Evaluating Transition Readiness in Older Adolescents and Young Adults With Type 1 Diabetes.

For older adolescents and young adults (AYAs) with type 1 diabetes, successful transition from pediatric to adult diabetes care requires ongoing planning and support. Yet, the transition to adult care is not always smooth. Some AYAs struggle to leave pediatric care or experience significant gaps between pediatric and adult diabetes care. The use of diabetes-specific transition readiness assessments can inform transition planning and support successful preparation for adult care. This study evaluated transition readiness in a diverse sample of AYAs nearing transition to adult diabetes care. Findings suggest that AYAs may benefit from additional preparation and education related to sexual health, tobacco use, and diabetes complications.

Parent Perspectives of School/Daycare Experiences in Young Children Newly Diagnosed With Diabetes.

OBJECTIVE: A central part of family adjustment to a new diagnosis of type 1 diabetes (T1D) is integrating T1D management into the child's school/daycare. This may be particularly challenging for young children who rely on adults for their diabetes management. This study aimed to describe parent experiences with school/daycare during the first 1.5 years following a young child's T1D diagnosis. METHODS: As part of a randomized controlled trial of a behavioral intervention, 157 parents of young children with new-onset (<2 months) T1D reported on their child's school/daycare experience at baseline and at 9- and 15-month post-randomization. We used a mixed-methods design to describe and contextualize parents' experiences with school/daycare. Qualitative data were collected via open-ended responses, and quantitative data were collected from a demographic/medical from. RESULTS: While most children were enrolled in school/daycare at all time points, over 50% of parents endorsed that T1D affected their child's enrollment, rejection, or removal from school/daycare at 9 or 15 months. We generated five themes related to parents' school/daycare experiences: Child factors, Parent factors, School/Daycare factors, Cooperation between Parents and Staff, and Socio-historical factors. Parents of younger children and those with lower subjective socioeconomic status were significantly more likely to endorse challenges with school/daycare enrollment. CONCLUSIONS: School/daycare settings present challenges for parents of young children with T1D. Changes may need to occur across contexts to support early childhood education, including advocacy resources for parents to navigate school policies, increased training for school staff, and healthcare team outreach initiatives to parents and schools.

Weight Management Behaviors are Associated with Elevated Glycemic Outcomes in Adolescents and Young Adults with Type 1 Diabetes.

Many adolescents and young adults (AYAs) with type 1 diabetes (T1D) engage in weight management behaviors (i.e., trying to lose weight), and efforts to manage weight may impact glycemic control. We assessed objective/subjective weight status and weight management behaviors in a diverse sample of 76 AYAs with T1D, and examined differences in sociodemographic characteristics and A1c levels by the following categories: (1) Overweight BMI/weight management (n = 21), (2) overweight BMI/no weight management (n = 6), (3) in/below-range BMI/weight management (n = 25), (4) in/below-range BMI/no weight management (n = 24). Subjective overweight status was more common among late adolescents and females; female gender was associated with weight management behaviors. AYAs endorsing weight management behaviors evidenced higher A1c values than those who did not. Clinicians working with AYAs should be aware of associations among weight management and glycemic indicators and routinely screen for weight management behaviors. Future research should explore interventions to promote healthy lifestyle behaviors among AYAs.

Mindfulness-Based Interventions: Focus on Pediatric Type 1 and Type 2 Diabetes.

PURPOSE OF REVIEW: Mindfulness-based interventions (MBIs) focus on promoting nonjudgmental, purposeful awareness of the present experience, and they include specific components such as body scan, meditation, and breathing techniques for healthier coping with stress and reduced negative affect. In adult populations with chronic illness (e.g., type 1 diabetes [T1D], type 2 diabetes [T2D], overweight), MBIs have been shown to improve psychosocial outcomes with some improvements in health outcomes as well. Youth with T1D/T2D frequently experience heightened depression as well as diabetes distress, which are associated with less frequent blood glucose monitoring, insulin administration, and nutrition oversight. Thus, MBIs have potential to alleviate psychosocial distress in youth with T1D/T2D and also improve health outcomes. This paper is a review of the literature on potential psychosocial and health benefits of MBIs for youth with T1D/T2D. RECENT FINDINGS: Among youth with T1D/T2D, MBIs have been shown to reduce symptoms of depression and diabetes distress. Improvements in health outcomes, such as A1c, have been inconsistent across studies. Although research on the efficacy of MBIs to improve psychosocial and health outcomes in youth with T1D/T2D is promising, this area of study is in its early stages. Future investigation of MBIs in youth with T1D and T2D is warranted, recognizing that these are heterogeneous groups with potential benefit of specifically tailored interventions.

