Diabetes Family Teamwork with Teens: What is Success?

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This is a presentation authored and developed by my friend and colleague Dr. Barbara Anderson of Baylor College of Medicine. The presentation is a module in the 2014 Advanced Diabetes Seminar, hosted by Texas Lions Camp.

In this discussion, Dr. Anderson dives into the topic of “Diabetes Family Teamwork with Teens: What is Success?”

Published in: Health & Medicine
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Diabetes Family Teamwork with Teens: What is Success?

  1. 1. Diabetes Family Teamwork with Teens: What is Success? Barbara J. Anderson, PhD Professor of Pediatrics Baylor College of Medicine Houston, TX
  2. 2. Page 1 xxx00.#####.ppt 4/21/2014 12:39:38 PM Objectives I. Why is family teamwork around diabetes (T1D) management sometimes difficult during teen years? II. What is Success in raising a teen with Type 1 Diabetes (T1D)? ―Begin with the End in Mind‖ What do you hope your teenager will be like when s/he is 22 years old?
  3. 3. Page 2 xxx00.#####.ppt 4/21/2014 12:39:38 PM Objectives III. Lessons from behavioral diabetes research about families living with teenagers with T1D. -parent involvement -conflict IV. Preparing for transition to young adulthood.
  4. 4. Page 3 xxx00.#####.ppt 4/21/2014 12:39:38 PM I. Why is T1D management at times a magnet for negativity & conflict during adolescence? 1. Parent-teen conflict increases normally over adolescence 2. Normal Tasks of teen development (drive for autonomy; peer bonds) clash with demands of daily T1D self-care •
  5. 5. Page 4 xxx00.#####.ppt 4/21/2014 12:39:38 PM Why is T1D management at times a magnet for negativity and conflict during adolescence? •3. Parent has normal concerns & worries about health of their teen with T1D 4. Parental Cognitive Biases can increase parental T1D concerns & focus the family on the negative & problematic around T1D management rather than talking about strengths & what is going well with T1D care.
  6. 6. Page 5 xxx00.#####.ppt 4/21/2014 12:39:38 PM Cognitive Biases •Short-cuts or glitches in thinking that cause us to make questionable decisions and reach erroneous conclusions Gambler’s Fallacy-the tendency to think that future probabilities are altered by past events when in reality they are unchanged. I’ve flipped heads with this coin 5 times in a row, so the chance of tails coming out on the 6th flip is much greater than heads.
  7. 7. Page 6 xxx00.#####.ppt 4/21/2014 12:39:38 PM Cognitive Biases related to diabetes management in the family 1. Confirmation Bias – the tendency to search for, interpret, & remember information in a way that confirms one’s preconceptions. Given how much candy Peter he ate over the holidays, I knew his A1c would be high in clinic today.
  8. 8. Page 7 xxx00.#####.ppt 4/21/2014 12:39:38 PM Cognitive Biases related to diabetes management in the family 2. Selective Perception Bias– the tendency for expectations (especially always, & never) to affect perception. •My daughter never remembers her meter. She always leaves her meter in her locker.
  9. 9. Page 8 xxx00.#####.ppt 4/21/2014 12:39:38 PM Cognitive Biases related to diabetes management in the family •3. Negativity Bias – the tendency to pay more attention, remember, frequently recall, & get aroused by negative rather than positive experiences or other kinds of information. •He did not check his blood before practice on Monday and Friday. •
  10. 10. Page 9 xxx00.#####.ppt 4/21/2014 12:39:38 PM II. What is your idea of „success‟ in raising your teen with T1D? •Look into your family’s & teen’s future…… •What do you hope your teenager will be like when s/he is 23 years old?
  11. 11. Page 10 xxx00.#####.ppt 4/21/2014 12:39:38 PM
  12. 12. Page 11 xxx00.#####.ppt 4/21/2014 12:39:38 PM What do you hope your teenager will be like when s/he is 23 years old? • Happy /Strong Self-Esteem • Pursuing work/education • Kind, Sensitive, Empathic • Good Communication skills • Supportive friends • Good Coping Skills/Resilient
  13. 13. Page 12 xxx00.#####.ppt 4/21/2014 12:39:38 PM Resilient •“Being resilient doesn‟t mean going through life without experiencing stress & pain. • Feeling grief, sadness & other emotions in the face of adversity & stress is normal. •The road to resilience lies in working through the emotions & effects of stress and challenges.”
  14. 14. Page 13 xxx00.#####.ppt 4/21/2014 12:39:38 PM Factors that contribute to resilience: 1. Close relationships with family & friends 2. Positive view of yourself and confidence in your strengths & abilities 3. Ability to manage strong feelings & impulses 4. Good problem-solving & communication skills 5. Feeling in control
