title: Reducing and preventing internalizing and externalizing behavior problems in children with type 1 diabetes: a randomized controlled trial of the Triple P-Positive Parenting Program.
abstract: BACKGROUND
  Children with type 1 diabetes are at increased risk of mental health problems, which in turn are associated with poor glycemic control, diabetes-related complications, and long-term psychiatric morbidity. We tested the efficacy of the Triple P-Positive Parenting Program in reducing or preventing mental health problems and improving glycemic control in children with type 1 diabetes in a randomized controlled trial.
  
  
  METHODS
  Participants were recruited from the Diabetes Clinic, Royal Children's Hospital, Melbourne, Australia, and randomized to Triple P or standard diabetes care. The primary outcome was child internalizing and externalizing behavior problems 3 and 12 months postrandomization. Secondary outcomes were glycemic control, parent mental health, parenting skills, and family functioning at 3 and 12 months, and glycemic control at 24 months.
  
  
  RESULTS
  A total of 76 participants were randomized (38 to intervention and 38 to control), 60 completed 3-month, and 57 completed 12-month assessments. Benefits of Triple P were evident at 3 months for parent mental health, parenting skills, and family functioning (p < 0.05), but not for child mental health or glycemic control, with little effect at 12 months. Prespecified subgroup analyses for children with pre-existing internalizing or externalizing behavior problems indicated greater improvements in child mental health, parent mental health, parenting skills, and diabetes family conflict (p < 0.05), but lower parenting self-efficacy at 3 months. Improvements in parent mental health and parenting competency associated with Triple P were sustained to 12 months for children with pre-existing mental health problems.
  
  
  CONCLUSIONS
  This study provides some support for the efficacy of Triple P in improving parent and family outcomes, and reducing child internalizing and externalizing behavior problems primarily in children who have pre-existing mental health problems.
authors.affiliation: Cell Biology, Development & Disease, Centre for Hormone Research, Murdoch Childrens Research Institute, Melbourne, Australia.|Department of Endocrinology and Diabetes, Royal Children's Hospital, Melbourne, Australia.
authors.forename: E M
authors.initials: EM
authors.lastname: Westrupp
authors.affiliation: Cell Biology, Development & Disease, Centre for Hormone Research, Murdoch Childrens Research Institute, Melbourne, Australia.|School of Psychology, The University of Melbourne, Melbourne, Australia.
authors.forename: E
authors.initials: E
authors.lastname: Northam
authors.affiliation: Clinical Epidemiology and Biostatistics Unit, Royal Children's Hospital, Melbourne, Australia.|Department of Paediatrics, University of Melbourne, Melbourne, Australia.
authors.forename: K J
authors.initials: KJ
authors.lastname: Lee
authors.affiliation: Cell Biology, Development & Disease, Centre for Hormone Research, Murdoch Childrens Research Institute, Melbourne, Australia.
authors.forename: S E
authors.initials: SE
authors.lastname: Scratch
authors.affiliation: Cell Biology, Development & Disease, Centre for Hormone Research, Murdoch Childrens Research Institute, Melbourne, Australia.|Department of Endocrinology and Diabetes, Royal Children's Hospital, Melbourne, Australia.
authors.forename: F
authors.initials: F
authors.lastname: Cameron
mesh_terms: D002648:Child; D002652:Child Behavior / Q000523:psychology*; D002653:Child Behavior Disorders / Q000517:prevention & control* / Q000523:psychology; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000150:complications / Q000523:psychology / Q000628:therapy*; D004505:Education, Nonprofessional; D005195:Family Relations / Q000523:psychology; D005260:Female; D005500:Follow-Up Studies; D007722:Health Knowledge, Attitudes, Practice; D006776:Hospitals, Pediatric; D006801:Humans; D006943:Hyperglycemia / Q000517:prevention & control*; D007003:Hypoglycemia / Q000517:prevention & control*; D008297:Male; D010044:Outpatient Clinics, Hospital; D016487:Parenting / Q000523:psychology*; D010352:Patient Dropouts; D011569:Psychiatric Status Rating Scales; D002666:Psychology, Child / Q000193:education* / Q000379:methods; D020377:Self Efficacy; D014739:Victoria
keywords: child behavior; parent mental health; parenting; type 1 diabetes