Supporting parents of very young children with type 1 diabetes: Results from a pilot study

Objective

To assess initial efficacy and feasibility of a telephone-based supportive intervention for parents of young children with type 1 diabetes (T1D) designed to improve parental quality of life (QOL) through decreased parental stress, increased social support, and improved daily management of their child's diabetes.

Methods

The research team developed a brief program based on social cognitive theory for parents of young children with T1D. Twenty-four parents (88% mothers) of young children with T1D (ages 2-5 years) participated in a pilot study of the program and completed psychosocial questionnaires and a program satisfaction survey.

Results

Paired t-tests of pre- and post-intervention scores suggested a favorable within-group impact for the intervention group, as evidenced by decreased pediatric parenting stress and a trend for increased perceived social support. The program was well-received, with the majority of participants rating it as helpful and interesting.

Conclusion

Assisting parents with the unique challenges of diabetes management in young children through implementation of a structured intervention is promising.

Practice implications

A telephone-based intervention focused on child development, coping, and problem-solving skills has the potential to positively impact parents’ QOL and may have implications for children's health.     

Stress Management Training for Adolescents with Diabetes

Evaluated the effects of stress management training (SMT) foradolescents with diabetes in a 9-month controlled treatment-outcomestudy. Nine patients were randomly assigned to a stress managementgroup while another 10 patients served as controls and receivedstandard outpatient treatment. The treatment program consistedof 10 sessions over 3 months, 3 additional sessions over 3 months,and a 3-month follow-up without treatment. Diabetes-specificstress decreased significantly for patients in the SMT groupover the course of the intervention and follow-up. However,metabolic control, regimen adherence, coping styles, and self-efficacyabout diabetes were unchanged. These findings suggest a SMTprogram for adolescents with diabetes may be helpful in reducingdiabetes-specific stress, but additional procedures are necessaryto improve adherence, coping styles, and metabolic control.     

Children's appraisals of maternal involvement in coping with diabetes: enhancing our understanding of adherence, metabolic control, and quality of life across adolescence

OBJECTIVE: To examine how children's appraisals of maternal involvement in coping with diabetes are associated with adherence, metabolic control, and quality of life across adolescence. METHODS: Children (N = 127, ages 10-15 years) with type 1 diabetes completed measures of adherence, quality of life, and appraisals of mothers' involvement in dealing with diabetes problems (i.e., mother appraised as uninvolved, controlling, or collaborative). Metabolic control was indexed through medical records. RESULTS: Regardless of age or sex of child, appraised maternal uninvolvement was associated with poorer adherence and quality of life, while appraised collaboration was associated with better adherence and metabolic control. There was evidence that the association between appraised collaboration and metabolic control was partially mediated by adherence. Appraised control was associated with poorer adherence among older, but not younger, children and with poorer quality of life among older females but not among older males or younger children of either sex. CONCLUSIONS: Maintaining maternal involvement in diabetes care is important across ages 10 to 15, but the optimal form of this involvement may need to be adjusted to be consistent with the child's level of development. The present findings suggest that better adherence is seen across age when mothers are viewed as collaborating with, as opposed to controlling, their child when dealing with diabetes problems.     

Maternal expressed emotion and metabolic control of children and adolescents with diabetes mellitus

BACKGROUND: The objectives of this study of children and adolescents with diabetes were to: (1) examine whether maternal expressed emotion (EE), in the form of critical comments (CC), hostility and emotional overinvolvement (EOI), is related to metabolic control; (2) determine if CC and EOI are separately related to poor metabolic control, and (3) ascertain whether high EE is related to psychopathology in these children. METHODS: The Present Episode version of the Schedule for Affective Disorders and Schizophrenia for School-Age Children (Kiddie-SADS-P/K-SADS-P) interview was administered to 55 children and adolescents with diabetes and the parental EE instrument, the 5-min speech sample, to 55 mothers. The same instruments were utilized with the 54 controls and their mothers. Glycosylated hemoglobin A1 values were used as a measure of metabolic control. RESULTS: More than half of the children with diabetes (58.2%) had mild to moderate symptoms of anxiety or depression as compared to 9.3% of the controls. High EE was exhibited by 70.9% of the index group mothers in contrast to only 29.6% of the control group mothers. High maternal EE was not related to the psychopathology of children with diabetes. High maternal EE and in particular its EOI component and excessive detail (a subcategory of EOI) were related to poor metabolic control of the index children. CONCLUSIONS: Maternal EE is related to metabolic control in childhood diabetes; maternal EOI in particular is related to poor metabolic control. Mental health professionals should work with mothers of children with diabetes in an effort to modify such attitudes and emotions.     