  15. 15. Page 14 xxx00.#####.ppt 4/21/2014 12:39:38 PM Factors that contribute to resilience: 6. Ability to seek help & resources when needed 7. Seeing yourself as resilient (rather than as a victim) 8. Coping with stress in healthy ways (seeking information & support) & avoiding harmful coping strategies (avoidance, substance abuse). 9. Helping others 10. Finding positive meaning in your life despite difficult or traumatic events
  16. 16. Page 15 xxx00.#####.ppt 4/21/2014 12:39:38 PM Getting to Resilience in T1D: The 4 R’s •Realistic goals for BG and Behavior •Reduce blame & criticism •Reach for progress –not perfection. •Recognize diabetes-related strengths --what is going well?.
  17. 17. Page 16 xxx00.#####.ppt 4/21/2014 12:39:38 PM III. Lessons from Research Family factors that predict optimal adherence, BG, & psychological health for teens with T1D: 1. Developmentally-appropriate parent involvement in DM management tasks. 2. Lower levels of parent-teen conflict about DM management.
  18. 18. Page 17 xxx00.#####.ppt 4/21/2014 12:39:38 PM 1. Parent Involvement in T1D mgt. 1) The “Old Message” (pre-1990): “The teen with diabetes must be independent in diabetes management.” 1990-- research caused a “Paradigm Shift” 2) The “New Message” (post-l990): “The teen with diabetes must work inter-dependently with parents, & this teamwork must change with development.”
  19. 19. Page 18 xxx00.#####.ppt 4/21/2014 12:39:38 PM 1. The „New Paradigm‟ for Parent Involvement Developmentally-appropriate parent-teen teamwork in managing diabetes predicts optimal adherence, blood sugar levels, and health outcomes. (Anderson et al, 1990; La Greca et al, 1990; Weissberg-Benchell et al, l995; Wysocki et al 1996; Anderson et al 1997; Anderson et al 1999; Laffel et al 2003; Anderson et al 2009)
  20. 20. Page 19 xxx00.#####.ppt 4/21/2014 12:39:38 PM 2. Family Conflict around T1D In school-aged children & adolescents, studies consistently document that lower levels of diabetes family conflict are related to better adherence & glycemic control. (Waller et al, 1986; Hauser et al, 1990; Miller-Johnson et al 1994; Viner et al 1996; Davis et al 2001; Anderson et al 2002; Anderson 2004; Berlin et al, 2012 )
  21. 21. Page 20 xxx00.#####.ppt 4/21/2014 12:39:38 PM Diabetes-related family conflict predicts poor adherence, diabetes outcomes & coping.
  22. 22. Page 21 xxx00.#####.ppt 4/21/2014 12:39:38 PM Family Communication and Conflict  How parent thinks about DM... - ―What does a blood sugar of 400 mean for my child?‖ - ―Why is his/her DM getting worse?‖  How parent feels about DM… - ―I’m scared when I see a blood sugar of 400. Why can’t s/he have stable blood glucose levels?‖  How parent talks about DM… - ―That blood sugar is so bad! What did you eat?‖
  23. 23. Page 22 xxx00.#####.ppt 4/21/2014 12:39:38 PM Talking about Blood Sugars That scares me! A high blood sugar like that could cause problems! Dad, my blood sugar is 385. Dad‟s really mad at me! He‟d be happier if my blood sugar were 120 or if I didn‟t check at all! 385?! Why so bad? What did you eat? 1) OCCASIONAL HIGH BLOOD SUGARS DON’T LEAD TO COMPLICATIONS. It is normal for growing children to have out-of-range blood sugars. An occasional blood sugar of 300 or even 400 or more will not cause complications. 2) THERE IS NO SUCH THING AS A ―BAD‖ BLOOD SUGAR. Any result from blood sugar monitoring is good because it gives helpful and important information that lets you make the best choices in insulin, activity, and food.
  24. 24. Page 23 xxx00.#####.ppt 4/21/2014 12:39:38 PM III. Applying these lessons in „real life‟ •Goals during Adolescence: ‐Prevent Premature Parent Withdrawal of T1D Involvement ‐Minimize Family T1D Conflict •Goals for Older Teen Transitioning to Young Adulthood: ‐Sustain diabetes self-care ‐Receive regular diabetes health care
  25. 25. Page 24 xxx00.#####.ppt 4/21/2014 12:39:38 PM Normal Developmental Tasks: Young Teens (11-14 yr.) •Pubertal changes impact self-image •Privacy is important. •Power shifts in P-C relationship increase family conflict. •Peers are the priority!
  26. 26. Page 25 xxx00.#####.ppt 4/21/2014 12:39:38 PM
  27. 27. Page 26 xxx00.#####.ppt 4/21/2014 12:39:38 PM Involvement & Conflict Challenges for parents of young teens T1D •Parent has to recognize this is a period of insecurity & intensity, to have consistent expectations, set limits with consequences, negotiate around parent involvement & support for T1D management. •Conflicts & frustrations increases normally in every family at puberty; protect T1D management from family conflict & stress.
  28. 28. Page 27 xxx00.#####.ppt 4/21/2014 12:39:38 PM Normal Developmental Tasks: Mid-Late Adolescence (15-17 yr) •Consolidate Identity Development (self-image, body image, sexuality, future education / training / employment) •Begin to plan for life after high school gradual transfer of many responsibilities •Bond with Peer Group •Shows some Cognitive growth (but not complete!)
