Abstract
Declining diabetes management and control are common as children progress through adolescence, yet many youths with diabetes do remarkably well. Risk factors for poor diabetes outcomes are well-researched, but fewer data describe processes that lead to positive outcomes such as engaging in effective diabetes self-management, experiencing high quality of life, and achieving in-range glycemic control. Resilience theory posits that protective processes buffer the impact of risk factors on an individual’s development and functioning. We review recent conceptualizations of resilience theory in the context of type 1 diabetes management and control and present a theoretical model of pediatric diabetes resilience. Applications to clinical care and research include the development of preventive interventions to build or strengthen protective skills and processes related to diabetes and its management. The ultimate goal is to equip youths with diabetes and their families with the tools to promote both behavioral and health-related resilience in diabetes.
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• Kia-Keating M, Dowdy E, Morgan ML, Noam GG. Protecting and promoting: an integrative conceptual model for healthy development of adolescents. J Adolesc Health. 2011;48:220–8. This recent paper coherently integrates related yet distinct bodies of literature addressing factors and processes that achievement of positive outcomes across multiple, important domains of functioning in adolescence.
•• Koinis-Mitchell D, McQuaid AL, Jandasek B, et al. J Pediatr Psychol. 2012;37:424–37. This paper is an exemplar application of a model of resilience specific to a chronic pediatric health condition, asthma. The use of both self-management behaviors and quality of life informed the “diabetes competence” concept underlying the behavioral resilience outcome in the diabetes resilience model.
•• Whittemore R, Jaser S, Guo J, Grey M. A conceptual model of childhood adaptation to type 1 diabetes. Nurs Outlook. 2010;58:242–51. This recent conceptual model of adaptation in type 1 diabetes provides a well-researched review of behaviors that youth with diabetes and their families engage in to respond to common risk factors. The emphasis on processes linked with adaptive outcomes was one foundational idea upon which the diabetes resilience model was guided.
•• Masten AS. Resilience in children threatened by extreme adversity: frameworks for research, practice, and translational synergy. Dev Psychopathol. 2011;23:493–506. This paper is a comprehensive overview of basic resilience concepts, recent and emerging conceptualizations of resilience, and implications for the application of resilience research. The paper is authored by a well-respected expert with decades of experience in this area of research.
Luthar SS. Methodological and conceptual issues in research on childhood dresilience. J Child Psychol Psychiatry. 1993;34:441–53.
Masten AS, Hubbard JJ, Gest SD, Tellegen A, Garmezy N, Ramirez M. Competence in the context of adversity: pathways to resilience and maladaptation from childhood to late adolescence. Dev Psychopathol. 1999;11:143–69.
Masten AS. Ordinary magic: resilience processes in development. Am Psychol. 2001;56:227–38.
Olsson CA, Bond L, Burns JM, Vella-Brodrick DA, Sawyer SM. Adolescent resilience: a concept analysis. J Adolesc. 2003;26:1–11.
Sandler I. Quality and ecology of adversity as common mechanisms of risk and resilience. Am J Community Psychol. 2001;29:19–61.
Grey M, Whittemore R, Tamborlane W. Depression in type 1 diabetes in children: natural history and correlates. J Psychosom Res. 2002;53:907–11.
• Northam EA, Lin A, Finch S, Werther GA, Cameron FJ. Psychosocial well-being and functional outcomes in youth with type 1 diabetes 12 years after disease onset. Diabetes Care. 2010;33:1430–7. This paper is a good example of recent, prospective research efforts to understand the factors linked with positive outcomes (both diabetes-related and not) among youth with type 1 diabetes.
Patterson JM, Blum RW. Risk and resilience among youth with disabilities. Arch Pediatr Adolesc Med. 1996;150:692–8.
Luthar SS, Sawyer JA, Brown PJ. Conceptual issues in studies of resilience: past, present, and future research. Ann N Y Acad Sci. 2006;1094:105–15.
Luthar SS, Cicchetti D, Becker B. The construct of resilience: a critical evaluation and guidelines for future work. Child Dev. 2000;71:543–62.
Masten AS. Regulatory processes, risk, and resilience in adolescent development. Ann N Y Acad Sci. 2004;1021:310–9.
•• Rutter M. Resilience as a dynamic concept. Dev Psychopathol. 2012;24:335–44. Rutter is an established expert in resilience research, and this recent paper reviews his emphasis on dynamic processes to overcome risk. This is a central tenet of current resilience conceptualizations and strongly informed the diabetes resilience model.
