Siblings & Diabetes They Count Too! Making It Work for everyone!

Transcription

1 Siblings & Diabetes They Count Too! Making It Work for everyone! Joe Solowiejczyk, RN MSW CDE Manager, Diabetes Counseling & Training

2 Background: Psychosocial Impact of Type 1 diabetes in Pediatrics Most research conducted has looked at child with diabetes & parents coping, parenting styles, etc. Relatively little attention has been paid to the impact of diabetes on well siblings Psychological development, behavioral responses, general coping strategies

3 General Observations: Positive: Increased sensitivity to sib & in general Increased sense of compassion for others Newly defined role in family as a helper Negative: Internal psychological conflicts Higher anxiety levels Fear Increased physical & emotional vulnerability

4 Study #1 Sharpe, D., Rossiter, L., Siblings with Children of a Chronic Illness; Journal of Pediatr. Psychol., (2002) 27 (8). Meta analysis of 51 published studies, found: Psychological functioning (i.e., depression, anxiety), peer activities & cognitive development scores were lower for siblings of children with a chronic illness as compared to controls. Parent reports were more negative than child self reports. Recommend intervention programs for siblings & families of children with a chronic illness should be developed/

5 Study #2 Fanos, J.H., Fahrner, K., Jelveh, M., King, R., Tejeda, D., The Sibling Center: A Pilot program for Siblings of Children & Adolescents with a Serious Medical Condition, Journal of Pediatrics; vol. 146 (6) pp , June A pilot program focusing on entire family, seen together & separately, for 4 sessions with a 6 month follow up session. Program integrated into normal peds/specialty clinic. A form of psycho education which included psychosocial support, targeted interventions, resource identification & consciousnessraising. Sibs were found to experience a variety of symptoms, including: Jealousy, attention seeking behavior, heightened sense of vulnerability, somatic expressions, anger, anxiety, depression, resentment & psychological and physical isolation from parents.

6 Study #3 Jackson C, Richer J, Edge, JA. Sibling psychological adjustment to type 1 diabetes mellitus. Pediatric Diabetes 2008: 9(Part I): families, cross sectional, self selected study, parents completed questionnaires measuring sibling adjustment, major life events, social support & parenting stress. Siblings completed questionnaires assessing functioning, coping strategies & completed a semi structured interview. Findings: Majority of siblings of children with T1DM were well adjusted. Higher overall levels of parenting stress & parental adjustment significantly associated with sibling adjustment to T1DM.

7 Study #4 F. Sleeman, E.A. Northam, W. Crouch, F.J. Cameron. Psychological adjustment of well siblings of children with Type 1 diabetes, Diabetic Medicine Diabetes UK, pp , siblings, y.o. & parents of children with Type 1 DM, treated at the Royal Children s Hospital, Melbourne, Australia; siblings and parents administered the Strengths & Difficulties Questionnaire; SDQ sib data and normative data sample compared. Findings: Siblings did not report increased behavioral or emotional dysfunction relative to children in the general population.

8 Questions/ Discussion

9 Emotional Assessment: At risk considerations: Grief Sadness Fear Isolation Vulnerable Behavior

10 Contributing factors: Usual individual response to diagnosis Dysfunctional parental/family coping to diagnosis and daily management Lack of inclusion in treatment plan and education process

11 Behavioral Issues: Outer a reflection of Inner General behavior acting out, aggressive, passive, isolating, moody Role in family philosopher, jokester, etc. School Friends Clinging vs. Independent

12 Interventions: Preventative & Corrective: Check in with them regarding: Their reactions, impressions and understanding of the diagnosis and the on going disease management. Their role in the family helper, destroyer, etc Do they think that will change now that their sib has diabetes. How they are feeling scared, angry, sad, unsure. Include siblings in all aspects of clinical care Initial hospitalization meetings, education sessions, family meetings. Provide accurate & realistic explanations & reassurance

13 Interventions: Preventative & Corrective: Cont d Explore family impressions & thoughts from each family member out loud & in presence of sib, about how they think things will or will not change at home. Ask each family member exactly what it is that they are most frightened about regarding the diagnosis and daily living with diabetes. Ask for feedback from sib after eliciting the above make sure that they (sibs) are clear and have had a chance to feel heard and acknowledged.

14 Interventions: Preventative & Corrective: Explore with family what things will look like when they get home and/or how they look at present. Specifically discuss family member roles now that diabetes is in their lives. Make a plan specifically tailored for the sib: e.g., once a week parent(s) will spend non diabetes time with the well sib; come hell or high water, totally consistent and dependable

15 Questions/ Discussion

16 Thank You & May the Force be with You! Joe Solowiejczyk, RN MSW CDE Manager, Diabetes Counseling & Training Johnson & Johnson Diabetes Institute (484)