Type 1 Diabetes in Adolescence

Dr Simon Chapman BA BM FRCPCH Consultant Paediatrician Dr Jenny Cropper BSc, Mphil, PsychD Clinical Psychologistsimon.chapman@nhs.net

‘THE YOUTH BULGE’

74%

‘PAEDIATRIC’ DIABETES

THE ADOLESCENT BODY

THE ADOLESCENT BRAIN

50% OF MENTAL ILLNESS BEGINS IN ADOLESCENCE

75% OF MENTAL ILLNESS BEGINS BY AGE 25 Y

IMPLICATIONS FOR TRANSITION

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

DIABETES CONTROL

Diagnosis

Secondary transfer

Foster Care

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

1

2

3

SchoolAttendance