Burt KB, Paysnick AA. Resilience in the transition to adulthood. Dev Psychopathol. 2012;24:493–505.
Vanderbilt-Adriance E, Shaw DS. Conceptualizing and re-evaluating resilience across levels of risk, time, and domains of competence. Clin Child Fam Psychol Rev. 2008;11:30–58.
Arrington EG, Wilson MN. A re-examination of risk and resilience during adolescence: incorporating culture and diversity. J Child Fam Stud. 2000;9:221–30.
Obradovic J, Burt KB, Masten AS. Pathways of adaptation from adolescence to young adulthood: antecedents and correlates. Ann N Y Acad Sci. 2006;1094:340–4.
Pinquart M, Teubert D. Academic, physical, and social functioning of children and adolescent with chronic physical illness: a meta-analysis. J Pediatr Psychol. 2012;37:376–89.
Wallander JL, Varni JW, Babani L, et al. The social environment and the adaptation of mothers of physically handicapped children. J Pediatr Psychol. 1989;14:371–87.
Wells RD, Schwebel AI. Chronically ill children and their mothers: predictors of resilience and vulnerability to hospitalization and surgical stress. J Dev Behav Pediatr. 1987;8:83–9.
Haase JE. The adolescent resilience model as a guide to interventions. J Pediatr Oncol Nurs. 2004;21:289–99.
Hauser ST, Vieyra MAB, Jacobson AM, Wertlieb D. Vulnerability and resilience in adolescence: views from the family. J Early Adolesc. 1985;5:81–100.
Rolland JS, Walsh F. Facilitating family resilience with childhood illness and disability. Curr Opin Pediatr. 2006;18:527–38.
Koinis-Mitchell D, Murdock KK, McQuaid EL. Risk and resilience in urban children with asthma: a conceptual model and exploratory study. Child Health Care. 2004;33:275–97.
Patterson JM. A family systems perspective for working with youth with disability. Pediatrician. 1991;18:129–41.
Herge WM, Streisand R, Chen R, et al. Family and youth factors associated with health beliefs and health outcomes in youth with type 1 diabetes. J Pediatr Psychol. 2012. doi:10.1093/jpepsy/jss067.
• Jaser SS, White LE. Coping and resilience in adolescents with type 1 diabetes. Child Care Health Dev. 2010;37:335–42. This recent paper is a good example of the growing body of research in type 1 diabetes focusing on the identification of factors and processes that promote positive diabetes outcomes.
Mackey ER, Hilliard ME, Berger SS, Streisand R, Chen R, Holmes C. Individual and family strengths: an examination of the relation to disease management and metabolic control in youth with type 1 diabetes. Fam Syst Health. 2011;29:314–26.
Mednick L, Cogen F, Henderson C, Rohrbeck CA, Kitessa D, Streisand R. Hope more, worry less: hope as a potential resilience factor in mothers of very young children with type 1 diabetes. Child Health Care. 2007;36:385–96.
Tran V, Wiebe DJ, Fortenberry KT, Butler JM, Berg CA. Benefit finding, affective reactions to diabetes stress, and diabetes management among early adolescents. Health Psychol. 2011;30:212–9.
Yi JP, Vitalino PP, Smith RE, Yi JC, Weinger K. The role of resilience on psychological adjustment and physical health in patients with diabetes. Br J Health Psychol. 2008;13:311–25.
Yi-Frazier YP, Smith RE, Vitaliano PP, et al. A person-focused analysis of resilience resources and coping in patients with diabetes. Stress Heal. 2010;26:51–60.
Helgeson VS, Snyder PR, Seltman H, Escobar O, Becker D, Siminerio L. Trajectories of glycemic control over early to middle adolescence. J Pediatr Psychol. 2010;35:1161–7.
Hilliard ME, Wu YP, Rausch J, Dolan LM, Hood KK. Predictors of deteriorations in diabetes management and control in adolescents with type 1 diabetes. J Adolesc Health. 2012. doi:10.1016/j.jadohealth.2012.05.009.
Luyckx K, Seiffge-Krenke I. Continuity and change in glycemic control trajectories from adolescence to emerging adulthood. Diabetes Care. 2009;32:797–801.
Rohan JM, Delamater A, Pendley JS, Dolan L, Reeves G, Drotar D. Identification of self-management patterns in pediatric type 1 diabetes using cluster analysis. Pediatr Diabetes. 2011;12:611–8.
