How families cope with diabetes in adolescence. An approach and case analyses.

In this paper we describe our newly constructed Family Coping Coding System. This scheme was constructed to identify family coping strategies that involve appraisal, problem solving, and emotion management dimensions. We discuss the theoretical rationale, meanings and reliability of the coping codes, and illustrate them through excerpts drawn from family discussions of a recent stressful situation (the onset of a chronic or acute illness in an adolescent member). Finally, we consider the clinical research relevance of this new assessment technique, exemplifying this potential with respect to medical compliance. We present analyses of two families with diabetic adolescents who strikingly differ with respect to compliance, and explore which family coping strategies may be predictive of an adolescent's favorable or problematic compliance to diabetes management.

Parental contexts of adolescent self-esteem: A developmental perspective.

Relationships between parental behaviors and adolescent self-esteem were analyzed in a group of 95 early adolescents from multiple settings. The study was designed to investigate hypotheses regarding associations between observed parental interactions (e.g., accepting and devaluing) and adolescent self-esteem. Parents' verbal interactions with their adolescents were assessed through application of the constraining and enabling coding system to transcribed family discussions, generated through a revealed differences procedure. Adolescent self-esteem was measured with the Coopersmith Self-Esteem Inventory. Parent interaction-self-esteem associations were examined in the pooled sample, as well as in specific sub-groups based on gender, health, and ego development (measured by the Washington University Sentence Completion Test). Boys had more numerous associations between their self-esteem and parental interactions than girls, and psychiatrically ill boys had particularly high associations. Parental interactions were found to be most strongly related to adolescent self-esteem for adolescents at the lowest levels of ego development. Our findings are consistent with the view that increasing individuation in self-esteem regulation occurs during adolescent development, such that adolescents at higher levels of ego development evaluate themselves more independently of parental feedback than do their less mature peers.

Interaction sequences in families of psychiatrically hospitalized and nonpatient adolescents.

A KEY theme running through competing views of family influences upon adolescent development is that of directionality, on two levels: influences within the flow of family interaction; and influences from family processes to individual adolescent development. In this paper our focus is upon the first level, intrafamilial sequences within families. More specifically, we study links between psychiatric impairment in adolescence and developmentally relevant parent-child and parent-parent sequences. This report extends a previous investigation (Hauser et al. 1984), which described our new family coding system and first correlational findings. We now study the flow of interactions within these families. Although there has been much recent empirical research in adolescent psychosocial development (e.g., Redmore and Loevinger 1979; Loevinger 1976; Adams and Fitch 1982; Hauser et al. 1984), one important area has received less attention--the relationship between developmentally relevant family processes and psychiatric disturbance during adolescence.

Sex differences within the family: Studies of adolescent and parent family interactions.

Sex differences in verbal family interactions were investigated in a group of 79 adolescents and parents from normal and psychiatric settings. The analyses were designed to study these differences in both generations, parent and adolescent. Parent and adolescent interactions with one another were observed in a semistructured, revealed-differences family discussion. All of the individual speeches were then scored with our Constraining and Enabling Coding System (CECS). Initial predictions involved both adolescent and parent differences. These hypotheses were only partially confirmed. The strongest findings pertained to parent sex differences, as we found strikingly higher levels of cognitive enabling speeches expressed by fathers and significantly more speeches addressed to fathers. We discuss several alternative interpretations of these findings. Perspectives included in our considerations are direction of effect and influences of task/context upon the expression of family sex differences.

Children with recently diagnosed diabetes: interactions within their families.

Cross-sectional findings drawn from the first year of a 4-year longitudinal study of preadolescent and early adolescent insulin-dependent diabetics and their families are presented. Using direct observation techniques and a specially designed coding system, the family interactions of 56 families with a recently diagnosed diabetic child are compared with those of 49 families with a child of similar age and sex, who has had a recent, serious acute illness. The two samples are contrasted in terms of each family member's (mother, father, and child) enabling and constraining interactions, controlling for social class differences. The findings reveal that the diabetic children and their parents expressed significantly more enabling (e.g., focusing, problem solving, active understanding) speeches than comparable members of the acute illness group. In addition, there are indications of particular constraining interactions (devaluing) occurring between fathers and diabetic children. Several alternative interpretations are offered to account for these results, together with plans for future research directions to investigate these hypothesized explanations.