasting at least six months post-treatment. In addition, all participants were satisfied with the intervention and almost all reported that training had improved goal management in daily life. However, no changes were detected on informant-reported EF after treatment.
The findings in Paper III indicated significant effects of GMT on measures pertaining to aspects of emotional health and coping. In particular, the GMT group showed significant improvement, compared to the WL group, on a self-report inventory of depressive and anxiety symptoms, confirmed six months post-treatment. Furthermore, both groups showed improvements following training on mental health components of health related quality of life. Finally, the GMT group showed a significant increase in task-focused coping and a decrease in avoidant coping following training when compared to pre-treatment baseline assessment scores.
In summary, the findings from the three papers indicate that by employing a structured group-based compensatory strategy-training intervention to manage executive problems, EF impairments can be ameliorated in adults with congenital brain dysfunction, and effective and lasting benefits can be achieved in aspects of emotional health and coping.