Behavioral functioning and treatment adherence in pediatric eosinophilic gastrointestinal disorders

Objective: To examine behavioral predictors of treatment adherence in patients with eosinophilic gastrointestinal disorders (EGID). Methods: Participants were 96 patients 2.5-18yr of age with eosinophilic esophagitis or eosinophilic gastroenteritis and their caregivers (mother, father). We assessed maternal and paternal report of child/adolescent internalizing symptoms (e.g., anxiety, depression) and externalizing symptoms (e.g., aggression, anger) using the Behavior Assessment System for Children, 2nd edition (BASC-2). A multi-informant adherence assessment approach and an 80% cut point were used to classify patients as adherent or non-adherent. Results: Sociodemographic predictors did not distinguish between adherent and non-adherent patients. Maternal report of internalizing symptoms significantly correlated with non-adherence (p<0.001). Post hoc probing revealed a significant contribution of depression, with depressed patients being more likely (OR=7.27; p<0.05) to be non-adherent than non-depressed patients. Paternal report of internalizing and externalizing symptoms was not associated with non-adherence. Conclusions: Maternal report of patient internalizing behavioral symptoms, particularly depression, is significantly associated with non-adherence in patients with EGID. These symptoms are potential risk factors and should be considered when assessing and treating non-adherence. Clinical care of patients with EGID should include routine screening for depression.