OBJECTIVE:To devise and implement a structured intervention for integrating peers into diabetes care in a healthy and adaptive manner.METHODS:Adolescents with diabetes (n = 21) and their best friends (n = 21) participated in a group intervention aimed at increasing diabetes knowledge and social support of diabetes care. Measures of social support, knowledge about diabetes and support, diabetes functioning, and social functioning were obtained prior to and following intervention.RESULTS:Following the intervention, adolescents and their friends demonstrated higher levels of knowledge about diabetes and support, as well as a higher ratio of peer to family support, and friends demonstrated improved self-perception. Parents reported decreased diabetes-related conflict.CONCLUSIONS:Peer group intervention approaches may result in increased positive peer involvement in adolescents' diabetes care.

OBJECTIVE:To describe the short-term results of a controlled trial of Behavioral Family Systems Therapy (BFST) for families of adolescents with diabetes.METHODS:We randomized 119 families of adolescents with diabetes to 3 months' treatment with either BFST, an education and support Group (ES), or current therapy (CT). Family relationships, psychological adjustment to diabetes, treatment adherence and diabetic control were assessed at baseline, after 3 months of treatment (reported here), and 6 and 12 months later.RESULTS:Compared with CT and ES, BFST yielded more improvement in parent-adolescent relations and reduced diabetes-specific conflict. Effects on psychological adjustment to diabetes and diabetic control were less robust and depended on the adolescent's age and gender. There were no effects on treatment adherence.CONCLUSIONS:BFST yielded some improvement in parent-adolescent relationships; its effects on diabetes outcomes depended on the adolescent's age and gender. Factors mediating the effectiveness of BFST must be clarified.

This paper reports the effects of Behavioral Family Systems Therapy (BFST) on directly observed interactions between parents and 119 adolescents with diabetes. Families received 3 months' treatment with BFST, an Education and Support Group (ES) or Current Therapy (CT). Multimodal assessments at baseline, posttreatment, and 6- and 12-month follow-ups included tape-recorded family problem-solving discussions scored with the Interaction Behavior Code. Compared with CT and ES, BFST yielded more improvement in family communication and problem-solving skills. Improvements in individual family members' communication were correlated with other improvements in family relationships and adaptation to diabetes, but not with changes in diabetic control. Increased positive and decreased negative reciprocity in family communication and improved family problem solving were associated with improved treatment adherence and adolescent adjustment to IDDM, but not with improved diabetic control.

Compared the social validity of behavior therapy vs. support group interventions for reduction of parent-adolescent conflict among families of adolescents with diabetes. Families were randomized to 10 sessions of an Education and Support group (ES) or 10 sessions of Behavioral Family Systems Therapy (BFST). We compared participants' social validity ratings of BFST and ES using the Treatment Evaluation Questionnaire (TEQ). Mean TEQ scores were significantly more positive for BFST than ES and, for 13 of 20 items, BFST was rated significantly more positively by parents and/or adolescents. Adolescents rated ES less positively than did parents. Fathers' responses reflected fewer differences between ES and BFST. Results extend previous research on BFST and confirm its superiority over ES for targeting family conflict.