Investigated whether family functioning and child psychosocial adjustment were associated with spinal lesion level and shunt status in 65 children and adolescents with spina bifida myelomeningocele (age range = 8-16). Mothers of children with higher lesion levels (i.e., thoracic level) reported more attachment to their children, less family conflict, and a greater willingness to grant autonomy to their offspring. Such findings support a "marginality" interpretation of the data, insofar as the least physically impaired children with spina bifida exhibited the greatest family difficulties. Based on maternal report, children with shunts performed more poorly in school and exhibited lower levels of cognitive competence than children without shunts. Findings are discussed in relation to literatures on neuropsychological functioning and psychosocial adjustment in children with spina bifida.