Search

Implementing psycho-educational programs for youth with type 1 diabetes in clinical care and reaching diverse youth with type 1 diabetes is challenging due to youth, provider, and organizational barriers. This study was designed to compare the effectiveness of an internet coping skills training program with a control condition of internet diabetes education. Each program consists of 5 weekly interactive lessons; the coping skills training program also provides the ability for youth to interact with each other as well as a health coach. Approximately 300 youths with type 1 diabetes will be recruited to participate in this multi-site clinical trial. The primary outcomes are metabolic control, quality of life, and family conflict. Secondary outcomes include stress, coping, self-efficacy, and social competence. Usage, satisfaction, and cost will also be evaluated. In addition, mediators and moderators to intervention effects will be explored. An internet based psycho-educational program for youth with type 1 diabetes may be a promising approach that can be easily be integrated into clinical care.

The objective of this study was to test a comprehensive model of biologic (pubertal status), family (communication and conflict), and psychological influences (behavioral autonomy) on diabetes management and glycemic control in a sample of youth (N = 226) with type 1 diabetes recruited during late childhood/early adolescence (ages 9–11 years). The study design was a prospective, multisite, multi-method study involving prediction of diabetes management and glycemic control 1 year post-baseline. The primary outcome measures included diabetes management behaviors based on the Diabetes Self-Management Profile (DSMP) administered separately to mothers and youth and glycemic control measured by glycated hemoglobin (HbA1c) obtained by blood samples and analyzed by a central laboratory to ensure standardization. Our hypothesized predictive model received partial support based on structural equation modeling analyses. Family conflict predicted less adequate glycemic control 1 year later (p < 0.05). Higher conflict predicted less adequate diabetes management and less adequate glycemic control. More advanced pubertal status also predicted less adequate glycemic control, but behavioral autonomy did not. Family conflict is an important, potentially clinically significant influence on glycemic control that should be considered in primary and secondary prevention in the management of type 1 diabetes in youth.

Objective To examine the relationship of paternal involvement in diabetes care with adherence and glycemic control. Methods One hundred and thirty-six mothers and fathers of preadolescents (aged 9–12 years) with type 1 diabetes reported on paternal involvement. Adherence was measured by interview and blood glucose meter downloads. Mothers’ and fathers’ ratings of paternal involvement in diabetes care were compared. We evaluated three structural equation models linking paternal involvement with adherence and glycemic control. Results Mothers and fathers reported similar amounts of paternal involvement, yet mothers rated paternal involvement as more helpful. The data supported a model indicating links between more paternal involvement and higher HbA1c and between lower adherence and higher HbA1c. Mediation and moderation models were not supported. Discussion Although paternal involvement was not directly associated with treatment adherence, it was associated with poorer glycemic control. Some fathers may increase their involvement in response to suboptimal glycemic outcomes.

The purpose of this study was to examine youths' knowledge of the hemoglobin A1c (HbA1c) test and glycemic control. Seventy youths (11-16 year olds) with type 1 diabetes were interviewed concerning their knowledge of the HbA1c test, health risks associated with particular HbA1c values, and their own glycemic goals. Results revealed that only 13% of youths accurately described the HbA1c test. Fewer correctly identified the HbA1c ranges for good, fair, and poor glycemic control. The majority of youths did not know the blood glucose values corresponding to specific HbA1c results. Only a small number of youth correctly estimated the short-term and long-term risks associated with maintenance of HbA1c of 7% and 12%. In this sample of mostly lower-income, minority youths with type 1 diabetes, there was a significant lack of knowledge concerning the meaning and implications of the HbA1c test. Findings suggest that interventions for this patient population should use the HbA1c test results to help young patients to better understand and set goals for their glycemic control.

