OBJECTIVE—This study examined 1) whether the benefits of mothers’ and fathers’ accepting relationships with their adolescents regarding diabetes control were due to parental monitoring and 2) how parents together may provide sufficient acceptance and monitoring for diabetes management. RESEARCH DESIGN AND METHODS—Adolescents aged 10–14 years with type 1 diabetes (n = 185) and their mothers (n = 185) and fathers (n = 145) completed assessments of parental acceptance and monitoring of diabetes tasks. Adolescents completed a modified version of the Self-Care Inventory (1) to measure adherence. A1C scores were used as a marker of glycemic control. RESULTS—Mediational analyses revealed that the benefits of adolescents’ reports of fathers’ acceptance on A1C and mothers’ and fathers’ acceptance on better adherence were partially mediated by monitoring. Both mothers’ and fathers’ monitoring and fathers’ acceptance had independent effects in predicting adherence. However, only fathers’ monitoring had an independent effect on A1C. The effect of fathers’ monitoring on A1C occurred as fathers were monitoring at a lower level than mothers. Mothers’ and fathers’ reports of their own acceptance and monitoring were not associated with A1C or adherence. CONCLUSIONS—Results reveal the importance of fathers’ acceptance and monitoring in diabetes management, a role that should be encouraged, despite the little attention it has received.

Objective The purpose of this study was to examine longitudinal trajectories of parental involvement and adolescent adherence to the Type 1 diabetes regimen, to determine whether changes in multiple facets of parental involvement over time predicted subsequent changes in adolescents’ adherence, and to examine whether adolescent self-efficacy mediated the effect of parental involvement on adherence. Method Two hundred fifty-two adolescents (M age = 12.49 years, SD = 1.53; 53.6% females) diagnosed with Type 1 diabetes mellitus, their mothers, and 188 fathers were enrolled in a 2.5-year longitudinal study. Across 5 time points, up to 252 adolescents and their parents completed measures of adherence, parental involvement (diabetes monitoring, behavioral involvement in diabetes management, and acceptance), and adolescent diabetes self-efficacy. Results Using multilevel modeling, analyses indicated significant average declines over time in adherence and most indicators of parental involvement. Lagged multilevel models indicated that declines in mothers’ and fathers’ acceptance and diabetes monitoring predicted subsequent declines in adolescents’ adherence. Additional analyses revealed that longitudinal associations between both maternal acceptance and diabetes monitoring and subsequent adolescent adherence were mediated by adolescents’ self-efficacy. Conclusions Results of this study, which were largely consistent across reporters, highlight the importance of maintaining parental involvement in diabetes across adolescence and suggest that parental involvement is beneficial for adolescents’ adherence, in part, because it contributes to higher self-efficacy for diabetes management among adolescents.

Objective To examine mediating processes linking parental involvement to diabetes management (adherence and metabolic control) during adolescence. Methods A total of 252 young adolescents (M age ¼ 12.49 years, SD ¼ 1.53, 53.6% females) with type 1 diabetes reported their parents' involvement in diabetes management (relationship quality, monitoring, and behavioral involvement), their own externalizing and internalizing behaviors, diabetes-self efficacy, and adherence behaviors. HbA1c was drawn from medical records. Results SEM analyses indicated that the associations of mothers' and fathers' relationship quality with diabetes outcomes were mediated by adolescents' perceptions of self-efficacy and externalizing behaviors, and the associations of fathers' monitoring and behavioral involvement with adherence were partially mediated by adolescents' self-efficacy. There were also direct (non-mediated) associations between mothers' monitoring and adherence, and fathers' monitoring and adherence and metabolic control. Conclusions Quality of the parent-adolescent relationship and monitoring are important for better adherence and metabolic control among adolescents through higher diabetes self-efficacy.

Transfer of responsibility for diabetes management across adolescence may be more optimal when adolescents' increased independence is titrated to their changing self-efficacy beliefs.

