Type 1 Diabetes in Adolescence
Transcript of Type 1 Diabetes in Adolescence
Type 1 Diabetes in Adolescence
Dr Simon Chapman BA BM FRCPCH Consultant Paediatrician Dr Jenny Cropper BSc, Mphil, PsychD Clinical [email protected]
Period of change• Education/Employment • Identity • Autonomy/independence • Relationships • Experimentation (drugs/alcohol) • Increased responsibility • Mental health
Main Task of Adolescent Development – Identity vs Role Confusion
• Main developmental task for adolescents is to separate from parents and develop their own identity.
• Adolescents develop a sense of self through exploring their new found independence, experimenting with roles, choices and ideologies
• As part of the process of separation, peer relationships and social acceptance become all important.
• Psychological Moratorium- society allows time for young people to develop identity
Characteristics of Adolescence
Adolescent characteristics
challengingRisk taking
Responsibility Vs
irresponsibility
control
belonging
peers
identity
separation
sex
transition
explorationattitude
conflict
Adolescent View of the World
Adolescent
isolated !Misunderstood
pressurised
overwhelming
untrusting
Intruded upon I am who I am I know everything
I don’t need help I can do it
Freedom
Now is what matters
I do what I want
Can’t envisage/plan for future
choices
immediate
Adults feelings in response to adolescents
Adult
confusion
frustration
fearful
intimidated
enviousold
anxiety love
protective
Joy & pleasure
What works?!• What do we value in our roles with adolescents/young
people? Are we: – Listening ear? – Concerned professional? – Information giver?
• Is engagement enough? • Sometimes altering communication style still won’t ‘work’ • Being aware of the ‘zone of proximal development’ • Putting some responsibility on to the young person?
– ‘it’s great you’re here today, what things were you thinking you’d talk about with me?’
Case Example• Young woman aged 15 • Bengali heritage • Type 1 diabetes for three years
– Management went well initially – One year in – things changed
• Significant difficulties with administering insulin and testing – Persistently high levels, ketones – Weight loss
• Parents feeling powerless to implement change • Safeguarding procedures
What does Paediatric Psychology offer adolescents?
• Assessment of emotional and psychological needs • Support around difficult times, e.g. diagnosis, transition to
secondary school • Integrated into paediatric clinics • Screening and Questionnaires in young people to identify
issues of depression, anxiety, mental health issues (MFQ, PHQ-9, GAD-7)
• Pump support • Individual and family work, working with the presenting
difficulties, particularly difficulties that impact on the ability to self-manage
• Referral and ‘Sign Posting’ to other agencies
THEILLNESS THECHILD
THEFAMILYTHEENVIRONMENT
ClinicAttendance
MetabolicControl
Diet
CarbohydrateAwareness
DiabetesHistory
CognitiveAbilities
Friendships
Pressures
RiskBehaviours
Emotionalwellbeing
CognitiveAbilities
HomeEnvironment
Financial/Housing/Health
Socialsupport
Cultural/Religiousbeliefs
RelationshipwithSchool
Relationshipwithdiabetesteam
Supportfromotheragencies
Interventionstried
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SchoolAttendance