OBJECTIVE: Examine weight in young Hispanic children over a two-year period; investigate the relationships among overweight, physical activity, caloric intake, and family history in the development of the metabolic syndrome (MS). METHODS: Forty-seven children (ages 5-8) from diverse Hispanic backgrounds recruited from elementary schools were evaluated. Laboratory analyses, anthropometric data, and measures of physical activity and caloric intake were included. RESULTS: The majority of the children were overweight at baseline (66%) and at follow-up (72%). Children who were overweight at baseline were more likely to exhibit MS at follow-up than were those who were not overweight at baseline. CONCLUSIONS: Overweight appears to be an independent predictor of MS among Hispanic children.

Studies indicate general psychological stress plays a role in the glycemic control of individuals with type 1 diabetes mellitus (T1DM). Disease-specific rather than general measures may be more closely related to measures of health outcomes. Therefore, measurement of diabetes-related stress is needed to advance knowledge of significant relationships between stress and glycemic control. The objective of this study was to evaluate the psychometric properties of a measure of diabetes-related stress for youth with T1DM.A 65-item diabetes stress questionnaire for youths (DSQY) was previously developed for use with older children and adolescents. The DSQY was completed by 417 youths with T1DM and the results were analyzed to determine the factor structure and psychometric properties of the questionnaire, as well as relationships of diabetes stress with demographic and clinical variables.A factor analysis of the DSQY yielded an eight-factor solution with acceptable internal consistencies. Significant relationships were observed between glycemic control and stress related to parents and dietary issues. While age and socioeconomic status were unrelated with DSQY scores, higher stress was associated with longer diabetes duration, female gender, and racial/ethnic minority status.The DSQY is a reliable and valid measure for assessment of diabetes-specific stress in youths with T1DM.

Neurocognitive functioning may be compromised in children with type 1 diabetes mellitus (T1DM). The factor most consistently implicated in the long-term neurocognitive functioning of children with T1DM is age of onset. The pediatric literature suggests that glycemic extremes may have an effect on the neurocognitive functioning of children, but findings are mixed. The purpose of this study was to compare the neurocognitive functioning of young children with T1DM diagnosed before 6 yr of age and healthy children (i.e., without chronic illness). Additionally, in the children with T1DM, we examined the relationship between their neurocognitive functioning and glycemic control. Sixty-eight (36 with T1DM and 32 without chronic illness) preschool-age children (M age = 4.4 yr ) were recruited and administered a battery of instruments to measure cognitive, language, and fine motor skills. Children with T1DM performed similar to the healthy controls and both groups' skills fell in the average range. Among children with diabetes, poor glycemic control [higher hemoglobin A1c (HbA1c)] was related to lower general cognitive abilities (r = -0.44,p0.04), slower fine motor speed (r = -0.64,p0.02), and lower receptive language scores (r = -0.39,p0.04). Such findings indicate that young children with T1DM already demonstrate some negative neurocognitive effects in association with chronic hyperglycemia.

This study investigated the relationship between compliance with a prescribed diabetic diet and metabolic control of insulin-dependent diabetes mellitus (IDDM). The study sought to determine the degree to which patients translated food exchange prescriptions into appropriate food choices and to identify correlations between metabolic control (as measured by glycosylated hemoglobin level) and compliance with prescribed food exchanges, body mass index (BMI), and intake of energy and fat. Subjects were 40 inpatients and 29 outpatients aged 4 to 18 years with IDDM. Records of the inpatients' food selections for 3 days and 3-day food records collected from the outpatients (or their parents) were analyzed. For all 69 subjects, the mean daily deviation from the prescribed food exchanges was 23.8%, which indicates that subjects added or deleted approximately one of four prescribed exchanges. Records of actual food intake revealed that both patient groups had greater mean energy intakes than had been prescribed: 196 additional kcal for inpatients and 372 additional kcal for outpatients; fat sources accounted for 92% and 68% of the greater energy intake, respectively. No correlation was found between glycosylated hemoglobin level and BMI, energy intake, or fat intake.

Type 1 diabetes mellitus is a chronic illness that affects about one in 700 children (Arslanian et al., 1994). The daily treatment regimen for type 1 diabetes is complex, requiring careful insulin administrations, monitoring of blood glucose, and modification of diet and exercise. The maintenance of optimal blood glucose is necessary to prevent the onset of a variety of shortterm complications, for example, hypoglycemia, hyperglycemia, and longterm complications, for example, retinopathy, neuropathy, nephropathy, and cardiovascular disease (Diabetes Control and Complications Trial, DCCT, 1993).