Understanding needle‐related distress in children with cystic fibrosis

Objective. To explore the nature and management of needle‐related distress in children and adolescents with cystic fibrosis (CF). Design. Qualitative study using semi‐structured interviews. Methods. Fourteen child–parent dyads took part. Children (5 male; 9 female) had a mean age of 12.4 years (range 7–17) and were mostly diagnosed with CF at birth (N= 11). Frequency of needle procedures ranged from once to six times a year. Parents (3 male; 11 female) had a mean age of 41.5 years and were from a variety of socio‐economic backgrounds. Interviews were transcribed and analysed using thematic analysis. Results. Most participants identified previous needle experiences and pain as related to their needle anxiety. Over half of parents and children considered ‘taking control’ to be the optimum coping strategy. The majority of parents and children thought inhaled nitrous oxide gas during needle procedures was helpful in managing needle‐related distress. Parent and staff influences on needle‐related distress are also examined. Conclusions. Needle‐related distress in children with CF has a substantial impact on children and their parents, and may lead to management problems and treatment refusal. Psychological and pharmacological interventions could reduce distress and aid management.     

Gender differences in the psychological adjustment to type 1 diabetes mellitus: an explorative study

This study examined gender differences in (1) the psychological adjustment to diabetes and (2) the relation between psychological adjustment and metabolic control in patients with type 1 diabetes. The 280 adult patients attending the outpatient diabetes clinic completed psychological self-rating questionnaires evaluating coping, depression, marital satisfaction, cognitive and emotional adjustment to diabetes. Glycaemic control was measured with HbA(1c)-values. This study revealed that men used significantly more active coping, less avoiding, less social support seeking and less depressive coping. Despite these differences, glycaemic control was not significantly better in men than in women. Women reported more depressive symptomatology than men did and more women were depressed. Significant gender differences were also found in psychological adjustment to diabetes. The psychological factors negatively related with the psychological adjustment to diabetes in men and women are depressive coping and depressive symptomatology.     

Stress and coping styles in guangzhou families with hepatitis B virus children

This study was conducted in Guangzhou, China. The study compared the stress coping styles of three groups of parents: (1) parents of children who are carriers of the hepatitis B virus (HBV) who attend a special health kindergarten; (2) parents of children with HBV who stay at home; and (3) parents of healthy children attending ordinary kindergarten. Parents of HBV children who stayed at home reported greater problems due to stress. The groups did not differ in reports of stress arising from life events other than their child's illness and the fact that their HBV-carrying children were prohibited from the kindergarten. Content analyses of the mothers' reported styles revealed five patterns of coping styles, which are explained with reference to the Chinese cultural context.     

Mother child appraised involvement in coping with diabetes stressors and emotional adjustment

OBJECTIVE: To examine how children's and mother's appraisals of each other's involvement in coping with diabetes events are associated with emotional adjustment. METHODS: One hundred and twenty-seven children (ages 10-15 years) with type 1 diabetes and their mothers reported on their own emotional adjustment and how each other was involved in coping strategies surrounding diabetes stressful events. RESULTS: Appraisals that mothers and children were uninvolved with each other's stressors were associated with greater depressive symptoms and less positive mood; children's appraisals of mother's supportive involvement with children's less depressive symptoms, and appraisals of collaborative involvement with less depressive symptoms and more positive mood for both mothers and children. Appraised control was most detrimental for children for older females and for mothers of younger children. CONCLUSIONS: Collaborative involvement in coping efforts may be an important resource for addressing negative emotions that both children and mothers experience surrounding type 1 diabetes, especially across adolescence.     

Differences between high and low coping children and between parent and staff behaviors during painful medical procedures.

