Treatment Adherence in Children with Type 1 Diabetes: The Role of Patient and Parental Executive Functioning

Treatment adherence in children with T1D: The role of patient and parental executive functioning Objective. Managing type 1 diabetes (T1D) requires the ability to make complex and critical decisions regarding treatment, to execute complex tasks accurately and to make adjustments when problems arise. This requires effective neuropsychological competencies of patients and their families, especially in the domain of executive functioning (EF). EF refers to a set of skills necessary for independent, purposeful, goal-directed activity (e.g., the ability to self-monitor, plan, solve problems, set priorities). Research on this matter in T1D is scarce and has focused mainly on EF in young patients, leaving the role of parental EF unaddressed. This multi-informant study examined associations and interactions between child and parental EF and treatment adherence in T1D. Methods. 284 patients with T1D (6-18 years old) were included (mean age 13yrs; 54% male). 229 mothers and 163 fathers parents filled out questionnaires on child and parental EF and on treatment adherence. Of the 11-18 year olds, 136 young patients filled out self-reports as well. Analyses within and across informants examined the associations between patient and parental EF and treatment adherence (and potential moderation effects in these associations). Results. Overall, especially child EF was consistently and clearly associated with treatment adherence (between and across informants). Moreover, there was a consistent interaction effect between child and parental EF in the prediction of treatment adherence. For instance, child EF had an effect on treatment adherence especially when parental EF was good. Conclusions. This multi-informant study adds to current knowledge about treatment adherence by implementing not only child but also parental EF. As the present study demonstrates the significant role of child as well as parental EF, researchers and clinicians should remain attentive towards the role of neuropsychological concepts such as EF in the domain of T1D. Implementation in clinical practice seems necessary and meaningful.status: publishe