Objective This study evaluated racial differences in the metabolic control of children and adolescents with insulin-dependent (type I) diabetes mellitus and examined the interactive effects of race with age and sex. Research Design and Methods Data on several demographic and clinical variables were obtained for 102 black and 108 white children, including the percentage of total HbA1, age, age at diagnosis, duration of diabetes, pubertal status, insulin dose (U · kg−1 · day−1), body mass index, number of clinic visits kept and missed, number of hospitalizations for diabetic ketoacidosis (DKA) for the year, and socioeconomic status (SES). Results Black children had higher insulin dosages (P < 0.05) and lower SESs (P < 0.001) than white children. HbA1 was higher in black than white children (P < 0.01) after statistically adjusting for the effects of insulin dose, diabetes duration, and SES. With HbA1-based criteria, more black than white children were in poor and fewer in good metabolic control (P < 0.001). Older children (≥ to 13 yr) had higher HbA1 levels than younger (< 13 yr) children (P < 0.002), but there were no differences in HbA1 between males and females nor were there interactive effects of race, sex, and age-group. Black children were hospitalized for DKA more frequently than white children (P < 0.04). More black than white children missed clinic visits (P < 0.01), but they did not differ in number of visits kept. Conclusions Black youths with type I diabetes mellitus are in poorer metabolic control than white youths.

Purpose The purpose of this study is to investigate parent reports of the diabetes care support their children receive in school, their concerns about diabetes management in school, and their knowledge of federal laws that protect children with diabetes. In addition, the study explores ethnic and socioeconomic status differences in diabetes management in school. Methods An ethnically heterogeneous sample of 309 parents of children with diabetes was recruited from a community-based and a university-based diabetes outpatient clinic. Parents completed a survey assessing supports their child's school provides for diabetes care, worries about diabetes care in school, and awareness of federal laws that pertain to children with diabetes. Results Many children did not have a written care plan or a nurse at school, but significantly more white children had these supports than Hispanic or black children. Most children were not allowed to check blood glucose levels or administer insulin in class. Most parents were worried about hyperglycemia and hypoglycemia in school, and most were not at all or only a little confident in the school's ability to care for diabetes. Most parents were not aware of federal laws, but high-income and white parents were more likely to be aware. Conclusions According to parents in the current study, children receive inadequate diabetes management support in schools. Minority children are less likely to receive supports than white children. Parents are worried about diabetes management in school, but most do not have the knowledge of federal laws necessary to protect their children.

This investigation extended prior work by determining if stress and body mass index (BMI) contributed independently to tumor necrosis factor-alpha (TNF-alpha) levels among prepubescent Latino children and if sex and family history of type 2 diabetes mellitus (T2DM) modified these relationships. Data were collected in South Florida from 112 nondiabetic school-aged Hispanic children, of whom 43.8% were obese (BMI/= 95th percentile) and 51.8% presented with a family history of T2DM. Stressful life events were assessed via parental report using a life events scale. Plasma TNF-alpha levels were determined with enzyme-linked immunosorbent assay. The relative contributions of stress and BMI with TNF-alpha levels and the potential interaction effects of sex and family history of T2DM were analyzed with multiple linear regression analyses. Stress and BMI each accounted for a significant proportion of the unique variance associated with TNF-alpha. The association between stress and TNF-alpha was not modified by sex or family history of T2DM. These findings implicate BMI and stress as independent determinants of TNF-alpha (an inflammatory cytokine and adipocytokine) among Latino children. Future investigations should examine the potential roles of exercise, nutritional status, age, and growth hormone in explicating the relationship between TNF-alpha production and psychosocial distress and risk for infection among obese children.

