Deviation from developmentally appropriate self-care autonomy. Association with diabetes outcomes.
OBJECTIVE
Treatment of IDDM in youth emphasized balancing children's self-care autonomy with their psychological maturity. However, few data exist to guide clinicians or parents, and little is known about correlates of deviations from this ideal.


METHODS
In this cross-sectional study, IDDM self-care autonomy of 100 youth was assessed using two well-validated measures. Three measures of psychological maturity (cognitive function, social-cognitive development, and academic achievement) were also collected for each child. Composite indexes of self-care autonomy and of psychological maturity were formed, and the ratio of the self-care autonomy index to the psychological maturity index quantified each child's deviation from developmentally appropriate IDDM self-care autonomy. Based on these scores, participants were categorized as exhibiting constrained (lower tertile), appropriate (middle tertile), or excessive (higher tertile) self-care autonomy. Between-group differences in treatment adherence, diabetes knowledge, glycemic control, and hospitalization rates were explored.


RESULTS
Analysis of covariance controlling for age revealed that the excessive self-care autonomy group demonstrated less favorable treatment adherence, diabetes knowledge, hospitalization rates, and, marginally, glycemic control. Excessive self-care autonomy increased with age and was less common among intact two-parent families but was unrelated to other demographic factors.


CONCLUSIONS
The findings indicate caution about encouragement of maximal self-care autonomy among youth with IDDM and suggest that families who succeed in maintaining parental involvement in diabetes management may have better outcomes.
Wysocki
T
T
Nemours Children's Clinic, Jacksonville, Florida, USA.
Taylor
A
A
Hough
B S
BS
Linscheid
T R
TR
Yeates
K O
KO
Naglieri
J A
JA
D000293:Adolescent; D000367:Age Factors; D000704:Analysis of Variance; D002648:Child; D003071:Cognition; D003430:Cross-Sectional Studies; D003922:Diabetes Mellitus, Type 1 / Q000523:psychology* / Q000534:rehabilitation*; D005190:Family; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D010555:Personality Inventory; D000297:Psychology, Adolescent; D002666:Psychology, Child; D015203:Reproducibility of Results; D012648:Self Care; D012919:Social Behavior; D016896:Treatment Outcome