Therapietrouw bij kinderen, adolescenten en opkomende volwassenen met Type 1 diabetes: de rol van opvoeding en executief functioneren

Type 1 diabetes is one of the most complex and frequent chronic diseases in children and adolescents affecting approximately 1.7 in 1,000 children worldwide (International Diabetes Federation, 2015). Type 1 diabetes requires intensive daily treatment consisting of blood glucose monitoring, insulin therapy, regulation of carbohydrate intake, and exercise, based on the principle of self-monitoring (Atkinson, Eisenbarth, & Michels, 2014). Treatment adherence, that is, the extent to which a patient’s behavior -taking medication, following a diet, and/or executing lifestyle changes-, corresponds with agreed recommendations from a health care provider (WHO, 2003), is crucial for reducing short- and long-term complications. However, most youth with type 1 diabetes do not attain optimal glycemic control (Wood et al., 2013). Therefore, examining the role of potential antecedent and intervening mechanisms for treatment adherence is crucial. The central aim of this dissertation is to address certain gaps in previous research regarding different aspects of the parental context in type 1 diabetes in children, adolescents, and emerging adults with type 1 diabetes in an attempt to inform clinical practice and health care professionals working with youth with type 1 diabetes. In Chapter 2, existing research on parenting in youth with type 1 diabetes is expanded to the understudied group of emerging adults. In a sample of 521 adolescents and emerging adults, and both their parents, three features of parenting (diabetes-specific parental regulation, responsiveness, psychological control) were examined in relation with treatment adherence. Results demonstrated the continuing importance of warm, responsive, and non-critical or intrusive parental involvement in adolescents as well as emerging adults. Findings were similar for fathers and mothers, therefore confirming the importance of targeting fathers as equal partners in the parenting process of adolescents and emerging adults with type 1 diabetes. In Chapter 3, the role of parental expectations and communication style (i.e., in an autonomy-supportive vs. controlling way) toward adolescents’ motivation (i.e., internalization and defiance) to adhere (or not) to treatment guidelines for type 1 diabetes was investigated. In a sample of 136 adolescents aged 11 to 18 years old, results revealed that differences in parental communication style relate differentially to adolescents’ motivation to adhere to treatment guidelines for type 1 diabetes and, subsequently, to treatment adherence and glycemic control. In Chapter 4, a specific part of parental functioning, namely executive functioning, was measured in addition to child executive functioning. In a sample of 232 mothers and 168 fathers of 270 patients aged 6 to18 years, results demonstrated a significant interplay between child and parental EF in the association with treatment adherence and glycemic control. Chapter 5 provides a summary of these findings, a discussion of limitations, as well as suggestions for clinical practice.status: publishe