Coded behaviors of pediatric oncology patients undergoing bone marrow aspirations and lumbar punctures, parents, and medical staff using the Child-Adult Medical Procedure Interaction Scale. Children were grouped into high and low coping groups for three analyses. Results indicated that adults with the high coping children engaged in more coping-promoting behaviors than adults with the low coping children. Further, high coping children were more likely to respond with coping to coping-promoting prompts. However, both groups of children were more likely to respond by coping following coping-promoting antecedents than following distress-promoting or adult neutral antecedents. Both groups were more likely to respond with distress following distress-promoting antecedents. When interacting with children, staff engaged in a higher proportions of giving control to the child and apologies than did parents. Also, children were more likely to display coping than distress following staff's and parents' nonprocedural talk (distraction).     

Evaluation of a group intervention for children with food allergy and their parents

BACKGROUND: Children with food allergy and their parents may experience substantial stress related to the risk of serious reactions and the demands of allergy management. OBJECTIVE: To evaluate a group intervention for children with food allergy and their parents designed to increase parent-perceived competence in coping with food allergy and to decrease the parent-perceived burden associated with food allergy. METHODS: Sixty-one children aged 5 to 7 years with food allergy and their parents attended 1 of 4 half-day workshops, with parent and child groups run concurrently. Parents completed self-report measures of perceived competence in coping with food allergy at 3 time points: preworkshop (within 8 weeks of the intervention), postworkshop (immediately after the intervention), and follow-up (4-8 weeks after the intervention). Parents completed a measure of burden associated with food allergy at preworkshop and follow-up. Parents and children also completed evaluations of the study intervention. RESULTS: Parent-perceived competence in coping with food allergy increased significantly from preworkshop to postworkshop and follow-up, and parent-perceived burden associated with food allergy decreased from preworkshop to follow-up. Parent and child evaluations of the workshop were favorable. CONCLUSIONs: These findings provide preliminary support for the effectiveness and feasibility of a group intervention for children with food allergy and their parents and suggest the importance of controlled evaluations of group interventions in this population in the future.     

孤独症儿童父母生活质量和应对方式的调查研究

目的探讨孤独症儿童父母的生活质量和应对方式。方法采用生活质量综合评定问卷-74(GQOLI-74)和特质应对方式问卷(TCSQ)对46例孤独症儿童的父母及46例健康儿童的父母进行对照研究。结果①孤独症儿童父母的GQOLI-74维度评分均明显低于对照组,其中以物质生活状态(t=1.98,P<0.05)和心理健康(t=2.56,P<0.01)尤为显著,具有统计学意义;②孤独症儿童父母的积极应对得分低于对照组(t=1.91,P<0.05),消极应对得分高于对照组(t=-2.59,P<0.01),消极应对表现突出,差异均具有统计学意义。结论孤独症儿童父母的生活质量较健康对照者差,他们应对生活应激事件时易采用消极的应对方式。     

Efficacy of a self-management program for childhood asthma–: A prospective controlled study

Asthma training programs for parents and children have been developed to increase both the self-management skills of asthmatic children and compliance with medical regimes. In order to evaluate two training programs for asthmatic children aged 7–14, 81 patients were randomly assigned to three groups. Group 1 consisted of 27 patients and their parents who participated in a five-day standardized family-oriented clinical asthma training program. They had monthly follow-up meetings with the training team for a period of six months. Group 2 (n=29) had the same clinical training without follow-up interventions; a control group (n=25) received regular medical treatment according to the international guidelines at the asthma clinics without a training program and served as control group. Questionnaires regarding self-management aspects, coping and anxiety were filled out by patients, parents, family doctors and the training team prior to as well as twelve months after the training. The results indicate that Training group 1 benefitted most with respect to active asthma self-management, Training group 2 to some degree while the control group showed no significant effects. The differences after one year between the three groups regarding physical parameters such as lung-function and days missed in school did not reach the level of significance. Our results indicate that the long-term efficacy of self management courses for asthmatic children is enhanced by regular follow-up training sessions.     