First STEPS: Primary Outcomes of a Randomized, Stepped-Care Behavioral Clinical Trial for Parents of Young Children With New-Onset Type 1 Diabetes.

OBJECTIVE: Despite the emotional challenges of parental adjustment to a child's type 1 diabetes diagnosis and the unique complexities of early childhood, there are few programs designed to meet the needs of parents of young children at new onset. This study evaluated First STEPS (Study of Type 1 in Early childhood and Parenting Support), a stepped-care behavioral intervention designed to support parents' psychosocial functioning and promote children's glycemic outcomes. RESEARCH DESIGN AND METHODS: Using a two-site randomized clinical trial design, parents (n = 157) of children aged 1-6 years completed baseline data within 2 months of diabetes diagnosis and were randomly assigned to intervention (n = 115) or usual care (n = 42) for 9 months. Intervention steps included: 1) peer parent coaching, with step-ups to 2) structured behavioral counseling and 3) professional consultations with a diabetes educator and psychologist, based on parent mood and child HbA1c. Participants completed follow-ups at 9 and 15 months postrandomization. Primary outcomes were parent depressive symptoms and child HbA1c. RESULTS: Depressive symptoms improved in both groups, and intervention parents had significantly lower depressive symptoms at the 9- and 15-month follow-ups compared with usual care. HbA1c decreased in both groups, but there were no between-group differences at 9 or 15 months. CONCLUSIONS: First STEPS improved parents' mood following young children's type 1 diabetes diagnosis. Results indicate likely benefits of parent coach support, supplemented by intervention intensifications, including behavioral intervention and diabetes education. This model has high potential for patient engagement. The absence of a medical intervention component may explain null findings for HbA1c; incorporating targeted behavioral support for intensive diabetes treatment may maximize intervention impact.

Correlates and Patterns of COVID-19 Vaccination Intentions among Parents of Children with Type 1 Diabetes.

OBJECTIVE: To examine psychosocial, sociodemographic, medical, and coronavirus disease 2019 (COVID-19) experiences as correlates of COVID-19 vaccination intentions among parents of children with type 1 diabetes (T1D). METHODS: 121 parents of children with T1D (Mchild age = 7.78 ± 1.70; MA1c = 8.3% ± 1.5%) in the mid-Atlantic and Southwest regions completed self-report measures in February to March 2021. RESULTS: Parents' general vaccination behaviors and attitudes were associated with COVID-19 vaccination intentions. Child insurance type and social distancing adherence were associated with vaccination intention in the Southwest site. Higher A1c was associated with lower intention. Vaccine safety was the top reported concern. CONCLUSIONS: COVID-19 vaccination intentions are important to address in parents of youth with health conditions.

Clinically elevated parent depressive symptoms and stress at child type 1 diabetes diagnosis: Associations with parent diabetes self-efficacy at 18-months post-diagnosis.

OBJECTIVE: Eighteen percent of new diagnoses of type 1 diabetes (T1D) occur in children ages 9 and younger, and the burden of diabetes management in young children predominantly falls on parents. Despite the significant amount of information parents must learn and implement quickly after diagnosis, little research has examined diabetes self-efficacy in parents of young children soon after diagnosis in a longitudinal manner. The current study examined changes in parent diabetes self-efficacy over time, and parent depressive symptoms and stress soon after child T1D diagnosis as predictors of parent diabetes self-efficacy at 12- and 18-months post-diagnosis. RESEARCH DESIGN AND METHODS: One hundred fifty-seven primary caregivers (91.7% female, 62.2% White, Non-Hispanic) of young children (Mage  = 4.47 ± 1.65 years, 54.8% female, 60% White, Non-Hispanic) were recruited within 2 months of their child's T1D diagnosis from two pediatric hospitals in the United States as part of a randomized clinical trial. Parents self-reported on their diabetes self-efficacy, depressive symptoms, and stress and at baseline (Mdays since diagnosis = 29) and on parent diabetes self-efficacy again 12- and 18-months post-diagnosis. RESULTS: Parent diabetes self-efficacy significantly improved from baseline to 12-months and 18-months post-diagnosis (p < 0.05). Parents exhibiting clinically elevated levels of depressive symptoms and stress at baseline had significantly lower parent diabetes self-efficacy 12- and 18-months post-diagnosis compared to parents with normal levels of depressive symptoms and stress. CONCLUSIONS: Brief interventions for parents with clinically elevated depressive symptoms and stress soon after their child's diagnosis may improve parents' diabetes self-efficacy and ultimately support the management of their child's diabetes.