This study was designed to evaluate the effects of a self-management training (SMT) program on metabolic control of children with insulin-dependent diabetes mellitus (IDDM) in the first 2 yr after diagnosis. After standard in-hospital diabetes education, 36 children (mean age 9.3 yr, range 3–16 yr) were randomized to conventional follow-up, conventional and supportive counseling (SC), or conventional and SMT, which emphasized use of data obtained from self-monitoring of blood glucose. SC and SMT interventions consisted of seven outpatient sessions with a medical social worker during the first 4 mo after diagnosis and booster sessions at 6 and 12 mo postdiagnosis. Groups were similar with respect to age, sex, body mass index, socioeconomic status, C-peptide, and severity of illness at diagnosis. Metabolic control, measured quarterly by glycosylated hemoglobin (HbA1), improved substantially in all three treatment groups during the first 6 mo. SMT patients had significantly lower HbA1 levels than conventional patients at 1 yr (P < 0.01) and 2 yr (P < 0.05) postdiagnosis. SMT patients also had lower HbA1 levels than SC patients, but this did not reach statistical significance. The lower HbA1 levels of SMT patients were not explained by severity of illness at diagnosis, or insulin dose, body mass index, and C-peptide levels at 2 yr. These results suggest that an SMT program during the first few months after diagnosis helps avoid the deterioration in metabolic control often seen in children with IDDM between 6 and 24 mo after diagnosis.

Objectives To compare the health-related quality of life (HRQOL) of youths on injection regimens to those prescribed insulin pump therapy and examine factors related to HRQOL in youths with type 1 diabetes. Methods An ethnically diverse group of youths (n = 160, ages 5-17 years) with type 1 diabetes and their caretakers completed family, parent, and child adjustment measures, as well as measures of generic- and disease-specific HRQOL. Metabolic control and regimen information were assessed through medical records. Results HRQOL was unrelated to regimen prescription. Child, family, and parent adjustment variables were significantly related to HRQOL, whereas other demographic and clinical variables were relatively less important. Conclusions Present findings indicate that insulin pump therapy does not have negative implications for HRQOL. They also suggest that interventions aiming to improve HRQOL in this population should target child, parent, and family adjustment and not focus solely on disease-related outcomes.

Objective To examine the appraisal of short- and long-term diabetes health risk and adherence, determine whether health risk predicts adherence and glycemic control in an ethnic minority sample, and determine whether perceptions of personal risk differ from risk to others. Methods Seventy-four youths with type 1 diabetes (ages 11–16) completed measures of risk perception and regimen adherence during their clinic visit; parents completed a measure of their children’s adherence. Glycosylated hemoglobin A1c level was measured as part of the clinic visit. Results Regression analyses predicting parental report and self-reported adherence from appraisal of risk yielded nonsignificant results; perceived short-term complications to self predicted glycemic control. Appraisal of risk was higher for short- and long-term complications occurring to someone else with diabetes than to self. Greater risk for short-term complications than for long-term complications to self and other was found. Conclusions The distinction between long-term and short-term complications and complications occurring to ones’ self or someone else with diabetes was supported. Assessment of perceived risks for short-term complications is important for this age group and should be addressed in interventions to improve adherence.

Objective: To examine the relationships between TNF-α, obesity, and insulin resistance among prepubescent children. Design: Cross-sectional study. Setting and subjects: Data were collected from 112 nondiabetic Latino schoolchildren from public schools in three South Florida communities. Of the enrolled participants, 43.8% were obese (BMI 95th percentile) and 51.8% presented with a family history of type 2 diabetes mellitus (T2DM). With one exception, all demonstrated normal glucose tolerance. Interventions: Plasma TNF-α levels were determined with enzyme-linked immunosorbance assay (ELISA). Homeostasis model assessment (HOMA-IR) was calculated as an index of insulin resistance. Mean levels of TNF-α among obese vs nonobese children were compared with a one-way analysis of variance with two groups, and the association between TNF-α and HOMA-IR was assessed with a Pearson's correlation. Results: Higher circulating TNF-α levels were revealed among nonobese vs obese children. Nonobese girls demonstrated higher TNF-α levels than obese girls, whereas there were no significant differences for boys. There were no significant differences after stratifying for family history of T2DM. There was a modest relationship between increased TNF-α levels and decreased insulin resistance. Conclusions: The observed elevated circulating TNF-α concentrations among leaner participants may reflect an inflammatory process that has been associated with higher levels of physical fitness in both adults and prepubescent children. This effect may remain stronger for prepubescent girls, and the mechanism may be attenuated by the hormonal changes that occur with the onset of puberty. Sponsorship: This research was supported, in part, by a clinical research grant from the American Diabetes Association, as well as NIMH NRSA # 5T32 MH18917-09.

