Observed Communication
in Adolescents with Type 1 Diabetes
and their Mothers
Sarah S. Jaser, PhD
Robin Whittemore, PhD, APRN
Margaret Grey, DrPH, FAAN
Funding for the current study was provided by a
Pilot/Feasibility Studies Program award (P30 NR008999)
and the Intramural Small Grant Program from the Yale
University School of Nursing.
Background
Adolescents with type 1 diabetes (T1D) at
increased risk for deteriorating metabolic control
and psychological disorders (Hocking & Lochman, 2005)
Parents continued involvement in treatment
management is linked with better outcomes
(Anderson et al., 2002).
Parents’ attempts to monitor or control diabetes
treatment perceived as intrusive or “nagging” (Berg
et al., 2007; Weinger et al., 2001)
Parental involvement perceived as collaborative
related to fewer depressive symptoms, better
metabolic control (Ellis et al., 2007)
Observed Parent-Child
Interactions
More emotionally-charged conversations related to
poorer adherence in adolescent girls with T1D
(Bobrow, 1985)
Higher levels of observed emotional support,
acceptance, and conflict resolution related to better
metabolic control (Martin et al., 1998)
Improvements in parent-child communication
related to better adherence, adjustment, and
metabolic control (Wysocki et al, 2002, 2008)
Purpose
To examine observed communication
behaviors in adolescents and their
mothers during a stressful interaction.
To determine whether observed
communication behaviors were related
to outcome variables (i.e., family
conflict, adolescents’ symptoms of
aggression and anxiety/depression, and
metabolic control).
Inclusion Criteria
Type 1 diabetes
Duration > 6 months
Age 10-16 years
Free of other chronic conditions
Sample (n = 30)
Adolescents
Mothers
Age
12.6 + 1.6
43.5 + 6.7
Gender
55% female
Race/Ethnicity
Treatment
Type
76% White
13% Hispanic
13% Black
Duration
74% Pump
26% Injections
5.8 + 4.7 yrs
HbA1c
7.9 + 1.5%
Procedure
Videotaped 15-minute conversation between
adolescents and their mothers
Determined common diabetes-related stressor
Given cue card to guide discussion
All interactions coded with the Iowa Family
Interaction Rating Scales (IFIRS, Melby et al., 1998)
Uses verbal and non-verbal behaviors to rate individuals
from 1 (not at all characteristic) to 9 (very characteristic)
Positive Communication: listener responsiveness,
communication, and prosocial
Negative Communication: avoidance, denial, and
antisocial
Data Collection
Diabetes-Related Family Conflict
Diabetes Responsibility and Conflict (Rubin, Young-Hyman, &
Peyrot, 1989) completed by mothers
Aggression & Anxiety/Depression
Child Behavior Checklist (CBCL, Achenbach, 2001) completed
by mothers
HbA1c
Observed Communication
Results
Observed Maternal Behavior
97% of mothers exhibited more positive communication
than negative communication
Observed Adolescent Behavior
Exhibited high levels of anxious (6.1 + 1.0) and avoidant
(6.0 + 1.7) behaviors
Demonstrated effective communication skills (5.7 + 1.5) and
active listening (5.8 + 1.2)
Video Clip
Video Clip
Correlations with Observed Maternal
Positive Communication and
Outcomes
*
**
Correlations with Observed Maternal
Negative Communication and
Outcomes
*
*
Correlations with Observed Positive
Adolescent Communication and
Outcomes
Correlations with Observed
Adolescent Negative Communication
and Outcomes
*
Summary
Mothers more positive than negative during
stressful interactions with their adolescent children
More positive communication and less negative
communication in mothers related to:
Lower levels of parent-reported family conflict
Lower levels of parent-reported adolescent aggression
Better metabolic control
More negative communication in adolescents
related to:
Higher parent-reported levels of aggression
Poorer metabolic control
Limitations
Small sample size limits generalizability
Unable to test for age or gender effects
Inter-rater reliability at a moderate level
for mothers’ observed behavior
Implications
Support the use of observational research in
this population
Observed communication may be a stronger
predictor of metabolic control than
questionnaire measures of family
functioning/parenting
Suggest that improving positive parent
communication may be a target for future
interventions