  29. 29. Page 28 xxx00.#####.ppt 4/21/2014 12:39:38 PM
  30. 30. Page 29 xxx00.#####.ppt 4/21/2014 12:39:38 PM Involvement & Conflict Challenges for parents of older teens T1D Negotiate consistent expectations, set limits & consequences for rule violation (must check BG before driving); maintain supportive involvement in T1D •Prevent Diabetes Burnout --ASK teen how parent can help with T1D?
  31. 31. Page 30 xxx00.#####.ppt 4/21/2014 12:39:38 PM “Burn-Out” •“A common response to a chronically difficult and frustrating job, where the individual works harder and harder each day and yet has little sense that these actions are making a real difference. “
  32. 32. Page 31 xxx00.#####.ppt 4/21/2014 12:39:38 PM Living with Type 1 Diabetes •Goal of diabetes self-management: Near- normal blood sugar ranges. Teen balances on a tightrope between low blood sugar (can cause behavioral & mood changes, & acute emergencies) & high blood sugar (can cause behavioral & mood changes, & if sustained, long-term problems)-- a chronic & impossible task, as the tools to manage diabetes are not perfect.
  33. 33. Page 32 xxx00.#####.ppt 4/21/2014 12:39:38 PM
  34. 34. Page 33 xxx00.#####.ppt 4/21/2014 12:39:38 PM Living with Type 1 Diabetes •Psychological consequences of ―tightrope balancing‖: Feelings of chronic frustration and failure from striving for near-normal (―perfect‖) blood sugar numbers, and from criticism from providers, family members & self.
  35. 35. Page 34 xxx00.#####.ppt 4/21/2014 12:39:38 PM Sample Session #6 Diabetes Burnout •Diabetes burn-out is preventable.  Watch for the early signs of burnout, and find ways to help relieve the stress.  Talk about your negative feelings about diabetes.  Set realistic goals with your health care team.  Think of ways that your family and friends can help ease the burden of diabetes.  Make changes in your diabetes care one small step at a time.  Diabetes is not about ―passing‖ or ―failing.‖  NO ONE can successfully manage diabetes all alone
  36. 36. Page 35 xxx00.#####.ppt 4/21/2014 12:39:38 PM Involvement & Conflict Challenges for parents of older teens T1D •AVOID ―Shame & Blame‖ language around BG checking…Say ―Hi /Low BG vs. Good/Bad BG ! Praise & encourage the behavior of BG checking •TRANSFER gradually responsibility for parts of T1D mgt. for which Teen has little experience— ordering supplies; understanding insurance and co-pays; advocating for self.
  37. 37. Page 36 xxx00.#####.ppt 4/21/2014 12:39:38 PM Older Teens with T1D Transitioning to Young Adulthood (18-23 yrs.) •Changes in family roles/relationships •Changes in relationships with health care providers •At risk for poor diabetes self-care •At risk for lapses in diabetes health care
  38. 38. Page 37 xxx00.#####.ppt 4/21/2014 12:39:38 PM Diabetes Challenges in Young Adulthood (for your 23 year old with T1D) 1. Changes in support systems for diabetes self- mgt. 2. Loss to medical follow-up 3. Accessing health insurance & health care providers
  39. 39. Page 38 xxx00.#####.ppt 4/21/2014 12:39:38 PM Changes in T1D Support Systems 1. Family Supports change 2. Peer supports change – changing schools, jobs, cities 3. Medical Support Systems – often prior risk factors (ped history) are unknown to new adult providers; adult medicine is a different culture from pediatric care
  40. 40. Page 39 xxx00.#####.ppt 4/21/2014 12:39:38 PM Loss to Medical Follow-Up 1. Loss of med follow-up strongest predictor of complications & mortality in British Diabetic Assoc. Cohort Study in 20-29-year-old group (Laing et al, l999). 2. Critical period for preventive screening of microvascular complications in Sweden’s Diabetes Incidence Study, 15 – 34-yr-olds (Svensson et al, 2003; Henricsson e al, 2003) 3. ―Window of opportunity‖ in later 20’s to establish better self-care patterns as transitions slow down
  41. 41. Page 40 xxx00.#####.ppt 4/21/2014 12:39:38 PM What do you hope your teenager will be like when s/he is 22 years? • Young adult who is happy, caring, independent, has career/educational goals. •A resilient young adult with T1D motivated for: ‐Self-Management ‐Self-Advocacy ‐Sustaining diabetes health care
  42. 42. Page 41 xxx00.#####.ppt 4/21/2014 12:39:38 PM Summary •Be aware of cognitive biases that add negatively to family climate •Foster resilience in your now so they can carry it into their 20’s •Watch for teamwork opportunities & for reducing T1D conflict •Prepare for transition to young adulthood
  43. 43. Page 42 xxx00.#####.ppt 4/21/2014 12:39:38 PM Getting to Resilience in T1D: The 4 R’s • Realistic goals for BG and Behavior • Reduce blame & criticism • Reach for progress –not perfection. • Recognize your teen’s strengths in T1D management –focus on what is going well.
  44. 44. Thank you for your attention! Comments? Questions?

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