Diabetes-specific functioning in parents of young children with recently diagnosed type 1 diabetes.

OBJECTIVE: A Type 1 diabetes (T1D) diagnosis in young children can cause significant family stress. Parents may experience increased depressive symptoms, but less is known about early diabetes-specific functioning (i.e., parental self-efficacy to manage diabetes, hypoglycemia fear, and coparenting conflict). We evaluated a theoretically based model of diabetes-specific functioning among parents of young children newly diagnosed with T1D (YC-T1D). The model included parent demographic variables, child illness-factors, family protective factors, and general parent emotional functioning. METHOD: One hundred fifty-seven newly diagnosed YC-T1D (Mage = 4.4 ± 1.7 years; M days postdiagnosis = 29.0 ± 15.4) and their primary caregivers (91.7% female; 61% non-Hispanic White) were assessed at baseline of a behavioral intervention randomized controlled trial. We used psychosocial measures to explore hypothesized domains associated with parents' diabetes-specific functioning using structural equation modeling. RESULTS: More difficulties with parent emotional functioning were related to more problems with parent diabetes-specific functioning, and higher family protective factors were related to fewer problems with diabetes-specific functioning. Child-illness factors were also directly related to more difficulties with parent diabetes-specific functioning and emotional functioning. Parents with college education reported more difficulties with emotional functioning and parent diabetes-specific functioning. Younger child age was associated with fewer difficulties with emotional functioning and more family protective factors. CONCLUSIONS: Results provide initial support for a model of parent diabetes specific-functioning at young child T1D diagnosis. Future research may examine this model in relation to children's glycemic outcomes over the first year after diagnosis. Implications are made for parent screening at the time of YC-T1D diagnosis. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Early intervention for inhibited young children: a randomized controlled trial comparing the Turtle Program and Cool Little Kids.

BACKGROUND: Children classified as behaviorally inhibited (BI) are at risk for social anxiety. Risk for anxiety is moderated by both parental behavior and social-emotional competence. Grounded in developmental-transactional theory, the Turtle Program involves both parent and child treatment components delivered within the peer context. Our pilot work demonstrated beneficial effects of the Turtle Program ('Turtle') over a waitlist control group. Herein, we report results of a rigorous randomized controlled trial (RCT) comparing Turtle to the best available treatment for young children high in BI, Cool Little Kids (CLK). METHODS: One hundred and fifty-one parents and their 3.5- to 5-year-old children selected on the basis of BI were randomly assigned to Turtle or CLK, delivered in group format over 8 weeks. Effects on child anxiety, life interference, BI, and observed parenting were examined at post-treatment and 1-year follow-up. ClinicalTrials.gov registration: NCT02308826. RESULTS: No significant main effect differences were found between Turtle and CLK on child anxiety; children in both programs evidenced significant improvements in BI, anxiety severity, family accommodation, and child impairment. However, Turtle yielded increased observed warm/engaged parenting and decreased observed negative control, compared with CLK. Parental social anxiety moderated effects; parents with higher anxiety demonstrated diminished improvements in child impairment, and parent accommodation in CLK, but not in Turtle. Children of parents with higher anxiety demonstrated more improvements in child BI in Turtle, but not in CLK. CONCLUSIONS: Turtle and CLK are both effective early interventions for young children with BI. Turtle is more effective in improving parenting behaviors associated with the development and maintenance of child anxiety. Turtle also proved to be more effective than CLK for parents with social anxiety. Results suggest that Turtle should be recommended when parents have social anxiety; however, in the absence of parent anxiety, CLK may offer a more efficient treatment model.

