adherence, executive functioning, caregiver monitoring, kidney diseases


Objective: To evaluate associations between executive functioning and caregiver adherence monitoring with objective antihypertensive medication adherence over 24 months in adolescents with chronic kidney disease (CKD).

Methods: Adolescents (N = 97, 11–20 years old) with CKD taking antihypertensive medication and their caregivers were recruited from three pediatric nephrology clinics. At baseline, adolescents and caregivers reported on adolescents’ executive functioning and caregivers reported on their adherence monitoring. Antihypertensive medication adherence was objectively assessed via electronic monitoring at baseline and every 6 months after for 24 months. Associations between executive functioning, caregiver monitoring, and longitudinal adherence were evaluated with linear mixed models.

Results: Up to 38% of adolescents had elevated executive functioning scores indicating more severe impairments, with rates varying by scale and reporter (adolescent versus caregiver). Caregiver monitoring showed a significant, negative association with adherence, but adolescents’ executive functioning was not significantly associated with adherence. Neither variable was associated with the rate of change in adherence over time.

Conclusions: Given that adolescents’ executive functioning was not associated with antihypertensive medication adherence or changes in adherence over time, adherence to daily pillform medications may involve less cognitive effort than more complex medical regimens. Higher levels of caregiver monitoring were unexpectedly associated with lower adherence levels. This unanticipated finding may reflect increased caregiver monitoring efforts when faced with

Original Publication Citation

Health Psychol. 2020 June ; 39(6): 509–518. doi:10.1037/hea0000851.

Document Type

Peer-Reviewed Article

Publication Date



Department of Health and Human Services




Family, Home, and Social Sciences



University Standing at Time of Publication

Assistant Professor

Included in

Psychology Commons