Saturday, March 29, 2014

Age Appropriate Management of Childhood Diabetes

Curtis-Taylor (2011) found patient centered care fostered children's independence. In particular, it was important to help children develop an expertise about their illness and to support them in exploring and voicing their sense of powerlessness over their disease. This includes their social experiences such as feeling isolated and different from other children.

In the medical milieu, not including children from discussions on their disease is counterproductive and damaging to their ability to become capable participants in the management of their disease (Curtis-Taylor, 2011; Roper et al., 2009). Age differences are apparent during development that change the way children and adolescents manage their disease (Hema et al., 2009), although rather than making age-related assumptions that younger children cannot play a central role in disease management, parents and health care professionals should identify and utilize resources that will foster independence and autonomy from a young age. Although traditionally children have been perceived as incapable of understanding their disease, even the youngest children develop the ability to understand their disease based on their routine experiences of care and physical sensations they experience related to their disease (Curtis-Taylor, 2011). It seems appropriate to include young children in disease management and to provide ongoing assessments of their ability to self-manage based on observation and discussions with the child. From the assessment, parents can increase the child's disease management role incrementally as the child develops the ability to be successful in the undertaking.

Two Potential Barriers for Effective Management
As mentioned above, maintaining a perception of control fosters treatment compliance as well as overall outcomes. Skinner, John, & Hampson (2000) found personal models of illness are predictive of the adolescents' health, well-being, and their response to a health threat. A personal model is a general personalized and internalized perception of how the individual adapts to his or her illness based on beliefs and previous experiences (Skinner, John, & Hampson, 2000). For example, when adolescents believed their treatment regimens were effective, the implemented more effective self care. Additionally, adequate social support predicted better self care as well (Skinner, John, & Hampson, 2000; Vesco et al., 2010)). For these reasons, not being included in, or lacking an understanding of prescribed treatments and their effectiveness and a lack of social support could be detriments to adequate self management (Vesco et al., 2010).

Behavioral Strategy for Self Management

Typically, children and adolescents with diabetes do not experience disease-related stress as a central issue in their lives. They cope according to disease severity as well as the extent to which their disease is managed. Maintaining a sense of control over disease is a salient issue and affects compliance and outcomes (Hema et al., 2009). Age, too, has an effect on how children and adolescents manage disease. For example, younger children utilized distractions as coping mechanisms, while older children used cognitive skills, such as changing their attitudes.

Wysocki and colleagues (2008) found that family therapy helped some adolescents in coping with diabetes and increased their self-management by improving interfamily communication and teaching them how to implement problem solving as a way to change non-compliant behaviors. Many different interventions produce positive outcomes for children and adolescents with diabetes, but the most effective ones work to change targeted behaviors (Hampson et al., 2000). Regardless of the number of effective interventions, addressing the child or adolescent's individual needs, stressors, and treatment barriers is critical to the success of the intervention (Salmon, Hains, Fleischman, Davies, & Kichler, 2010).

Because Skinner, John, and Hampson (2000) found that developing a positive personal model was beneficial, I would include fostering the development of such a model in concert with teaching the adolescent how to access and develop resources such as social support systems, since adequate social support has been shown to be predictive of more effective self care (Skinner, John, & Hampson, 2000; Vesco et al., 2010). In addition, including the child or adolescent in discussions about the disease and individualized treatment plans is critical for the development of self management skills (Vesco et al., 2010).


Curtis-Tyler, K. (2011). Levers & barriers to patient-centered care with children: Findings from a synthesis of studies of the experiences of children living with type 1 diabetes or asthma. Child: Care, Health and Development, 37(4), 540–550.

Hampson, S. E., Skinner, T. C., Hart, J., Storey, L., Gage, H., Foxcroft, D., & … McEvilly, E. A. (2000). Behavioral interventions with adolescents with type 1 diabetes: How effective are they? Diabetes Care, 23(9), 1416–1422.

Hema, D. A., Roper, S. O., Nehring, J. W., Call, A., Mandleco, B. L., & Dyches, T. T. (2009). Daily stressors and coping responses of children and adolescents with type 1 diabetes. Child: Care, Health and Development, 35(3), 330–339.

Roper, S. O., Call, A., Leishman, J., Ratcliffe, G. C., Mandleco, B. L., Dyches, T. T., & Marshall, E. S. (2009). Type 1 diabetes: Children and adolescents’ knowledge and questions. Journal of Advance Nursing, 65(8), 1705–1714.

Salamon, K. S., Hains, A. A., Fleischman, K. M., Davies, W. H., & Kichler, J. (2010). Improving adherence in social situations for adolescents with type 1 diabetes mellitus (T1DM): A pilot study. Primary Care Diabetes, 4(1), 47–55.

Skinner, T. C., John, M., & Hampson, S. E. (2000). Social support and personal models of diabetes as predictors of self-care and well-being: A longitudinal study of adolescents with diabetes. Journal of Pediatric Psychology, 25(4), 257–267.

Vesco, A. T., Anderson, B. J., Laffel, L. M., Dolan, L. M., Ingerski, L. M., & Hood, K. K. (2010). Responsibility sharing between adolescents with type 1 diabetes and their caregivers: Importance of adolescent perceptions on diabetes management and control. Journal of pediatric psychology, 35(10), 1168–1177.

Wysocki, T., Harris, M. A., Buckloh, L. M., Mertlich, D., Lochrie, A. S., Taylor, A., Sadler, M., & White, N. H. (2008). Randomized, controlled trial of behavioral family systems therapy for diabetes: Maintenance and generalization of effects on parent-adolescent communication. Behavior Therapy, 39(1), 33–46.

Ziaian, T., Sawyer, M. G., Reynolds, K. E., Carbone, J. A., Clark, J. J., Baghurst, P. A., & …French, D. J. (2006). Treatment burden and health-related quality of life of children with diabetes, cystic fibrosis and asthma. Journal of Pediatrics and Child Health, 42(10), 596–600.

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