Hood KK, Peterson CM, Rohan JM, Drotar D. Association between adherence and glycemic control in pediatric type 1 diabetes: a meta-analysis. Pediatrics. 2009;124:e1171–9.
Varni JW, Burwinkle TM, Jacobs JR, Gottschalk M, Kaufman F, Jones KL. The PedsQL™ in type 1 and type 2 diabetes: reliability and validity of the Pediatric Quality of Life Inventory ™ generic core scales and type 1 diabetes module. Diabetes Care. 2003;26:631–7.
Kovacs M, Goldston D, Obrosky S, Iyengar S. Prevalence and predictors of pervasive noncompliance with medical treatment among youths with insulin-dependent diabetes mellitus. J Am Acad Child Adolesc Psychiatry. 1992;31:1112–9.
Weissberg-Benchell J, Glasgow AM, Tynan WD, Wirtz P, Turek J, Ward J. Adolescent diabetes management and mismanagement. Diabetes Care. 1995;18:77–82.
Herzer M, Hood KK. Anxiety symptoms in adolescents with type 1 diabetes: associations with blood glucose monitoring and glycemic control. J Pediatr Psychol. 2010;35:415–25.
Holmes CS, Chen R, Streisand R, et al. Predictors of youth diabetes care behaviors and metabolic control: a structural equation modeling approach. J Pediatr Psychol. 2006;31:770–84.
Hood KK, Huestis S, Maher A, Butler D, Volkening L, Laffel LMB. Depressive symptoms in children and adolescents with type 1 diabetes: association with diabetes-specific characteristics. Diabetes Care. 2006;29:1389–91.
Polonsky W. Diabetes burnout: what to do when you can’t take it anymore. American Diabetes Association; 1999.
Hoey H, Aanstoot H, Chiarelli F, et al. Good metabolic control is associated with better quality of life in 2,101 adolescents with type 1 diabetes. Diabetes Care. 2001;24:1923–8.
Soutor SA, Chen R, Streisand R, Kaplowitz P, Holmes CS. Memory matters: developmental differences in predictors of diabetes care behaviors. J Pediatr Psychol. 2004;29:493–505.
Wysocki T, Taylor A, Hough BS, Linscheid TR, Yeates KO, Naglieri JA. Deviation from developmentally appropriate self-care autonomy: association with diabetes outcomes. Diabetes Care. 1996;19:119–25.
Anderson BJ. Family conflict and diabetes management in youth: clinical lessons from child development and diabetes research. Diabetes Spectr. 2004;17:22–6.
Harris MA. Dogs, cats, and diabetes. Diabetes Spectr. 2006;19:187–9.
Weissberg-Benchell J, Nansel T, Holmbeck G, et al. Generic and diabetes-specific parent–child behaviors and quality of life among youth with type 1 diabetes. J Pediatr Psychol. 2009;34:977–88.
Grey M, Boland EA, Yu C, Sullivan-Bolyai S, Tamborlane WV. Personal and family factors associated with quality of life in adolescents with diabetes. Diabetes Care. 1998;21:909–14.
Hanson CL, Henggeler SW, Harris MA, Burghen GA, Moore M. Family system variables and the health status of adolescents with insulin-dependent diabetes mellitus. Health Psychol. 1989;8:239–53.
Wysocki T, Nansel TR, Holmbeck GN, et al. Collaborative involvement of primary and secondary caregivers: associations with youth’s diabetes outcomes. J Pediatr Psychol. 2009;34:869–81.
Harris MA, Greco P, Wysocki T, Elder-Danda C, White NH. Adolescents with diabetes from single-parent, blended, and intact families: health-related and family functioning. Fam Syst Health. 1999;17:181–96.
Swift EE, Chen R, Hershberger A, Holmes CS. Demographic risk factors, mediators, and moderators in youths’ diabetes metabolic control. Ann Behav Med. 2006;32:355–65.
Butler DA, Zuehlke JB, Tovar A, Volkening LK, Anderson BJ, Laffel LMB. The impact of modifiable family factors on glycemic control among youth with type 1 diabetes. Pediatr Diabetes. 2008;9:373–81.
Lloyd SM, Cantell M, Pacaud D, Crawford S, Dewey D. Hope, perceived maternal empathy, medical regimen adherence, and glycemic control in adolescents with type 1 diabetes. J Pediatr Psychol. 2009;34:1025–9.