Diabetes imposes considerable demands on children and their families. As they are coping with normal developmental challenges, the additional burden of diabetes may be difficult for many children and families to deal with effectively. Especially challenging may be the demands of intensive management. With children as patients, families play a significant role in diabetes management, and are instrumental in the implementation of interventions. The quality of life of all family members is potentially affected by diabetes.

This study investigated the relationship between parental self-efficacy and asthma-related morbidity. Participants included 139 parents of children (ages 5-8) who were diagnosed with asthma and were primarily from lower-income and minority backgrounds. Parents completed a 22-item measure of self-efficacy; factor analysis was conducted on this measure, yielding two factors: learned helplessness and self-efficacy. Correlational analyses indicated that higher scores on the learned helplessness factor were significantly related to increased asthma-related morbidity for the majority of morbidity variables. The self-efficacy factor was significantly related to days of school missed. Regression analyses conducted with the factor scores and the morbidity variables provide further support that the learned helplessness factor accounts for a significant amount of the variance in asthma morbidity for many of the variables studied, while the self-efficacy factor was related to only a few. Although improving health outcomes of children with asthma is a multifaceted process, the results of this study suggest that targeting parental self-efficacy, particularly with parents who are experiencing high levels of perceived learned helplessness, may be a helpful component of an intervention program with this population.

This study examined child development in relation to post-traumatic stress disorder (PTSD) after hurricane exposure. The study subjects were 175 3 to 5-year old minority children enrolled in Head Start programs. Children were evaluated 12 and 18 months after Hurricane Andrew struck south Florida. Mothers were interviewed concerning symptoms of PTSD and completed a questionnaire regarding their children's development. RESULTS indicated that 16.5% of exposed children met DSM-IV diagnostic criteria for PTSD at 12 months, and 11.6% had PTSD at 18 months post-hurricane. Children who had PTSD at 12 months were more likely to be delayed in their development at 18 months, and those with PTSD at 18 months similarly were more likely to be delayed. These findings indicate that children with PTSD are at risk for delays in their overall development. Language: en

of life trended toward being lower (P=0.055) in the dropout group. There were no differences in demographic characteristics between dropouts and completers. Conclusions: 1) Convenience or bother appear to play a greater role in contributing to dropout than study burden; 2) Against prediction, there were no differences in psychological or demographic characteristics between dropouts and completers in the trial; 3) The trend toward lower quality of life in dropouts raises the question as to whether those most needing intervention are being reached. Studies are needed investigating factors contributing to dropout rates and interventions to enhance completion of IBS trials, particularly in children.

Background Many unhealthy dietary and physical activity habits that foster the development of obesity are established by the age of five. Presently, approximately 70 percent of children in the United States are currently enrolled in early childcare facilities, making this an ideal setting to implement and evaluate childhood obesity prevention efforts. We describe here the methods for conducting an obesity prevention randomized trial in the child care setting. Methods/design A randomized, controlled obesity prevention trial is currently being conducted over a three year period (2010-present). The sample consists of 28 low-income, ethnically diverse child care centers with 1105 children (sample is 60% Hispanic, 15% Haitian, 12% Black, 2% non-Hispanic White and 71% of caregivers were born outside of the US). The purpose is to test the efficacy of a parent and teacher role-modeling intervention on children’s nutrition and physical activity behaviors. . The Healthy Caregivers-Healthy Children (HC2) intervention arm schools received a combination of (1) implementing a daily curricula for teachers/parents (the nutritional gatekeepers); (2) implementing a daily curricula for children; (3) technical assistance with meal and snack menu modifications such as including more fresh and less canned produce; and (4) creation of a center policy for dietary requirements for meals and snacks, physical activity and screen time. Control arm schools received an attention control safety curriculum. Major outcome measures include pre-post changes in child body mass index percentile and z score, fruit and vegetable and other nutritious food intake, amount of physical activity, and parental nutrition and physical activity knowledge, attitudes, and beliefs, defined by intentions and behaviors. All measures were administered at the beginning and end of the school year for year one and year two of the study for a total of 4 longitudinal time points for assessment. Discussion Although few attempts have been made to prevent obesity during the first years of life, this period may represent the best opportunity for obesity prevention. Findings from this investigation will inform both the fields of childhood obesity prevention and early childhood research about the effects of an obesity prevention program housed in the childcare setting. Trial registration Trial registration number: NCT01722032

