Reducing Externalising Behaviour Problems in Children with Type 1 Diabetes: A Controlled Evaluation of the Triple P-Positive Parenting Program.

INTERVENTION: Triple P Positive Parenting Intervention: Following Sanders (1999), parents randomly assigned to this condition will be taught 17 core child management strategies. Ten of the strategies are designed to promote children’s competence and development (i.e., quality time; talking with children; physical affection; praise; attention; engaging activities; setting a good example; ‘Ask’, ‘Say Do’; incidental teaching; and behaviour charts), and 7 strategies are designed to help parents manage misbehaviour (i.e., setting rules; directed discussion; planned ignoring; clear, direct instructions; logical consequences; quiet time; and time out). Parents will further be taught a six‐step planned activities routine to enhance the generalization and maintenance of parenting skills (i.e., plan ahead, decide on rules, select engaging activities, decide on rewards and consequences, and hold a follow‐up discussion with child). Each family will receive *Every Parent (Sanders, 1992) and a workbook, *Every Parent’s Family Workbook (Markie‐Dadds, Sanders, & Turner, 2001). Parents will also receive active skills training and support from a trained practitioner (Liz Westrupp) as described by Sanders and Dadds (1993). Active skills training methods will include modelling, role‐plays, feedback, and the use of specific homework tasks. On average, parents will attend approximately 10 individual appointments with the practitioner and complete approximately 10 hours of intervention in this condition. CONDITION: Type 1 Diabetes and externalising behaviour problems PRIMARY OUTCOME: Behavior Assessment System for Children, Second Edition (BASC‐2; Reynolds & Kamphaus, 1992, parent‐report version). The BASC‐2 is a multi‐method, multi‐dimensional system that evaluates the behaviour of children aged 4‐18 years. The present study will use only the Parent Rating Scale (PRS) of the BASC‐2 (to be completed by the participant?s parent), which provides a comprehensive measure of a child?s adaptive and problem behaviours in community and home settings. The PRS contains descriptors of behaviours that the respondent rates on a four‐point scale of frequency, ranging from never to almost always. The PRS assesses clinical problems in the broad domains of Externalising Problems and Internalising Problems and it also measures Adaptive Skills. A T‐score of > 60 on either of the scales indicates the presence of substantial problems. The BASC‐2 has excellent norms based on a large sample of the general population, representative with regard to gender, race, ethnicity, clinical classification and parent education. Internal consistency reliabilities are in the middle 0.80s to low 0.90s for all composite scores. Evidence of validity is supported via factor structure analyses and comparison to the Achenbach Child Behaviour Checklist, showing strong, significant correlations with relevant composites (Reynolds & Kamphous, 1992). SECONDARY OUTCOME: Measure of Glycemic Control. Blood sampling to assess glycaemic control (HbA1c levels) routinely occurs at each three‐monthly diabetic clinic visit. With consent, this information will be accessed from the diabetes unit database. In addition, an average of each child?s Total Daily Insulin Dose will be calculated for the treatment period (units of insulin per kilo of body weight, per day). No additional blood samples are required for study purposes. INCLUSION CRITERIA: 1.Children with diagnosed Type 1 Diabetes (of a minimum of 6 months duration) who attend the Diabetes Clinic at the Royal Children's Hospital Melbourne (RCH). 3.Children without clinically significant emotional or behaviour problems (i.e., (i.e., Internalising T Score < 60 + Externalising T score < 60). 2.Children with clinically significant emotional problems and/or behaviour problems (i.e., Internalising T Score > 60 or Externalising T score > 60) will be eligible to participate and will be allocated on the basis of their Externalising or Internalising behaviour problem T score.