This study explores the "higher order" cognitive abilities of conceptual reasoning, problem solving, mental flexibility, and efficiency in 36 adolescents with spina bifida. The subjects, age 10 to 23 years, were assessed on a set of neuropsychological measures, and an individual profile analysis was conducted. All subjects, regardless of intelligence quotient, evidenced significant impairments of mental flexibility, efficiency of processing, conceptualization, or problem-solving ability. Separate data analysis was carried out for subjects with an average intelligence quotient. Results indicated a high degree of variability within profiles with at least one area of dysfunction (as determined by performance less than the 15th percentile) for each subject. This study demonstrates the need for individual analysis of "higher order" cognitive functions including conceptual reasoning, problem solving, mental flexibility, and efficiency of thinking for children who have spina bifida, regardless of level of lesion or general intelligence level. It is argued that neuropsychological deficits underlie the "motivational" and academic difficulties observed often among this population, especially for those with an average intelligence quotient. These data support the need to assess conceptual abilities in children with spina bifida and to provide consultation and early intervention services.