Parent-adolescent dyads: association of parental autonomy support and parent-adolescent shared diabetes care responsibility.

Transitioning diabetes care responsibility from parents to adolescents is challenging. However, during adolescence, diabetes management and metabolic control is poor and continued parental involvement is advocated (Silverstein et al., 2005). Desirable diabetes and psychosocial outcomes occur when parents share responsibility or collaborate about diabetes care with their adolescents (Anderson et al., 1999; Helgeson et al., 2008; Vesco et al., 2010; Wysocki et al., 2009). Given the importance of shared responsibility, it is essential to identify processes that contribute to it. Further, it is important to address this during early and middle adolescence; late adolescents already dominate diabetes management (Schilling, Knafl, & Grey, 2006). An important antecedent to sharing responsibility may be parental support for adolescents’ autonomy development. Such support has been defined as being responsive to youths’ perspectives and needs, providing choices, encouraging initiative, and reasoning about expectations or requirements (Lekes et al., 2010). Autonomy is a central developmental task during adolescence (Allen et al., 1999); it is foundational to diabetes self-care behaviors (Dashiff & Bartolucci, 2002; Hanna & Guthrie, 2003); and volitional autonomy (self-governance) is more optimal than independent functioning for youth in general (Soenens et al., 2007). Volitional autonomy is encouraged by parental autonomy support that minimizes control of the adolescent and encourages choice on the part of the adolescent (Soenens et al., 2007). Experts indicate this approach contributes to shared responsibility (Helgeson et al. 2008) and better metabolic control (Palmer et al. 2004). Parental autonomy support may be most salient during early and middle adolescence when dependencies on parents lessen (Steinberg & Silverberg, 1986). However, the influence of parental autonomy support might depend on whose perceptions are being taken into account. Adolescents with diabetes and their parents have unique perspectives related to autonomy (Palmer et al., 2004; Ott et al., 2000; Butner et al., 2009), yet their perspectives are likely intertwined. This interplay between parent and adolescent is an excellent candidate for testing using a dyadic method referred to by Kenny, Cashy, and Cook (2006) as the Actor Partner Interactive Model (APIM). The APIM differentiates between actor (intrapersonal) and partner (interpersonal) effects through statistical methods, estimating these effects in tandem. In this study, relationships among variables within either the adolescent or within the parent are actor effects. Partner effects would consist of relationships between adolescent and parental variables. Four types of dyadic interrelationships have been identified (Kenny, Cashy & Cook, 2006): actor-oriented, partner-oriented, couple-oriented and social comparison. An actor-oriented model has significant actor effects, but no partner effects. Actor-oriented models suggest that a person’s outcome is determined by his or her own attributes and not the partner’s attributes. In an actor-oriented model, for example, the adolescent’s perception of shared responsibility would depend solely on the adolescent’s perception of autonomy support, and not the parent’s perception of autonomy support. Within an actor-oriented model, interventions to increase adolescent shared responsibility would focus solely on the adolescent’s perception of autonomy support, as parental perception would not have an influence. A partner-oriented model shows significant partner effects, but no actor effects, reflecting the influence of the partner’s attributes as opposed to his or her own attributes. In a partner-oriented model the adolescent’s perception of shared responsibility might, for example, depend solely on the parent’s perception of autonomy support, and not the adolescent’s perception of autonomy support. Within this partner-oriented model, interventions to increase adolescent shared responsibility would focus only on the parent’s perception of autonomy support. A couple-oriented model indicates that actor effects are just as important as the partner effects in explaining each person’s outcome in the dyad. For example, the adolescent’s perception of shared responsibility would depend on both the adolescent’s and the parent’s perceptions of autonomy support. Within a couple-oriented model, interventions to increase adolescent shared responsibility would include both the parent’s and adolescent’s perceptions of autonomy support, as both have an influence. A social comparison model maintains that the sum of the actor and partner effects cancel each other out. For example, if the adolescent’s perception of shared responsibility depended on both the adolescent’s and the parent’s perceptions of autonomy support, but the influence of parental perception of autonomy support was of similar strength but opposite direction to the influence of adolescent perception of autonomy support. Within a social comparison model, interventions to increase adolescent shared responsibility would need to take into consideration the opposite effects of parent and adolescent perception of autonomy support, so that parental perceptions do not negate any gains that might result from attempts to alter adolescent perception. Thus, we tested interdependent associations of parents’ and adolescents’ perceptions of parental diabetes-specific autonomy support on their own and the other’s perceptions of shared diabetes care responsibility during early and middle adolescence (see Figure 1). We proposed direct effects of parental support on shared responsibility and direct effects of age on parental support and shared responsibility. The hypotheses were: Figure 1 Model Results: Association of Parental Autonomy Support, Parent-Adolescent Shared Responsibility and Adolescents’ Age Each partner’s perception of parental autonomy support will have direct effects on his or her own perception of shared responsibility (actor effect), as well as the other’s perception of shared responsibility (partner effect). Adolescent age will exhibit direct effects on parental autonomy support as reported by parents and adolescents. Adolescent age will exhibit direct and indirect effects on shared responsibility as reported by parents and by adolescents.