The adjustment to diabetes of school-age children with psychological adjustment problems.

Abstract

Objective: To determine whether diabetic children with psychological adjustment problems have greater difficulties in specific areas of disease adaptation than their welladjusted diabetic peers by comparing their diabetes-related adjustments in the family, school and peer environments. Method: Mothers of 47 school-age preadolescent children with diabetes completed a standardized assessment of general psychological functioning. Children with psychological adjustment problems were then compared with children who did not exhibit problems along the following dimensions: their demographic and medical profiles, maternal diabetes knowledge, associations between general psychological functioning and diabetes control, and the quality of their diabetes adjustment. Results: No differences were found between children with psychological adjustment problems and their better-adjusted peers along any of the demographic or health status variables tested or in maternal diabetes knowledge. However, children with adjustment problems were more likely to receive visits from the hospital's home-care team and to be absent from school. Also, for children with psychological difficulty, indices of diabetes control and general psychological functioning were related, and the nature of this relation differed across the school and family environments. In addition, poorer psychological adjustment was associated with diabetes-specific problems in both mother and child. These included individual adjustment problems such as feeling different, relationship difficulties with family and peers, and difficulties with the treatment protocol, in particular, with the dietary regime. Conclusion: These findings are considered in relation to (1) the importance of multi-method techniques in research which concerns adjustment to diabetes, in particular the need to use both psychological and disease-specific instruments, and (2) clinical evaluations and interventions for children with diabetes and their families.