Eckshtain D, Ellis DA, Kolmodin K, Naar-King S. The effects of parental depression and parenting practices on depressive symptoms and metabolic control in urban youth with insulin dependent diabetes. J Pediatr Psychol. 2010;35:426–35.
Wiebe DJ, Gelfand D, Butler JM, et al. Longitudinal associations of maternal depressive symptoms, maternal involvement, and diabetes management across adolescence. J Pediatr Psychol. 2011;36:837–46.
Streisand R, Mackey ER, Elliot BM. Parental anxiety and depression associated with caring for a child newly diagnosed with type 1 diabetes: opportunities for education and counseling. Patient Educ Couns. 2008;73:333–8.
Cunningham NR, Vesco AT, Dolan LM, Hood KK. From caregiver psychological distress to adolescent glycemic control: the mediating role of perceived burden around diabetes management. J Pediatr Psychol. 2011;36:196–205.
Hains AA, Berlin KS, Davies WH, et al. Attributions of teacher reactions to diabetes self-care behaviors. J Pediatr Psychol. 2009;34:97–107.
Sato AF, Berlin KS, Hains AA, et al. Teacher support of adherence for adolescents with type 1 diabetes: preferred teacher support behaviors and youths’ perceptions of support. Diabetes Educ. 2008;34:866–73.
La Greca AM, Auslander WF, Greco P, Spetter D, Fisher EB, Santiago JV. I get by with a little help from my family and friends: adolescents’ support for diabetes care. J Pediatr Psychol. 1995;20:449–476.
Hanson CL, Henggeler SW, Burghen GA. Social competence and parental support as mediators of the link between stress and metabolic control in adolescents with insulin-dependent diabetes mellitus. J Consult Clin Psychol. 1987;55:529–33.
Hains AA, Berlin KS, Davies WH, Smothers MK, Sato AF, Alemzadeh R. Attributions of adolescents with type 1 diabetes related to performing diabetes care around friends and peers: The moderating role of friend support. J Pediatr Psychol. 2007;32:561–70.
Drew LM, Berg C, Wiebe DJ. The mediating role of extreme peer orientation in the relationships between parent-adolescent relationship and diabetes management. J Fam Psychol. 2010;24:299–306.
Helgeson VS, Reynolds KA, Escobar O, Siminerio L, Becker D. The role of friendship in the lives of male and female adolescents: does diabetes make a difference? J Adolesc Health. 2007;40:36–43.
MCCubbin HI, Thompson EA, Thompson AI, MCCubbin MA, Kaston AJ. Culture, ethnicity, and the family: critical factors in childhood chronic illness and disabilities. Pediatrics. 1993;91:1063–70.
Gallegos-Macias AR, Macias SR, Kaufman E, Skipper B, Kalishman N. Relationship between glycemic control, ethnicity, and socioeconomic status in Hispanic and white non-Hispanic youth with type 1 diabetes. Pediatr Diabetes. 2003;4:19–23.
Modi AC, Pail AL, Hommel KA, et al. Pediatric self-management: a framework for research, policy, and practice. Pediatrics. 2012;129:e473–85.
McGrady ME, Laffel L, Drotar D, Repaske D, Hood KK. Depressive symptoms and glycemic control in adolescents with type 1 diabetes: mediational role of blood glucose monitoring. Diabetes Care. 2009;32:804–6.
Graue M, Wentzel-Larsen T, Bru E, Hanestad BR, Sovik O. The coping styles of adolescents with type 1 diabetes are associated with degree of metabolic control. Diabetes Care. 2004;27:1313–7.
Hughes AE, Berg CA, Wiebe DJ. Emotional processing and self-control in adolescents with type 1 diabetes. J Pediatr Psychol. 2012. doi:10.1093/jpepsy/jss062.
Berg CA, King PS, Butler JM, et al. Parental involvement and adolescents’ diabetes management: the mediating role of self-efficacy and externalizing and internalizing behaviors. J Pediatr Psychol. 2011;36:329–39.
Johnston-Brooks CH, Lewis MA, Garg S. Self-efficacy impacts self-care and HbA1c in young adults with type 1 diabetes. Psychosom Med. 2002;64:43–51.
Hill-Briggs F, Gemmell L. Problem solving in diabetes self-management and control: a systematic review of the literature. Diabetes Educ. 2007;33:1032–50.
Ellis DA, Podolski C, Frey M, Naar-King S, Wang B, Moltz K. The role of parental monitoring in adolescent health outcomes: impact on regimen adherence in youth with type 1 diabetes. J Pediatr Psychol. 2007;32:907–17.
