Behavioral Family Systems Therapy
for Adolescents With Diabetes
Nemours Children's Clinic, Jacksonville, FL
Michael A. Harris
Neil H. White
Washington University School of Medicine, St. Louis, MO
To keep Type 1 diabetes under adequate control and avoid long-term complications of the disease, patients and families must implement a complex treatment regimen including multiple daily insulin injections and blood glucose tests, a prescribed meal plan, regular physical exercise, and problem solving based on blood glucose test results. Not surprisingly, the management of diabetes presents quite a challenge during adolescence. Numerous studies have shown that diabetes treatment adherence and diabetic control decline during adolescence (see Johnson, 1995; Wysocki & Greco, 1997, for reviews). Other studies have shown that parent-adolescent communication and conflict resolution skills may be important mediators of the efficacy of family management of diabetes ( Bobrow, AvRuskin, & Siller, 1985; Miller-Johnson et al., 1994; Wysocki, 1993). The magnitude of this challenge stimulated our interest in evaluating psychological and behavioral interventions that might help adolescents and their families cope more effectively with diabetes and its treatment. About 4 years ago, in a similar chapter we described the research methods that comprised our randomized controlled trial of behaviorally oriented family therapy for adolescents with Type 1 diabetes ( Wysocki, White, Bubb, Harris, & Greco, 1995). In the present chapter, we report the results of our investigation and offer suggestions for future research based on our findings.
There are several cross-sectional and longitudinal studies indicating that family conflict, in particular parent-adolescent conflict, is a key pre-