Date Presented 04/04/19
Celiac disease is a chronic condition that requires daily health management of a strict lifelong gluten-free diet. Adherence and self-management among adolescents can be challenging. Understanding the relationships between the skills involved in managing the diet, while participating in food-related activities, may assist in promoting adherence and self-management. This approach may contribute to developing occupational-based interventions in an emerging field of chronic health management.
Primary Author and Speaker: Sonya Meyer
Additional Authors and Speakers: Sara Rosenblum
PURPOSE: The study aimed to examine the relationship between participation in food-related activities and executive functions (EFs) among adolescents with celiac disease.
Celiac is a chronic health condition precipitated by exposure to gluten. Managing a restrictive lifelong gluten-free diet is the only treatment. Adherence among adolescents unique age-related challenges and there is often a decrease in the rate of adherence. Therefore, identifying and removing barriers in the transactional process from childhood through adolescence to adulthood is important (Ludvigsson et al., 2016). However, there is paucity in the understanding of the actual challenges that adolescents face in daily life while managing the diet and participating in food-related activities. Managing the diet requires cognitive skills such as planning, organization, and problem-solving that are encompassed in the umbrella term of EFs (World Health Organization, 2001). Integrating the occupational view of participation together with knowledge about cognitive self-management skills may promote new understanding of the real-life challenges with CD.
DESIGN: This cross-sectional study included 65 adolescents (43 girls), aged 12 to 18 years (M=14.67, SD=1.77) with a confirmed diagnosis of CD for no less than 6-months prior to the study. The time since diagnosis ranged from 6-12 months = 4.6% to >3 years = 70.8%. Adolescents with other physical and/or neurological disabilities were excluded. Participants were recruited via the local celiac association and social media.
METHOD: Parents completed a demographic questionnaire and the Behavior Rating Inventory of Executive Function (BRIEF). The CD children's activities report (CD-Chart), a questionnaire focused on participation in food-related activities, was administered to the adolescents by interview. Descriptive statistics described the demographic characteristics and questionnaire scores. In order to focus on EF deficits, the adolescents were divided into: 1) Group "without EF deficits" (n=39), (i.e., all BRIEF scale scores < 65). 2) Group "with EF deficits" (n=26) in any one or more of the BRIEF clinical scales (i.e., one or more scale scores = 65 or above). Multivariate analysis of variance (MANOVA) was used to test for group differences and univariate analysis of variance (ANOVAs) was calculated to examine the source of the significance. Pearson chi-square values determined associations between participation and EF.
RESULTS: Poorer participation outcomes significantly correlated with poorer EFs. For example, a negative medium correlation was found in the group "without EF deficits", between how much they like participating in meals during trips (CD-Chart) and shifting (BRIEF) (r = -.416*, p < .05). In the group "with EF deficits", a negative correlation was found between how important it is to them to be involved in pre-preparation before participating in meals during trips (CD-Chart) and initiation (BRIEF) (r = -.508*, p < .05). Namely, poorer EFs (BRIEF) correlate with poorer participation (CD-Chart).
CONCLUSION: The results highlight the importance exploring the characteristics of participation in food-related activities among adolescents with CD and of evaluating their EF abilities. Understanding the relationships between these factors may assist in promoting adherence and self-management among adolescents with CD.
IMPACT STATEMENT: Accentuating the occupational view of participation among adolescents with CD, together with knowledge about the underline cognitive mechanism of self-management skills, may contribute to developing occupational-based interventions. Self-tailored interventions, based on assessment that combines both a bottom-up and top-down approach, may be beneficial for managing this chronic health condition.
References
Ludvigsson, J. F., Agreus, L., Ciacci, C., Crowe, S. E., Geller, M. G., Green, P. H., . . . Koltai, T. (2016). Transition from childhood to adulthood in coeliac disease: The Prague consensus report. Gut, 65, 1242-1251. https://doi.org/10.1136/gutjnl-2016-311574
World Health Organization. (2001). International classification of functioning, disability and health (ICF). Geneva, Switzerland: Author.
