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Journal of Pediatric Psychology Advance Access originally published online on May 22, 2006
Journal of Pediatric Psychology 2007 32(2):178-188; doi:10.1093/jpepsy/jsj122
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© The Author 2006. Published by Oxford University Press on behalf of the Society of Pediatric Psychology. All rights reserved. For permissions, please e-mail: journals.permissions@oxfordjournals.org

Decision-Making Competence and Adherence to Treatment in Adolescents with Diabetes

Victoria A. Miller, PhD1 and Dennis Drotar, PhD2

1 Department of Psychology, Case Western Reserve University and, 2 Case Western Reserve University School of Medicine and Rainbow Babies and Children’s Hospital

All correspondence concerning this article should be addressed to Victoria A. Miller, Center for Research Integrity, The Children’s Hospital of Philadelphia, CHOP North Room 1514, 34th Street and Civic Center Boulevard, Philadelphia, Pennsylvania 19104. E-mail: millerv{at}email.chop.edu.


  Abstract

Objective To examine decision-making competence (the ability to form effective plans for managing different situations) in a sample of adolescents with type I diabetes and their parents. We hypothesized that adolescent decision-making competence would mediate the relationship between parent–adolescent communication and adherence to treatment. Methods The sample consisted of 63 adolescents and their parents. Parent–adolescent communication during a problem-solving task was assessed, as well as adolescent maladaptive decision-making (adolescent report), adherence to treatment (parent and provider report; number of glucose tests), and metabolic control (HbA1C). Results Parent–adolescent communication was associated with adherence to treatment but not with adolescent decision-making. Poorer decision-making was associated with lower adherence per parent report but not provider report or the number of glucose tests. Decision-making competence did not mediate the relationships between parent–adolescent communication and adherence. Conclusions These results are consistent with prior research demonstrating associations between parent–adolescent communication and adherence and identify adolescent decision-making competence as another potentially important correlate of adherence. These findings highlight several areas for future research.

Key words: adherence; decision-making; parent–adolescent communication; type I diabetes.

Received August 25, 2005; revision received December 9, 2005; revision received March 31, 2006; accepted April 12, 2006


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