Evaluated the effects of stress management training (SMT) for adolescents with diabetes in a 9-month controlled treatment-outcome study. Nine patients were randomly assigned to a stress management group while another 10 patients served as controls and received standard outpatient treatment. The treatment program consisted of 10 sessions over 3 months, 3 additional sessions over 3 months, and a 3-month follow-up without treatment. Diabetes-specific stress decreased significantly for patients in the SMT group over the course of the intervention and follow-up. However, metabolic control, regimen adherence, coping styles, and self-efficacy about diabetes were unchanged. These findings suggest a SMT program for adolescents with diabetes may be helpful in reducing diabetes-specific stress, but additional procedures are necessary to improve adherence, coping styles, and metabolic control.

The psychosocial functioning of patients arriving at the emergency department with an acute myocardial infarction early enough to be candidates for treatment with thrombolytic agents was compared with that of those arriving later. Patients who arrived within 3 hours were significantly more anxious when assessed 1 week after admission and had a consistently worse pattern of psychosocial adjustment 3 months after hospital discharge than did those who arrived later. The implications of these findings for efforts to improve early arrival at the emergency department, as well as for medical and psychosocial outcomes after acute myocardial infarction, were considered.

Determined the relationships among the learned helplessness attributional style, depression, regimen adherence, and metabolic control in a sample of diabetic youth. Fifty children (20 male and 30 female) between the ages of 10 and 16 completed the Children's Attributional Style Questionnaire and the Children's Depression Inventory. Regimen adherence was assessed with three 24-hr recall interviews conducted separately with patients and their mothers over a 1-week period. Metabolic control was measured by glycosylated hemoglobin A1 (HbA1). Learned helplessness was significantly associated with depression (p less than .001) and HbA1 (p less than .02), but was not associated with regimen adherence. Depression was unrelated to regimen adherence and metabolic control. The adherence measures together accounted for 24% of the variance of HbA1. Significant correlations were obtained between HbA1 and the exercise (p less than .05) and eating/testing frequency (p less than .05) adherence factors, indicating that lower levels of adherence were associated with worse metabolic control. Age, pubertal status, sex, disease duration, and SES were unrelated to regimen adherence and metabolic control. These results support the notion that the learned helplessness attributional style for negative events is related to both depression and long-term metabolic control problems in diabetic youths.

The diagnostic category of learning disabilities is a heterogeneous one, but few empirical attempts have been made to distinguish subgroups. Recent research, however, suggests that it may be meaningful to discriminate between “hyperactiveℍ and “nonhyperactiveℍ learning-disabled children. In the present study, 21 learning-disabled children identified as “hyperactiveℍ through teacher nominations and ratings were compared to 15 learning-disabled children identified as “nonhyperactiveℍ in the same manner. The two groups differed on rated behavior, birth order, amount of prescribed stimulant medication, amount of psychosocial stress, and Verbal, Performance, and Full Scale WISC-R IQ scores. They did not differ, however, on several demographic variables, the number of perinatal complications, reading achievement, and a number of tonic and phasic measures of autonomie activity. These findings support the distinction between “hyperactiveℍ and “nonhyperactiveℍ subgroups of learning-disabled children, but suggest that the two subgroups may have a similar biological substrate.

