Family Therapy for Adolescents with Poorly Controlled Diabetes: Initial Test of Clinical Significance

Objective We examined a structured family therapy approach in promoting clinically meaningful improve-ments in parent–adolescent conflict in adolescents with poorly controlled diabetes. Method Eighteenadolescents with poorly controlled diabetes and their parent(s) participated in 10 sessions of home-basedBehavioral Family Systems Therapy (BFST). Outcome comparisons were made using a sample of adolescentswith poorly controlled diabetes (n¼40) from a previous study. Clinically significant improvements weredetermined by calculating SD differences between treatment and comparison groups on measures of diabetes-related and general parent–adolescent conflict. Results Home-based BFST produced change in diabetes-related family conflict ranging from 1/3 to 1/2 SD and general family conflict ranging from 1/3 to 3/4 SD.Conclusions BFST produced change in family conflict, a variable shown through previous research to relateto treatment adherence in adolescents with diabetes. The test of clinical significance represents an exampleof a method useful for pediatric research.Diabetes mellitus affects up to 1 in 500 children in NorthAmerica (Chase, 2006). Type 1 diabetes mellitus (T1DM)is thought to be an autoimmune disease in which insulin-producing pancreatic islet cells are attacked and destroyed,the treatment of which is quite complex. Typical regimensinclude insulin replacement either via multiple injectionsof insulin per day or an insulin pump, several daily bloodglucose checks, regulation of carbohydrates, regularexercise, and management of low blood glucose levels(American Diabetes Association [ADA], 2007). Type 2diabetes mellitus (T2DM) results from decreased insulinsensitivity and reduced insulin secretion, and is often asso-ciated with obesity. Treatment of T2DM in youth generallyinvolves dietary management and regular exercise;however, many youths with T2DM also require insulininjections (ADA, 2007). Thus, the differences in prescribedtreatment regimen can be minimal between T1DM andT2DM, particularly for youth with severe or poorlycontrolled T2DM. Long-term complications for bothT1DM and T2DM are the result of elevated blood glucoselevels and include blindness, kidney failure, nerve damageand heart, and blood vessel disease (ADA, 2007).Cross-sectional and prospective studies have demon-strated that higher levels of general and diabetes-relatedfamily conflict are related to poorer metabolic controland poorer adherence to treatment in youth withdiabetes (Anderson, Miller, Auslander, & Santiago,1981; Gustafsson, Cederblad, Ludvigsson & Lundin,1987; Hauser et al., 1990; Miller-Johnson et al., 1994;Wysocki, 1993). As a result, family-based psychosocialinterventions targeting family conflict could improve dia-betes outcomes. One such intervention, Behavioral FamilySystems Therapy (BFST), is a flexible, multi-componentintervention targeting family communication and problemsolving (Robin & Foster, 1989). Wysocki and his associ-ates demonstrated that 10 sessions of BFST improvedfamily communication and problem-solving based onparent and adolescent report (Wysocki et al., 2000) anddirect observation of family interactions (Wysocki et al.,1999). These benefits persisted for 12 months (Wysocki,Greco, Harris, Bubb, & White, 2001). Wysocki and associ-ates (Wysocki et al., 2006, 2007) conducted anotherrandomized trial implementing a modified version ofBFST that focused more specifically on diabetes-related