Maternal parenting style is associated with well-being in adolescents with diabetes, but this association is complex and moderated by age and gender.

We examined whether intra-family discrepancies in perceptions of the adolescent's competence and independence were associated with autonomy and also well-being for adolescents and parents. The latent discrepancy model was used to examine the ways that mothers and fathers consistently differed from their adolescent across measures of independence and competence regarding type 1 diabetes, a stressful context for families. One-hundred and eighty-five mothers, fathers, and adolescents (M age= 12.5 SD= 1.3) completed measures of the adolescent's independence in completing diabetes tasks, problems with diabetes management, adherence to the medical regimen, measures of wellbeing, and metabolic control. The latent discrepancy model was conducted via structural equation modeling that generated latent discrepancies from the adolescent for mothers and fathers. Both mothers and fathers viewed the adolescent's competence more negatively than did the adolescent. These discrepancies related to more parental encouragement of independence and adolescent autonomy, but also poorer metabolic control, and poorer parental psychosocial well-being. ThePublisher's Disclaimer: The following manuscript is the final accepted manuscript. It has not been subjected to the final copyediting, fact-checking, and proofreading required for formal publication. It is not the definitive, publisher-authenticated version. The American Psychological Association and its Council of Editors disclaim any responsibility or liabilities for errors or omissions of this manuscript version, any version derived from this manuscript by NIH, or other third parties. The published version is available at www.apa.org/journals/dev. results are interpreted within a developmental perspective that views discrepancies as reflecting normative developmental processes of autonomy, but associated with disruptions in well-being in the short term. NIH Public AccessKeywords parent-child relationship; autonomy; adolescence; parent adjustment; type 1 diabetes Adolescence is a time when children and their parents work toward a new type of relationship as adolescents experience socio-emotional and cognitive developments (Steinberg & Silk, 2002). As a consequence, adolescents and their parents frequently view the family (Carlson, Cooper, & Spradling, 1991) and their relationship in discrepant ways (Tein, Roosa, & Michaels, 1994). A key parent-child discrepancy involves views of adolescents' competence and independence (Holmbeck & O'Donnell, 1991), with adolescents perceiving themselves as more competent and independent than do parents. In this paper, we examine discrepancies between the adolescent's and the parent's views of the adolescent's competence and independence with respect to diabetes management. We utilize a developmental and transactional perspective that views the parent-child relationship as a dynamic one where both parent and adolescent develop Kim, Conger, Lorenz, & Elder, 2001). We examine how discrepancies across multiple metrics of independence and competence ...

Objective To examine whether benefit finding was associated with better adjustment among adolescents with diabetes by buffering negative affective reactions to diabetes stress and by promoting positive affective reactions. Design Early adolescents aged 10-14 with type 1 diabetes (n=252) described recent diabetes stressors, affective reactions, and perceived coping effectiveness. They also completed measures of benefit finding, depressive symptoms, and adherence. Metabolic control (i.e., HbA1c) was obtained from medical records. Main Outcome Measures The main outcome measures were perceived coping effectiveness, depressive symptoms, adherence, and HbA1c. Results Benefit finding was associated with lower depressive symptoms, higher perceived coping effectiveness and better adherence, and with higher positive as well as negative affective reactions to diabetes stress. Benefit finding interacted with negative affective reactions to predict depressive symptoms and HbA1c. Negative affective reactions to stress were associated with poorer adjustment among those with low benefit finding, but were unrelated or more weakly related to poor adjustment among those with high benefit finding. Positive affective reactions did not mediate associations between benefit finding and any outcome. Conclusions Consistent with a stress-buffering process, benefit finding may be a resource that buffers the disruptive aspects of negative affective reactions to stress for adolescents’ diabetes management.

Adolescent perceptions of components of parental involvement are interrelated, yet separate constructs for both mothers and fathers. Parental monitoring was an important predictor of management of type 1 diabetes during adolescence.