Associations between executive functioning and adherence in pediatric celiac disease

A strict gluten-free diet is the only treatment for celiac disease (CD), yet dietary adherence can be challenging for youth and may be impacted by the youth's executive functioning and attentional abilities. This study aimed to investigate whether attention and executive functioning (EF) were associated with dietary adherence in children with CD. Parents of 34 children (child age M(SD)=13.01(3.88), 56% female) from a multidisciplinary CD clinic completed ratings of attention and EF and dietary adherence. Parent-reported adherence was negatively correlated with behavioral regulation (r = -.52, p < .01, r ² = .27, 95% confidence interval (CI) [-.73, -.22]) and cognitive regulation (r = -.48, p < .01, r ² = .23, 95% CI [-.71, -.17]), with an interaction by age (p = .01, adjusted R ² = .35, B = -0.15, 95% CI [-0.29, -0.07]) for behavior regulation. Youth who were rated as less adherent by their parents were rated as having more problems with behavioral (e.g., inhibition and self-monitoring) and cognitive regulation (e.g., planning, organization), and adolescents with lower parent-rated adherence were rated as having more problems with behavioral regulation in particular. Executive functioning deficits are an important treatment consideration for CD, particularly during adolescence.