Associations Among Executive Functioning, Family Functioning, Adolescent Responsibility, and Adherence in Pediatric Inflammatory Bowel Disease

Background: Inflammatory Bowel Disease (IBD) is a common cause of chronic pain for adolescents in the United States. Adherence to the treatment regimen is a significant concern, particularly for adolescents. Barriers to adherence are varied, but include cognitive factors, such as forgetting. Parent involvement is associated with increased adherence in this population, though adolescent involvement is less studied. Family functioning is associated with adherence to medication regimen across pediatric chronic illnesses, including IBD treatment regimen. To better inform clinical care, this study aims to understand the relations among adolescent’s responsibility, executive functioning, family functioning, and adherence. Methods: The current study used a cross-sectional, observational design with a sample of 48 adolescents with IBD and their caregivers. Adolescents completed measures of family responsibility in IBD care and executive functioning at one time point. Parents completed measures of demographics, family responsibility in IBD care, and family functioning. Additionally, parents and adolescents conjointly completed a measure of medication adherence. The PROCESS macro was used to conduct a mediation analysis to determine if adolescent responsibility served as a mechanism or a mediator in the relation between executive functioning and adherence. The PROCESS macro was also used to test if executive functioning and family functioning acted as moderators in the relation between adolescent responsibility and adherence. Results: Adolescents in the study who took daily medications (N = 23) reported high adherence rates even after a correction factor was used to account for inflation in self-report (M = 90.41%, SD = 3.44). Mediation analyses between executive functioning, adolescent responsibility, and adherence were not significant using either parent-reported child involvement or self-reported child involvement scores. However, executive functioning was a significant predictor of adherence even when adolescent involvement was included in the model, with greater challenges with executive functioning associated with worse adherence (B = -.19, SE = .07, t = -2.63, β = -.53, p = .02 with parent-report; B = -.18, SE = .07, t = -2.44, β = -.50, p = .03 with child-report). Moderation analyses between adolescent responsibility, executive functioning, family functioning and adherence were not significant. Discussion: There seems to be evidence to support an association between executive functioning and adherence. This association should be further studied in a larger sample for confirmation. Additionally, the low percentage of participants who took daily medications suggests a changing landscape in the IBD treatment regimen, which has implications for future research