This paper provides the framework for assessing and treating chronically depressed, multiproblem children. A clinical case study was chosen as the vehicle to illustrate, in a sequential manner, an approach which utilizes intensive milieu interventions, dynamically oriented psychotherapy, antidepressant medication, and behavior therapy (social skills training) to convey the rationale and methodology for a pragmatic, comprehensive, multi-modal approach to the therapy of chronically depressed children.

Thirty-six learning disabled children (21 of whom were also classified as hyperactive) were subgrouped according to teacher ratings of tension-anxiety and conduct problems and then compared on measures of tonic and phasic autonomic arousal. The results indicated that children rated high on the conduct problem dimension evidenced smaller amplitude specific skin conductance responses, and that anxiety appeared to exert a moderating effect on physiological responses. When the hyperactive sample was considered separately, lower skin conductance levels were observed in children rated high on conduct problems than in hyperactive children rated low in conduct problems. These findings support the notion that hyperactive and learning-disabled children are heterogeneous at a physiological level and suggest that physiological differences previously attributed to hyperactivity may actually be correlates of the conduct problem dimension.

The purpose of this study was to test the hypothesis that social demand could substantially affect reports of self-monitored blood glucose (BG) in adolescents with insulin-dependent diabetes mellitus. Of 34 patients initially enrolled in the study, 10 were excluded because they did not bring any BG records with them to an outpatient clinic appointment. The remaining 24 patients were randomly assigned to either a low or high social demand condition that provided instructions for monitoring of BG for the week following the appointment. The subjects' BG records were quantified to provide frequency of measurement and mean reported BG for the week prior to and after the clinic visit. Five subjects did not return their BG records for the week following the intervention. The analyses were therefore based on the 19 subjects from whom complete records were obtained. The 12 subjects in the low social demand group and 7 subjects in the high social demand group were equivalent with regard to age, duration of diabetes, socioeconomic status, and glycosylated hemoglobin. Frequency of BG measurement was similar in both groups during both weeks. The mean BG value reported in the week prior to intervention was similar for the groups. However, analyses of the post-intervention BGs revealed that subjects in the low-demand group reported significantly higher BGs compared to pre-intervention and to subjects in the high-demand group. These findings suggest that self-monitoring and reporting of BG is a social behavior that is affected by the demand characteristics of the interpersonal patient-health provider relationship. Because optimal treatment planning for individuals with diabetes requires accurate BG records, care must be taken to interpret them in light of the social demand characteristics associated with clinical assessment.

The present study sought to determine the most efficient means of staff management by comparing three training procedures: (1) in-service training, using Brown and Presbie's (1974) Behavior Modification Skills, (2) direct feedback of actual staff performance, and (3) role-playing, involving instruction, modeling, behavioral rehearsal, feedback, and reinforcement with an experienced behavior therapist. Direct naturalistic observational procedures were used to obtain behavioral data to eight staff members' (nurses and aides) interactions with children on an inpatient psychiatric unit. The phases of the study, which spanned twenty-one weeks, included: baseline 1, in-service training, in-service plus direct feedback (administered sequentially across subjects), baseline 2, and role-playing. Results indicated that (1) the in-service training had little effect on staff behavior, (2) direct feedback in some cases resulted in increased frequency of appropriate staff responding, including greater use of positivereinforcement and vocalizations, but these gains were not maintained across time, and (3) the greatest gains in staff behavior occurred as a result of role-playing. These results are discussed in terms of both the specific advantages anddisadvantages of each of the training procedures, and the practicality and political issues involved.

