Low levels of paternal monitoring affected adolescents’ HbA1c

Issue: April 2008

Parental monitoring had a significant role in diabetes management among adolescents with type 1 diabetes, specifically fathers' acceptance and monitoring of their children’s diabetes management behaviors.

In a new analysis, researchers from the University of Utah, University of Wisconsin-Stevens Point and the University of Texas Southwestern Medical Center examined the benefits of parental monitoring on diabetes self-management in 185 adolescents aged 10 to 14 years. The children, mothers (n=185) and fathers (n=145) completed assessments of parental monitoring, including questions on parental acceptance and regular monitoring of diabetes tasks.

The findings suggest independent effects of parental monitoring on predicting adherence. Only father’s monitoring had an independent effect on HbA1c. For example, low parental monitoring by the father led to HbA1c increases in adolescents.

“It is the adolescents’ perceptions of acceptance and monitoring that predicts diabetes outcomes, rather than the parents’ perceptions,” the researchers wrote.

Parental reports of their own acceptance and monitoring were not associated with differences in HbA1c or adherence. The researchers stressed parental monitoring during this period, “a time when parents are decreasing their level of involvement in diabetes management.” – by Katie Kalvaitis

For more information:
Berg CA, Butler JM, Osborn P, et al. The role of parental monitoring in understanding the benefits of parental acceptance on adolescent adherence and metabolic control of type 1 diabetes. Diabetes Care. 2008;doi:10.2337/dc07-1678.

Diabetes care regimens can be complicated and time consuming for both children and parents. Adolescents with diabetes have consistently been shown to have problems maintaining optimal glycemic control and adherence. Part of this stems from adolescents’ attempts to define identities and new roles both within and outside of the family context. Further, parents begin to expect their child to demonstrate increased responsibility in managing their diabetes care. During this time there also tends to be increased parent-child conflict. Many parents resort to coercive, rather than supportive, methods to maximize metabolic control. Young teens experience anger and frustration associated with their regimen, and toward their parents whom they perceive as being harsh and critical. This tends to make teens less likely to cooperate in managing their care. Further, parents' own grief, reactions and frustrations to care tasks may inhibit parental involvement.

Berg et al. point out several interesting findings regarding parental involvement. Although parental monitoring appears to be important for helping teens successfully adhere to their regimen, it appears that parental acceptance of their child’s illness can facilitate parents, especially fathers, in taking more active roles. Further, adolescent’s report, rather than parental report, of parental acceptance was associated with more positive outcomes. This suggests that adolescents who perceive their parents as being more accepting and taking a more active role experience the most benefit, increased adherence and better metabolic control.

Overall, these results suggest that it is worthwhile to target increasing parental acceptance and involvement in their child’s care. The level of support parents and children require varies based on the risks associated with their ability to successfully manage their illness. Parents may benefit from validation of their concerns, fears and the burden they experience in parenting a child with a chronic illness. Many parents may feel guilty about feeling overwhelmed or frustrated by their child’s illness. Physicians and mental health professionals are encouraged to help parents understand that these feelings are normal and do not indicate that they are 'bad' parents. It may also be beneficial to target support to fathers, as they tend to be least involved in their child’s diabetes regimen and their concerns and questions may be under-addressed by health professionals. Health professionals can help parents gradually increase the amount of responsibility the child assumes regarding their diabetes care. Families can benefit from a parent-child teamwork approach in managing their regimen. Finally, educating parents that successful transfer of responsibility is maximized when a scaffolding approach is used taking into consideration the child’s developmental and ability level.

For families experiencing greater challenges, programs aimed at supporting families with chronic illness can be useful for increasing adherence and metabolic control. For example, telehealth programs (children and parents communicate with a trained mental health therapist to provide support and assistance with family, and illness management challenges) and multisystemic approaches (goal-oriented treatment targeting multiple areas of the child’s social network; for example, school, home and peers) provide services that my help to generalize skills into the home and school. Approaches should target helping families problem solve challenging situations, use more effective communication skills, as well as ways to manage family conflict. Also, it is beneficial to help parents learn new ways to support their teens in managing their care, rather than “nagging,” blaming or shaming their children for nonadherence. More effective strategies include providing information (eg, stating the number of carbohydrates in a snack), or using gentle reminders when it is time to check blood glucose or administer shots. External reminders, such as alarms can be useful to help the teen be more independent. Finally, positive attention and praise for adherence should be used rather than punishment for nonadherence.

– Chrissy Cammarata, MA

Predoctoral Psychology Intern, Departments of Psychiatry
and Clinical and Health Psychology, University of Florida

– Eric A. Storch, PhD

Assistant Professor
Department of Psychiatry and Pediatrics, University of Florida