Promoting High-Quality Health Communication Between Young Adults With Diabetes and Health Care Providers.

Young adults with diabetes assume increasing responsibility for communicating with their health care providers, and engaging in high-quality health communication is an integral component of overall diabetes self-management. This article provides an overview of the main features of health communication, factors that may influence communication quality, interventions to promote communication skills, and practical strategies for clinicians working with young adults with diabetes. The review concludes with a comprehensive summary of future directions for health communication research.

Tryptophan plays an important role in yeast's tolerance to isobutanol.

BACKGROUND: Isobutanol is considered a potential biofuel, thanks to its high-energy content and octane value, limited water solubility, and compatibility with gasoline. As its biosynthesis pathway is known, a microorganism, such as Saccharomyces cerevisiae, that inherently produces isobutanol, can serve as a good engineering host. Isobutanol's toxicity, however, is a major obstacle for bioproduction. This study is to understand how yeast tolerates isobutanol. RESULTS: A S. cerevisiae gene-deletion library with 5006 mutants was used to screen genes related to isobutanol tolerance. Image recognition was efficiently used for high-throughput screening via colony size on solid media. In enrichment analysis of the 161 isobutanol-sensitive clones identified, more genes than expected were mapped to tryptophan biosynthesis, ubiquitination, and the pentose phosphate pathway (PPP). Interestingly, adding exogenous tryptophan enabled both tryptophan biosynthesis and PPP mutant strains to overcome the stress. In transcriptomic analysis, cluster analysis of differentially expressed genes revealed the relationship between tryptophan and isobutanol stress through some specific cellular functions, such as biosynthesis and transportation of amino acids, PPP, tryptophan metabolism, nicotinate/nicotinamide metabolism (e.g., nicotinamide adenine dinucleotide biosynthesis), and fatty acid metabolism. CONCLUSIONS: The importance of tryptophan in yeast's tolerance to isobutanol was confirmed by the recovery of isobutanol tolerance in defective strains by adding exogenous tryptophan to the growth medium. Transcriptomic analysis showed that amino acid biosynthesis- and transportation-related genes in a tryptophan biosynthesis-defective host were up-regulated under conditions similar to nitrogen starvation. This may explain why ubiquitination was required for the protein turnover. PPP metabolites may serve as precursors and cofactors in tryptophan biosynthesis to enhance isobutanol tolerance. Furthermore, the tolerance mechanism may also be linked to tryptophan downstream metabolism, including the kynurenine pathway and nicotinamide adenine dinucleotide biosynthesis. Both pathways are responsible for cellular redox balance and anti-oxidative ability. Our study highlights the central role of tryptophan in yeast's isobutanol tolerance and offers new clues for engineering a yeast host with strong isobutanol tolerance.

Source-specific social support and psychosocial stress among mothers and fathers during initial diagnosis of type 1 diabetes in young children.

Background: Given parents' elevated stress following children's diagnoses of type I diabetes (T1D), more information about protective factors is needed. The current study examined social support from various sources (e.g., partner, family, general) in relation to stress among mothers and fathers of young children shortly following T1D diagnosis. Methods: Participants included 157 children ages 1-6 recently diagnosed with T1D and their parents (152 mothers and 59 fathers) who were enrolled in a behavioral randomized controlled trial (RCT). Mothers and fathers self-reported on their demographic background, social support and stress; T1D data were parent report and/or gathered from medical records. Results: Maternal and paternal stress were examined in two separate regression models. Higher general social support predicted less stress for both mothers and fathers. For mothers, higher family support predicted less stress, while college educations status predicted more stress. For fathers, more partner support predicted less stress. Discussion: Findings contribute to the literature on gender differences in source-specific social support and psychosocial functioning in a pediatric health population. Sample characteristics limit generalizability of results, and future studies should aim to include diverse samples. Results have both scientific and clinical implications for supporting families following T1D diagnosis. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Predictors of mood, diabetes-specific and COVID-19-specific experiences among parents of early school-age children with type 1 diabetes during initial months of the COVID-19 pandemic.

