Abstract
Recent literature suggests that maintaining good relationships with parents and peers is important to the emotional and physical stability of youngsters with insulin dependent diabetes mellitus (IDDM). The goal of this study was to design and implement a form of psychosocial intervention which would improve these relations by increasing assertive behavior in adolescents with IDDM. It was hypothesized that the effects of such intervention might generalize to overall assertiveness, improve adjustment to diabetes, and improve metabolic control through decrease in emotional stress. A form of training was devised, which included cognitive problem solving and social assertiveness training. This training was conducted during sessions with 25 youngsters who were in attendance at a camp for children with diabetes. Twenty-three additional youngsters also met in groups and served as an attention control group. The mean age of the adolescents was 14. Assessment measures were given to the adolescents and their parents before and after training and at follow-up. Results on both role play and self-report measures of assertiveness in diabetes-related situations showed that relative to controls, the experimental group increased in assertiveness and decreased in passivity at post-test. No change in aggressive responses was seen. None of the observed changes were maintained at follow-up. On the Childrens' Assertive Behavior Scale (CABS), both groups decreased in passive responding at post-test and follow-up. No other changes were noted. On the Diabetes Adjustment Scale (DAS), no significant treatment effects were found. On measures of compliance and control, there were no significant changes related solely to treatment, but both groups did increase in compliance at post-test. On the parent measures, no treatment related effects were found, although the control group decreased in the total number of problem behaviors from pre-test to follow-up. These results suggest that coping skills training can be used to teach adolescents increased assertiveness in situations related to diabetes. The study showed that though the generalizability and maintenance of the treatment requires further refinement of the evaluation methods and treatment format, coping skills training did help adolescents to learn and demonstrate more assertive skills in situations related to diabetes that involved parents and peers.