Parenting style and parents’ sense of helplessness in influencing their child’s behavior are both associated with adherence to treatment and metabolic control in adolescents who have type 1 diabetes, according to a report in the August issue of Diabetes Care.
In a study of 100 adolescents with type 1 diabetes and their mothers and fathers, these parenting factors remained significant predictors of the adolescents’ diabetic control even after the data were adjusted to account for potentially confounding factors, such as the child’s age and sex and the method of treatment, said Maayan Shorer, Ph.D., of the Schneider Children’s Medical Center of Israel, Petach Tikva, and her associates.
The investigators defined three mutually exclusive parenting styles as follows:
• An authoritative style is characterized by clear limits to the child that are set by the parents in a caring, noncoercive manner.
• A permissive style is characterized by few efforts by the parents to direct and limit the child’s behavior.
• An authoritarian style is characterized by a coercive, harsh, and punitive approach and parental attempts to control the child’s behavior.
In all, 100 adolescents aged 11-18 years (mean age, 14 years) were enrolled in the cross-sectional study, along with 79 mothers and 63 fathers. The 47 girls and 53 boys had been diagnosed as having type 1 diabetes at a mean of 4.9 years previously.
Most families (approximately 40%) reported high incomes, whereas 32% reported midrange and 28% reported low incomes. The parents were divorced in 11% of families.
A total of 32 adolescents used an insulin pump, and 68 used multiple daily insulin injections.
Each child, together with one parent, completed the Adherence to Diabetes Treatment Regimen Questionnaire, and parents completed the Parental Authority Questionnaire, the Parental Helplessness Questionnaire, and a questionnaire soliciting demographic information. Glycemic control was estimated by assessing each patient’s average HbA1c value over the course of 1 year.
An authoritative parenting style, particularly among fathers, was associated with better adherence to treatment and glycemic control. In contrast, both permissive and authoritarian parenting styles were associated with poorer adherence and poorer outcome, Dr. Shorer and her colleagues said (Diabetes Care 2011;34:1735-6).
In addition, a greater sense of helplessness in influencing the child’s behavior, particularly among mothers, was associated with worse glycemic control.
The strong association between a father’s authoritativeness on the one hand and the adolescent’s better adherence and diabetes control on the other "highlights the importance of fathers’ involvement in children’s diabetes management," the researchers noted.
"Unfortunately, our clinical experience along with the empirical evidence suggests that compared with mothers, fathers tend to take a too-small role in their child’s diabetes management and exert fewer efforts at monitoring the child.
"We believe fathers should be more engaged in their child’s routine diabetes care, and to do so, specifically, by adopting an authoritative stance," they said.
These study findings spurred the investigators to perform a short-term prospective study, which is now underway, to assess whether improving parental authoritativeness skills will influence adolescents’ glycemic control.
The investigators reported no financial conflicts of interest.