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Protective factors, health-risk behaviours and the impact of coexisting ADHD among adolescents with diabetes and other chronic conditions
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
2016 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Mental health problems are increasing in Swedish adolescents and mortality rates are higher in this age group than among younger. 10-20% of all adolescents suffer from a chronic medical condition (CC). Few protective factors (PF) and clustering of health-risk behaviours (HRB) are frequent among adolescents with CCs.

One of the most common CC in Swedish adolescents is type 1 diabetes mellitus (T1DM). Metabolic control often deteriorates during adolescence, especially in girls. Poor metabolic control is associated with increased risk for long-term complications, of which cognitive problems are common. However, the implication of cognitive/executive problems in patients with T1DM has not been sufficiently studied. Neither has the impact of neurodevelopmental problems (NDP), such as ADHD, on HRB in adolescents with CCs been analysed.

Methods: In paper I and II the questionnaire ”Life and Health in Youth” was distributed to all students in year nine and year two of the upper secondary school in the county of Sörmland, 2008 (n=5771) and 2011 (n=5550). Adolescents with CCs were compared to healthy peers with regard to PFs and HRBs. In paper III, the ”Five to Fifteen” questionnaire was used in 175 paediatric patients with T1DM. Patients with indications of NDPs were compared with patients without such problems with regard to metabolic control. In paper IV, the BRIEF questionnaire and the ADHD Rating Scale as well as data from the Swedish Childhood Diabetes Registry was used in 241 adolescents with T1DM. Patients with indications of executive problems were compared with patients without such problems with regard to diabetes control.

Results: CCs were associated with few PFs and clustered HRBs. The combination of CCs and low numbers of PFs was found to be associated with an increased risk of clustered HRBs. In the presence of coexisting ADHD the pattern of few PFs and clustering of HRBs was aggravated. ADHD was more common among adolescents with other CCs.

Definite memory and learning problems as well as mild executive problems were associated with poor metabolic control, especially among adolescents. Executive problems were also associated with many outpatient visits and low physical activity. Girls with T1DM tended to self-report executive problems to a larger extent than boys, while parents more often reported these problems in boys.

Conclusion: Knowledge about factors influencing treatment adherence and life in general is essential in the work with chronically ill adolescents. Focus must be put on enhancing PFs in order to avoid HRBs. Identification of coexisting NDPs, such as ADHD, is crucial, since such problems can adversely influence treatment adherence, HRBs and school achievements

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2016. , 75 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1213
Keyword [en]
Adolescent development, adolescent medicine, health behaviour, protective factors, risk-taking, type 1 diabetes, HbA1c, neurodevelopmental problems and ADHD
National Category
Pediatrics
Research subject
Medical Science
Identifiers
URN: urn:nbn:se:uu:diva-282964ISBN: 978-91-554-9553-4 (print)OAI: oai:DiVA.org:uu-282964DiVA: diva2:917967
Public defence
2016-06-03, Rosénsalen, Ingång 95/96 nbv, Uppsala Akademiska Sjukhus, Uppsala, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2016-05-13 Created: 2016-04-08 Last updated: 2016-06-01
List of papers
1. The triply troubled teenager - chronic conditions associated with fewer protective factors and clustered risk behaviours
Open this publication in new window or tab >>The triply troubled teenager - chronic conditions associated with fewer protective factors and clustered risk behaviours
2014 (English)In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 103, no 2, 194-200 p.Article in journal (Refereed) Published
Abstract [en]

AIM: This study aimed to measure protective factors and risk behaviour among adolescents with chronic conditions (CCs) and to evaluate the impact of protective factors on risk-taking.

METHODS: A population-based study of 7262 students aged 15 and 17 years old was performed in Sörmland, Sweden 2008 (response rate 82%). The questionnaire explored background factors, CCs, risk behaviours and protective factors. CCs were reported by 8%, while 58% had no health problems.

RESULTS: Girls with CCs encompassed less individual protective factors, while boys with CCs tended to over-report all individual risk behaviours compared with healthy peers. Both boys and girls with CCs were more likely to report few protective factors and co-occurrence of risk behaviours. The adjOR for clustered health risk behaviours was 1.6 (1.0-2.5) in youths with CCs and ≥4 protective factors and 6.3 (3.6-10.9) in youths with CCs and 0-3 protective factors, as compared to healthy peers with ≥4 protective factors.

CONCLUSION: Adolescents with CCs reported fewer protective factors and more risk behaviours than their healthy peers. The vulnerability of adolescents with CCs and few protective factors is important to acknowledge. Professionals should provide stronger protection for these adolescents, to prevent risky behaviour.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-215016 (URN)10.1111/apa.12461 (DOI)000330723200022 ()24117768 (PubMedID)
Available from: 2014-01-09 Created: 2014-01-09 Last updated: 2017-12-06Bibliographically approved
2. Chronic conditions and coexisting ADHD-a complicated combination in adolescents
Open this publication in new window or tab >>Chronic conditions and coexisting ADHD-a complicated combination in adolescents
2015 (English)In: European Journal of Pediatrics, ISSN 0340-6199, E-ISSN 1432-1076, Vol. 174, no 9, 1209-1215 p.Article in journal (Refereed) Published
Abstract [en]

