Abstract
Childhood onset diabetes (Type I diabetes) is a chronic condition whose
symptoms may be controlled using a careful regimen of diet and insulin therapy,
which must be tailored to suit the sufferer's lifestyle. The ability of a child to cope
with these aspects of diabetes management has a wide range of short-term and longterm
implications. In the short-term, diabetes may disrupt everyday functioning,
family relationships, social roles and psychological adjustment. Deficits in cognitive
functioning, psychological adjustment and physical health may occur in the longterm
if coping has been suboptimal over an ongoing period. Medical treatment must
clearly aim to maximise diabetic control and to minimise such negative outcomes. In
order to do this, factors involved in optimising the coping process in children must be
understood.
While research has shown that managing children at home on diagnosis rather
than routinely admitting them to hospital has no effect on diabetic control, little
research has been carried out into the possible psychological benefits of these two
approaches (Howie, 1998). This study therefore investigates the coping process and
compares aspects of this process between children who were routinely admitted to
hospital at diagnosis (in an Aberdeen clinic) and those who were managed at home
(in a Dundee clinic).
The Self-Regulation Model (Leventhal, Nerenz & Steele, 1984) was used to
guide the study. This model highlights the role of patients' illness representations,
coping, appraisal of coping and emotional reactions - each of which may be viewed
within a developmental framework - in the progression of chronic disease. 72
children aged 7-14 attending diabetes outpatient clinics in the Dundee and Aberdeen
clinics were assessed using standardised questionnaires of illness representations,
coping, state anxiety and behaviour problems. The relationship between these
variables and diabetic control and the effects of age, time since diagnosis and management at diagnosis on the process and outcome of coping were also assessed.
The results are discussed in terms of their implications for management at diagnosis
and for cognitive and behavioural methods of enhancing coping in children of
different ages.
