Self-care independence in children with neurological disorders: An interactional model of adaptive demands and executive dysfunction

Objective: To describe a neuropsychological assessment model that proposes executive functioning as a key moderator in the development of self-care independence. Setting: Inpatient and outpatient rehabilitation facilities. Participants: Transition-age youths with congenital and acquired neurological disorders. Intervention: Transition to the adaptive roles and expectations of adulthood can be challenging for adolescents with neurological disorders and other chronic medical conditions. These individuals frequently encounter functional problems related to additional time requirements, new life skill demands, and increased need for organization and planning. In addition, the neuropsychological consequences of these disorders often include deficits in motor speed and coordination as well as executive control (including planning, organization, and working memory). Consideration of the integrity of executive function skills and the presence of atypical adaptive demands is crucial during planning for transition of individuals into self-care independence and development of an approach to assessment and intervention. Conclusions: Rehabilitation psychologists have the potential to improve the quality of life of adolescents with neurological disorders as they transition into adulthood by considering the "executive burden" posed to the individuals by various combinations of executive dysfunction and atypical adaptive demands.