Date of Award

Summer 2013

Document Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

Department

Clinical Psychology

First Advisor

Kaugars, Astrida S.

Second Advisor

VanHeck,e Amy

Third Advisor

Nielson, Kristy

Abstract

Children and adolescents living with Type 1 Diabetes Mellitus (T1DM) face many challenges in their daily lives due to the extensive care tasks that the illness requires. Adolescence is a period of development in which treatment adherence and metabolic control has been found to greatly decline. Research examining correlates of this decline in self-management has tended to focus on familial and psychosocial variables such as parental involvement and T1DM-related conflict. The period of adolescence is also marked by several changes in the development of the frontal lobes and prefrontal cortex, which are areas of the brain that are central to executive functioning abilities. The present study will examine executive functioning among adolescents with T1DM to explore its relationship with treatment adherence, metabolic control, and with measures of family involvement in the management of T1DM.

Eighty four adolescents diagnosed with T1DM (ages 12-18) and their parents completed the study. Parents and adolescents completed questionnaires assessing adolescents' executive functioning, parental involvement, monitoring, and conflict.

Adolescents completed neuropsychological measures assessing several aspects of their neuropsychological functioning including their executive functioning, intelligence, and

memory. In addition to this, adolescents' medical records were reviewed to collect hemoglobin A1c (HbA1c) values, which represent levels of metabolic control.

In general, results supported our hypotheses, in that adolescents with better developed parent and self-reported executive functions tended to display better adherence to their T1DM treatment regimen. Additionally, parent and self-reports of adolescent executive functioning were shown to be significant predictors of adherence beyond the contributions of several demographic and family functioning variables. Examination of parents' contributions to adolescents' T1DM management revealed that parental involvement was a significant moderator of the relationship between adolescents' executive functioning and treatment adherence, such that parental involvement had a larger impact for adolescents who demonstrated poorer executive functions.

Overall, the study finds support for measuring executive functioning abilities in adolescents with T1DM as a potentially important contributing factor in aiding adolescents with the complex management of this illness.

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