Adolescents with chronic conditions (CCs) take more health risks than peers. However, coexisting ADHD has not sufficiently been considered. The aim of the present study was to investigate the impact of different CCs on protective factors and health-risk behaviors, taking coexisting ADHD into account. A school-based study among 6895 15- and 17-year-old students was performed in the county of Sormland, Sweden in 2011 (response rate 80 %). The questionnaire explored background factors, CCs, protective factors, and health-risk behaviors. CCs were reported by 11 %, while 55 % were healthy. Students with CCs more often reported coexisting ADHD than healthy students. In adolescents with neurological conditions, the odds ratio for having ADHD was 7.34 (95 % CI 3.00-17.99) as compared to healthy peers. Few protective factors (< 4) and clustered health-risk behaviors (a parts per thousand yen4) were more common among students with CCs, especially if ADHD or a combination including ADHD was reported. Conclusion: CCs and coexisting ADHD are associated with few protective factors and clustered-health risk behaviors. Adolescents with ADHD-in addition to a chronic condition-should be specially acknowledged by health care professionals in order to prevent health risk behaviors. ADHD should be considered when studying these outcomes in adolescents.

Keyword
Adolescent medicine, Chronic disease, ADHD, Health behavior, Risk-taking, Protective factors
National Category
Pediatrics
Identifiers
urn:nbn:se:uu:diva-261936 (URN)10.1007/s00431-015-2521-9 (DOI)000359821700009 ()25823759 (PubMedID)
Available from: 2015-09-22 Created: 2015-09-07 Last updated: 2017-12-04Bibliographically approved
3. Children and adolescents with type 1 diabetes and high HbA1c: a neurodevelopmental perspective
Open this publication in new window or tab >>Children and adolescents with type 1 diabetes and high HbA1c: a neurodevelopmental perspective
Show others...
2013 (English)In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 102, no 4, 410-415 p.Article in journal (Refereed) Published
Abstract [en]

Aim

To examine the association between neurodevelopmental problems and high HbA1c among paediatric patients with type 1 diabetes.

Methods

A population-based study was performed among patients with type 1 diabetes (5–16 years) in two Swedish counties (n = 233). The Five to Fifteen (FTF) questionnaire targeted neurodevelopmental qualities. Scores above the 90th percentile in the various domains are considered as definitive problems and scores above the 75th percentile as mild. FTF scores were compared with regard to HbA1c ≤73 mmol/mol and >73 mmol/mol (8.0%).

Results

The response rate was 190 (82%). Neurodevelopmental problems were not overrepresented among patients in general. Memory and learning problems were associated with HbA1c >73 mmol/mol (p = 0.01). This correlation was especially seen in adolescents (12–16 years) where mild executive problems (adjOR 3.1), definite memory problems (adjOR 5.0) and definite learning problems (adjOR 5.0) were associated with HbA1c >73 mmol/mol after adjustment for gender, diabetes duration and age of onset.

Conclusion

Our findings that high HbA1c is more common in adolescent diabetes patients with neurodevelopmental problems generate the hypothesis that these problems might precede poor metabolic control. If so, early detection of neurodevelopmental problems would allow individually tailored treatment that may improve metabolic control and prevent complications.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-196581 (URN)10.1111/apa.12128 (DOI)000316325400030 ()23278767 (PubMedID)
Available from: 2013-03-11 Created: 2013-03-11 Last updated: 2017-12-06Bibliographically approved
4. Executive problems in adolescents with type 1 diabetes are associated with poor metabolic control and low physical activity
Open this publication in new window or tab >>Executive problems in adolescents with type 1 diabetes are associated with poor metabolic control and low physical activity
(English)Manuscript (preprint) (Other academic)
Abstract [en]

Management of diabetes is demanding and requires efficient cognitive skills, especially in the domain of executive functioning. However, the impact of impaired executive functions on diabetes control has only been studied to a limited extent.

Objective: To investigate the association between executive dysfunctions and diabetes control in adolescents with type 1 diabetes.

Research design and methods: 241/477 (51 %) of 12-18 year-old adolescents, with a diabetes duration of >2 years, in Stockholm. Uppsala and Jönköping participated. Parents and adolescents completed questionnaires, including BRIEF, ADHD Rating Scale (ADHD-RS) and background factors. Diabetes related data was collected from the Swedish Childhood Diabetes Registry, SWEDIABKIDS. Self-rated and parent-rated executive functioning problems were analyzed with regard to gender, HbA1c, frequency of outpatient visits and physical activity, taking background factors into account.

Results: Executive functioning problems, according to BRIEF and/or ADHD-RS, respectively, were associated with mean HbA1c > 70 mmol/mol, many outpatient visits and low physical activity for both genders. Self-rated executive problems were more prevalent in girls, while parents reported these problems to a larger extent in boys.

Conclusion: Patients with executive functioning problems need to be recognized by the diabetes team. The diabetes care should be especially tailored to provide adequate support to these patients. 

Keyword
Type 1 diabetes, ADHD
National Category
Pediatrics
Identifiers
urn:nbn:se:uu:diva-282961 (URN)
Available from: 2016-04-08 Created: 2016-04-08 Last updated: 2016-06-01

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