During adolescence, children increasingly establish autonomy from parents and develop a separate concept of self. When a child has diabetes, making this transition involves special challenges for adolescents and their parents. Studies have found that families characterized by high control, low cohesion and high conflict are associated with children having lower self-concepts and poor metabolic control. However, developmental differences in adolescence have not been studied and little systematic attention has been focused on identifying diabetes-specific parent behavior associated with adjustment.

The purpose of this study was to examine how perceived parent closeness, diabetes-specific parent behavior (warmth and control), and family conflict, organization and control differ by age and gender among 278 adolescents (aged 9-17 years) who had diabetes for at least one year. The study investigated which aspects of parent-child relationships were associated with self-concept and metabolic control (MC) by age-group and gender. Participants attended a diabetes summer camp. A subgroup (52 girls, 50 boys) had glycosylated hemoglobin data, a reliable index of MC. The subgroup and larger sample were similar on blood glucose at camp, demographics and relationship indices. Pubertal status and duration were controlled. Three age-groups (9- 11, 12-14, 15-17) were compared in MANOVA, ANCOVA and regression analyses.

Findings revealed that diabetic adolescents perceive age-related transitions in parent-child relations. Older subjects reported less diabetes-specific parent control than younger subjects; older subjects also reported less closeness with mother and father than younger subjects. Consistent with hypotheses, high parent warmth, high mother/father closeness and low conflict were associated with higher self-concept, but in contrast to hypotheses, MC was unrelated to family conflict, organization and control. With age covaried, the association between diabetes-specific parental control and metabolic control (MC) was curvilinear with higher parent control reported by adolescents in good and poor MC. Analyses of diabetes-specific parent warmth and MC revealed that good MC was associated with higher parent warmth for 12-14 year olds, but for 15-17 year olds poor MC was associated with higher parent warmth. Assessing developmental and diabetes-specific aspects of relationships with parents can enhance our understanding of adjustment in adolescence.