Berg CA, Butner JE, Butler JM, et al. Parental persuasive strategies in the face of daily problems in adolescent type 1 diabetes management. Health Psychol. 2012. doi:10.1037/a0029427.
Hilliard ME, Holmes CS, Chen R, et al. Disentangling the roles of parental monitoring and family conflict in adolescents’ type 1 diabetes self-care. Health Psychol. 2012. doi:10.1037/a0027811.
Amiel SA, Sherwin RS, Simonso DC, Lauritano AA, Tamborlane WV. Impaired insulin action in puberty. NEJM. 1986;315:215–9.
Weissberg-Benchell J, Wolpert H, Anderson BJ. Transitioning from pediatric to adult care: a new approach to the post-adolescent young person with type 1 diabetes. Diabetes Care. 2007;30:2441–6.
Peters A, Laffel L, American Diabetes Association Transitions Working Group. Diabetes care for emerging adults: recommendations for transition from pediatric to adult diabetes care systems. Diabetes Care. 2011;34:2477–85.
Rutter M. Some research considerations on intergenerational continuities and discontinuities: comment on special section. Dev Psychol. 1998;34:1269–73.
Cichetti D, Rogosch FA. Gene x environment interaction and resilience: effects of child maltreatment and serotonin, corticotrophin releasing hormone, dopamine, and oxytocin genes. Dev Psychopathol. 2012;24:411–27.
Obradovic J. How can the study of physiological reactivity contribute to our understanding of adversity and resilience processes in development? Dev Psychopathol. 2012;24:371–87.
Feder A, Nestler EJ, Charney DS. Psychobiology and molecular genetics of resilience. Nat Rev Neurosci. 2009;10:446–57.
Harris MA, Freeman KA, Duke DC. Getting (the most) out of the research business: interventions for youth with T1DM. Curr Diab Rep. 2010;10:406–14.
Wysocki T, Harris MA, Buckloh LM, et al. Randomized, controlled trial of behavioral family systems therapy for diabetes: maintenance and generalization of effects on parent-adolescent communication. Behav Ther. 2008;39:33–46.
Anderson BJ, Brackett J, Ho J, Laffel LMB. An office-based intervention to maintain parent-adolescent teamwork in diabetes management: impact on parent involvement, family conflict, and subsequent glycemic control. Diabetes Care. 1999;22:713–21.
Ellis DA, Frey MA, Naar-King S, Templin T, Cunningham P, Cakan N. Use of multisystemic therapy to improve regimen adherence among adolescents with type 1 diabetes in chronic poor metabolic control: a randomized controlled trial. Diabetes Care. 2005;28:1604–10.
Grey M, Boland EA, Davidson M, Li J, Tamborlane WV. Coping skills training for youth with diabetes mellitus has long-lasting effects on metabolic control and quality of life. J Pediatr. 2000;137:107–13.
De Wit M, Delemarre-van de Waal HA, Bokma JA, et al. Monitoring and discussing health-related quality of life in adolescents with type 1 diabetes improves psychosocial well-being: a randomized controlled trial. Diabetes Care. 2008;31:521–1526.
Fogel NR, Weissberg-Benchell J. Preventing poor psychological and health outcomes in pediatric type 1 diabetes. Curr Diab Rep. 2010;10:436–43.
Gillham J, Reivich K. Cultivating optimism in childhood and adolescence. Ann Am Acad Pol Soc Sci. 2004;591:146–63.
Greenberg MT. Promoting resilience in children and youth: preventive interventions and their interface with neuroscience. Ann N Y Acad Sci. 2006;1094:139–50.
Beaver BR. A positive approach to children’s internalizing problems. Prof Psychol Res Pract. 2008;39:129–36.
Disclosure
Conflicts of interest: M.E. Hilliard, none; M.A. Harris, none; J. Weissberg-Benchell has been paid by Roche Diagnostics to give lectures at a variety of diabetes conferences on the topics of adaptation and coping with diabetes and with technology, has also coauthored a book on transitioning from pediatric to adult care for ADA, and receives occasional royalty checks from the American Diabetes Association.
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Hilliard, M.E., Harris, M.A. & Weissberg-Benchell, J. Diabetes Resilience: A Model of Risk and Protection in Type 1 Diabetes. Curr Diab Rep 12, 739–748 (2012). https://doi.org/10.1007/s11892-012-0314-3
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DOI: https://doi.org/10.1007/s11892-012-0314-3