Predictors of youth diabetes care behaviors and metabolic control: a structural equation modeling approach

OBJECTIVE: To empirically test a biopsychosocial model of predictors of youth diabetes care behaviors and metabolic control. METHODS: A cross-sectional multisite study of youths (N = 222) with T1D (mean age = 12.6) used structural equation modeling to examine interrelations among predictors, with follow-up analyses of covariance (ANCOVAs). RESULTS: Youths' memory skills related to diabetes knowledge which, along with self-efficacy and age, was associated with greater youth responsibility that in turn predicted poorer self-care behaviors. Less frequent/briefer exercise and less frequent blood glucose monitoring/eating were found; the latter directly related to poorer metabolic control. Behavior problems also were associated directly with poorer metabolic control. A parsimonious model found memory directly related to blood glucose testing. CONCLUSIONS: Continued parental supervision of adolescents, along with monitoring diabetes knowledge and efficacy, may help optimize transfer of diabetes care from parents to youths. Behavior problems warrant immediate attention because of their direct and adverse relation to metabolic control.     

Predicting children's response to an invasive medical investigation: the Influence of effortful control and parent behavior

OBJECTIVE: To investigate the relative contributions of effortful control (reflecting the child's ability to shift and refocus attention) and parental coping- and distress-promoting behaviors to children's coping and distress during the voiding cystourethrogram (VCUG, X-ray of the kidneys). METHOD: Thirty-two children between ages 2 and 7 years were videotaped undergoing the VCUG. Parent and child behaviors were coded according to the CAMPIS-R (Blount et al., 1997), and parents completed a temperament inventory assessing effortful control across a range of everyday situations. RESULTS: Children manifested relatively high rates of distress and low rates of coping. Their coping attempts were not associated with reduced rates of distress. The most frequent child coping behavior was distraction. Both effortful control and parent coping-promoting behavior (particularly talk about topics other than the VCUG) made independent contributions to child coping behavior. Parent distress-promoting behavior (particularly reassurance) made a strong contribution to child distress behavior. CONCLUSIONS: Factors relating to the child (effortful control) and parent (coping and distress-promoting behaviors) both contribute to children's response to an aversive medical procedure. Interventions that facilitate parent coping and promoting behavior, reduce their distress-promoting behavior, and compensate for children's infrequent and ineffective use of coping strategies (such as distraction) may be optimal for young children, particularly those low in effortful control.     

Brief report: glycemic control, quality of life, and school experiences among students with diabetes

OBJECTIVE: To investigate the relationships among perceived school experiences, diabetes control, and quality of life (QOL) in children with diabetes. METHODS: Fifty-eight children with type 1 diabetes and their parents participated. The typical child was 12 years old, had diabetes for 5 years, and attended public, suburban, middle/junior high schools with 300-500 students. RESULTS: Children whose parents reported that school personnel received diabetes training showed significantly better diabetes control than those who reported untrained school personnel. Children who reported their classmates received diabetes training had significantly better QOL than those who reported untrained classmates. Children who reported greater flexibility in performing diabetes care tasks at school had significantly better diabetes control than children who reported less flexibility. CONCLUSIONS: Students with diabetes continue to face challenges at school. Training staff and classmates and allowing students the maximum appropriate flexibility in diabetes care appears beneficial for disease control and QOL.     

Maternal trait anxiety and diabetes control in adolescents with type 1 diabetes

OBJECTIVE: To examine the relationship of maternal trait anxiety with diabetes regulation among adolescents with type 1 diabetes. METHODS: Adolescents and their mothers completed surveys assessing trait anxiety, maternal involvement in diabetes care, adolescent management skills, autonomous motivations, mood state, and absenteeism due to diabetes. HbA1c readings, used to assess metabolic control, were obtained from medical records. RESULTS: Trait-anxious mothers reported taking more responsibility for diabetes management tasks and perceived their adolescents as having poorer management skills. Adolescents with high-anxious mothers reported stronger beliefs that their mothers had high control over their diabetes and their parents were over-protective. For younger adolescents, maternal trait anxiety was associated with higher HbA1c levels and greater absenteeism. For older adolescents, maternal trait anxiety was associated with lower autonomous motivations for diabetes care and lower positive affect. CONCLUSIONS: Interventions for adolescents with diabetes may benefit from addressing these maternal anxiety dynamics in ways that improve diabetes control.     