OBJECTIVE: The current study explored pre-pandemic sociodemographics, medical characteristics, social/family support, and mood symptoms, and current COVID-19 experiences as predictors of mood, positive/negative diabetes-specific experiences, and COVID-19-specific distress among parents of children with type 1 diabetes during the COVID-19 pandemic. We hypothesized that parents from marginalized backgrounds, youth with higher pre-pandemic A1c and no CGM use, parents with lower pre-pandemic social/family support and more pre-pandemic mood/anxiety symptoms, and those with more negative COVID-19 experiences would have more depressive symptoms, fewer positive and more negative diabetes-specific experiences, and more COVID-19-specific distress during the initial months of the pandemic. RESEARCH DESIGN AND METHODS: Participants were parents of early school-age children with type 1 diabetes (n = 100; 65% non-Hispanic, white, 92% mothers, 75% married; Mchild age  = 6.74 ± 1.59 years) who had completed a behavioral intervention trial ≥6 months ago and were re-contacted in June/July 2020 to report on their COVID-19 pandemic experiences and parent psychosocial outcomes. Pre-pandemic parent mood/anxiety symptoms, family/social support, and children's medical characteristics (CGM use; MA1C  = 8.17% ± 1.40%) were assessed M = 1.45 ± 0.59 years prior. RESULTS: More pre-pandemic social support predicted fewer depressive symptoms, more positive diabetes-specific experiences, and less COVID-19-specific distress during the pandemic. More pre-pandemic depressive symptoms predicted more depressive symptoms during the pandemic. More life disruptions due to the pandemic were associated with more negative diabetes-specific experiences and more COVID-19-specific distress. Parents of color had more negative diabetes-specific experiences. CONCLUSIONS: Social support may be particularly important to assess and address through intervention. Pediatric diabetes care providers should monitor parent experiences in relation to children's diabetes management. ClinicalTrials.gov identifier: NCT02527525.

Patterns of Continuous Glucose Monitor Use in Young Children Throughout the First 18 Months Following Type 1 Diabetes Diagnosis.

Objective: To describe sociodemographic and parent psychosocial characteristics associated with patterns of continuous glucose monitor (CGM) use across the first 18 months post-type 1 diabetes (T1D) diagnosis among young children. Methods: One hundred fifty-seven parent-child dyads enrolled in a behavioral intervention for parents of young children (1-6 years) newly diagnosed with T1D. Parents reported on baseline sociodemographic characteristics and psychosocial functioning; child CGM use was assessed at five time points during the first 18 months post-diagnosis. Results: Most participants (81.8%) used CGM at least once. Four CGM trajectories emerged (always, later/stable, inconsistent, and never). Participants with private insurance were more likely to be in the always, later/stable, or inconsistent groups versus the never group. Youth in the always and later/stable groups had lower mean HbA1c at 18 months than those in the never group. Conclusions: Given the health benefits of CGM, further exploration of barriers to CGM use in families with public health insurance is needed. ClinicalTrials.gov identifier: NCT02527525.

Recruiting and retaining parents in behavioral intervention trials: Strategies to consider.

OBJECTIVE: Recruitment and retention are paramount to the success of randomized controlled trials (RCTs); however, strategies and challenges to optimize recruitment and retention are often omitted from outcomes papers. The current manuscript presents strategies used to recruit and retain over 97% parents of young children newly diagnosed with type 1 diabetes for over 15-months post-randomization enrolled in First STEPS, a behavioral, two-site RCT. METHOD: Participants included 157 primary caregivers of young children newly diagnosed with type 1 diabetes. Recruitment and retention strategies are described and include collaboration with medical teams, careful selection and training of study staff, inclusion of a behavioral run-in prior to randomization, financial incentives, creation of a study identity using retention items, obtainment of feedback from community stakeholders, and minimization of participant burden. RESULTS: Use of recruitment and retention strategies resulted in enrollment of 58% of eligible and reached families, with retention of the enrolled sample above 97% for over 15 months. Participants reported high acceptability of and satisfaction with specific recruitment and retention strategies. CONCLUSIONS: The strategies used to recruit and retain caregivers of young children newly diagnosed with a chronic illness were feasible to implement within multidisciplinary diabetes clinics and may apply to other pediatric populations. Future research may benefit from a focus on strategies to engage more diverse samples. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT02527525.

Recurrence and Timing of Maternal Depression Predict Early Adolescent Functioning for Children With and Without ADHD.