This study examined the cardiovascular (CV) correlates of the primary Type A behavior components during social interactions. Brief dialogues were created to role-play (RP) stereotypic Type A and Type B ways of responding to three common social situations designed to elicit hostility (H), time-urgency (T), and competition (C). Situations and dialogues were validated by independent raters. Thirty undergraduate students were identified as Type A and 30 as Type B, with 15 males and 15 females in each group. Subjects were provided scripts for each of the six experimental RPs and rehearsed them prior to the CV assessment. Measures of systolic and diastolic blood pressure (SBP, DBP) and heart-rate (HR) were obtained during an adaptation period and during each RP. Analyses of the "A" (i.e. H, T, C) versus "B" (i.e. non-H, non-T, non-C) RPs indicated that DBP (p less than 0.03) and HR (p less than 0.002) were higher during the H as compared with non-H RP. Significantly higher SBP was observed in the T as compared with the non-T RP (p less than 0.04). No CV differences were observed in the comparison of the C and non-C RPs. Analyses comparing the three "Type A" RPs revealed higher SBP during H and T RPs, as compared with the C RP (p less than 0.003). Effects of subject Type (i.e. A/B) were not obtained in any analysis. These findings indicate that hostile and time-urgent social interactions are associated with significant increases in CV arousal which are independent of overall Type status.

This study was designed to objectively measure dietary skills of diabetic children and their mothers and to assess dietary adherence in specific situations. Subjects were 34 children with Type I diabetes mellitus and their mothers. Recall of diet prescriptions and performance on skills tests averaged around 50% for both children and mothers. Adherence problems were most frequent during afternoon snack, while at school, with friends, and at restaurants. Significant relationships between glycosylated hemoglobin values and adherence at school and with friends were observed. Older children had more adherence problems with afternoon snack, while alone, and while with parents. Dietary skills were unrelated to adherence. These findings demonstrate that children with diabetes and their mothers have substantial dietary skills deficits and situationally related dietary adherence problems.

Diabetes mellitus is the most common metabolic disease of childhood. Many children with diabetes have disease-related problems (e.g., family conflict over regimen adherence, peer relationship difficulties) that are best understood and approached from a psychological perspective. Effective treatment, therefore, requires consideration of psychological and behavioral factors, as well as biomedical factors (Drash, 1981; Fisher, Delamater, Bertelson, & Kirkley, 1982; Hamburg, Lipsett, Inoff, & Drash, 1980). In recent years, as the psychological aspects of childhood diabetes have been better understood, psychologists have played an increasingly important role in diabetes care.

This paper describes the use of behavioral techniques with a 101/2-year-old boy diagnosed as having hysterical paralysis of both legs. The case demonstrates the use of withdrawal of reinforcement for hysterical behavior and the use of positive reinforcement for successive approximations of walking behavior. The patient regained full mobility within 2 weeks after the beginning of the program, and showed other behavioral improvements as well (increased vocalizations, decreased isolative behavior and lethargy-dejection). At 6-month follow-up, the patient had maintained his gains, with no symptom substitutions. The treatment is discussed within its context (a pediatric psychiatric inpatient facility) with consideration to the role of psychiatric staff in employing behavioral methods.

The purpose of this study was to determine whether measures of anxiety, stress, and means of coping with stress differ in diabetic adolescents in good, fair, and poor metabolic control. Trait anxiety, perceived daily stress, and coping responses to a recent stressful event were assessed in 27 adolescents with Type 1 diabetes mellitus. Information also was obtained regarding the type of stressful events that subjects referred to in completing the coping measure, as well as their appraisals of the events. Hemoglobin A1 (HbA1) obtained at the time of the study was used as a measure of antecedent metabolic control. Based upon their HbA1, patients were divided into three metabolic control subgroups: good control (M = 8.4%; n = 8), fair control (M = 10.9%; n = 9), and poor control (M = 13.3%; n = 10). Patients in these subgroups were similar with regard to age, disease duration, and socioeconomic status. Results indicated that the subgroups did not differ on the anxiety and stress measures; however, analyses of the coping data indicated that patients in poor control employed significantly more wishful thinking and avoidance/help-seeking than did patients in good metabolic control. Furthermore, the metabolic control subgroups differed in the type of stressful events reported and their appraisals of the stressful events. These results support the hypothesis that the ways in which individuals with diabetes appraise and cope with stress is related to their metabolic control. The findings are discussed in relation to methodological issues and treatment implications.