Influence of stressful life events on the onset of Type 1 diabetes in childhood

The study focuses on the effects of different psychosocial stress on the onset of Type 1 diabetes in Zimbabwe. Type 1 diabetic children were compared with healthy control group. A set of relevant anthropometric indices was used to asses their physical development and fitness. Diabetic children were admitted to hospital with diabetic ketoacidoses, high blood glucose levels and severe dehydration. It was difficult to achieve stable long-term metabolic control because of acute infections , diatery lapses, frequent hypoglycemic attacks due to poverty and malnutrition, lack of intensive insulin therapy and glucose monitoring. It was found that diabetic children had higher heart rates (97.7 bts/min) and showed lower results when submitted to apnoeic test (20.6 sec) and tipping test (233.2 points). Stressful events that occurred within the family during the year prior to the clinical, onset of Type 1 diabetes were recorded on an inventory consisting of 45 questions. The total frequency of stressful life events were higher for diabetic children (95.4) than in the control group.(4.2). The relative frequencies of events that included actual or threatened loss within the family were significantly higher for the diabetic children (32-53%). In conclusion, severe emotional stress induced by life events such as the birth of another sibling, the influence of a step-parent, serious illness of the mother, marital separation or divorce of parents and the change in parent's financial status are associated with the onset of childhood diabetes and may be considered as risk factors.     

Structured parent education in the management of childhood atopic dermatitis: the Berlin model

Childhood atopic dermatitis (AD) is a common disease with the prevalence rates increasing. Its chronic course with frequent relapses puts a special burden on both children and their parents. To maximise positive long-term outcome in the management of AD it is important to support parents in dealing with the chronic condition of their child in addition to treating symptoms. In the present article, we describe in detail the goals, structure, and content of the Berlin education program for parents of children with AD. The program aims to contribute towards a comprehensive, family-oriented management of childhood AD. Its objective is to improve parent’s self-management skills with regard to their child’s disease and to positively impact the course of the disease as well as the family’s quality of life. Medical, nutritional and psychological issues are covered in six group sessions which are conducted by a multiprofessional team of paediatricians, psychologists and dieticians. Preliminary data show that the program has a desirable effect on aspects of quality of life and coping.     

Parent Stress and Coping in Relation to Child ADHD Severity and Associated Child Disruptive Behavior Problems

Examined parent role distress and coping in relation to childhood attention deficit hyperactivity disorder (ADHD) in mothers and fathers of 66 children age 7 to 11 (42 boys, 24 girls; mean age = 10.2). Parents of children with ADHD combined and inattentive subtypes expressed more role dissatisfaction than parents of control children. Parents of ADHD combined and inattentive type children did not differ significantly in levels of distress. For mothers, child inattention and oppositional-conduct problems but not hyperactivity contributed uniquely to role distress (dissatisfaction related to parenting or parenting performance). For fathers, parenting role distress was associated uniquely with child oppositional or aggressive behaviors but not with ADHD symptom severity. Parent coping by more use of positive reframing (thinking about problems as challenges that might be overcome) was associated with higher role satisfaction for both mothers and fathers. Community supports were associated with higher distress for mothers only.     

Parent and adolescent distribution of responsibility for diabetes self-care: links to health outcomes

OBJECTIVE: To examine the relation of adolescent and parent responsibility distribution for diabetes self-care to psychological and physical health. METHODS: We interviewed children (mean age 12 years) annually for 3 years and asked parents to complete a questionnaire. Both reported how diabetes self-care was distributed in the family. Amount of responsibility held by the child only, the parent only, and shared between child and parent was calculated. Psychological distress, competence, and diabetes outcomes were assessed at each wave. RESULTS: In both cross-sectional and longitudinal (lagged) analyses, multilevel modeling showed that shared responsibility was consistently associated with better psychological health, good self-care behavior, and good metabolic control, whereas child and parent responsibility were not. In some cases, links of shared responsibility to health outcomes were stronger among older adolescents. CONCLUSIONS: These findings highlight the importance of shared responsibility for diabetes self-care through early to middle adolescence.