Objective: To examine recurrence and timing of maternal depression as predictors of depressive and conduct symptoms in children with and without ADHD. Method: Children aged 4 to 6 years (125 ADHD, 122 comparison) were followed over 8 years. Maternal depression was assessed annually. Youth depressive and conduct symptoms were assessed at ages 12 to 14. Results: Recurrence of maternal depression predicted youth depressive and conduct symptoms at ages 12 to 14; child ADHD moderated relations between recurrence of maternal depression and youth depressive (but not conduct) symptoms. Early adolescent exposure to maternal depression predicted age 12 to 14 depressive symptoms for all children. Exposure to maternal depression during early childhood, childhood, and early adolescence each independently predicted youth conduct symptoms. Conclusion: Recurrence and timing of maternal depression predict comorbid symptoms in early adolescents, particularly for youth with ADHD. Findings inform the prevention of comorbidities in children with ADHD where maternal depression is present. (J. of Att. Dis. XXXX; XX(X) XX-XX).

Parent ADHD and Evidence-Based Treatment for Their Children: Review and Directions for Future Research.

One fourth to one half of parents of children with attention-deficit/hyperactivity disorder (ADHD) have ADHD themselves, complicating delivery of evidence-based child behavioral and pharmacological treatments. In this article, we review the literature examining the relation between parent ADHD and outcomes following behavioral and pharmacological treatments for children with ADHD. We also review research that has incorporated treatment of parent ADHD (either alone or in combination with child treatment) with the goal of improving parenting and child outcomes. Finally, we offer recommendations for future research on the relation between parent ADHD and evidence-based treatment outcomes for their children, with the purpose of advancing the science and informing clinical care of these families.

Personalized Treatment of Mothers With ADHD and Their Young At-Risk Children: A SMART Pilot.

Young children of mothers with adult attention-deficit/hyperactivity disorder (ADHD) are at risk for ADHD by virtue of genetics and environmental factors. Moreover, parent ADHD is associated with maladaptive parenting and poor child behavioral treatment response. Thus, a combined approach consisting of behavioral parent training (BPT) and maternal stimulant medication (MSM) may be needed to effectively treat ADHD within families. However, providing combined BPT+MSM initially to all families may be unnecessarily burdensome because not all families likely need combined treatment. The purpose of this study is to examine how to combine, sequence, and personalize treatment for these multiplex families in order to yield benefits to both the parent and child, thereby impacting the course of child ADHD and disruptive behavior symptoms. This article presents our rationale for, design of, and preliminary experiences (based on 26 participants) with an ongoing pilot Sequential Multiple Assessment Randomized Trial (SMART) designed to answer questions regarding the feasibility and acceptability of study protocols and interventions. This article also describes how the subsequent full-scale SMART might change based on what is learned in the SMART pilot and illustrates how the full-scale SMART could be used to inform clinical decision making about how to combine, sequence, and personalize treatment for complex children and families in which a parent has ADHD.

Family functioning in the context of parental bipolar disorder: associations with offspring age, sex, and psychopathology.

Previous research has shown that families with a parent who has bipolar disorder (BD) may experience family functioning difficulties. However, the association between family functioning and psychopathology among offspring of parents with BD, and offspring characteristics that may moderate this association, remains poorly understood. This study examined the cross-sectional associations between family functioning (cohesion, expressiveness, and conflict) and psychopathology in 117 offspring (ages 5-18) of 75 parents with BD. We also examined whether age and sex differences moderated these associations. We measured offspring psychopathology by examining current dimensional symptoms and DSM-IV emotional and behavioral disorders. Correlational analyses indicated that higher family conflict and lower cohesion were associated with higher internalizing and externalizing symptoms in offspring. Lower family cohesion was also associated with current offspring mood disorders. Moderation analyses indicated, first, that the link between lower family cohesion and internalizing symptoms was stronger for younger offspring compared to older offspring. Second, higher family conflict and current mood disorder were associated in younger males but not in older males or in females. Results remained the same after controlling for parental anxiety or substance use disorder comorbidity. Our study highlights the importance of accounting for family functioning when working with offspring at risk for BD, while also recognizing that the connections between family functioning and offspring outcomes are complex and differ based on offspring sex and developmental stage.