We examined whether intra-family discrepancies in perceptions of the adolescent's competence and independence were associated with autonomy and also well-being for adolescents and parents. The latent discrepancy model was used to examine the ways that mothers and fathers consistently differed from their adolescent across measures of independence and competence regarding type 1 diabetes, a stressful context for families. One-hundred and eighty-five mothers, fathers, and adolescents (M age= 12.5 SD= 1.3) completed measures of the adolescent's independence in completing diabetes tasks, problems with diabetes management, adherence to the medical regimen, measures of wellbeing, and metabolic control. The latent discrepancy model was conducted via structural equation modeling that generated latent discrepancies from the adolescent for mothers and fathers. Both mothers and fathers viewed the adolescent's competence more negatively than did the adolescent. These discrepancies related to more parental encouragement of independence and adolescent autonomy, but also poorer metabolic control, and poorer parental psychosocial well-being. ThePublisher's Disclaimer: The following manuscript is the final accepted manuscript. It has not been subjected to the final copyediting, fact-checking, and proofreading required for formal publication. It is not the definitive, publisher-authenticated version. The American Psychological Association and its Council of Editors disclaim any responsibility or liabilities for errors or omissions of this manuscript version, any version derived from this manuscript by NIH, or other third parties. The published version is available at www.apa.org/journals/dev. results are interpreted within a developmental perspective that views discrepancies as reflecting normative developmental processes of autonomy, but associated with disruptions in well-being in the short term. NIH Public AccessKeywords parent-child relationship; autonomy; adolescence; parent adjustment; type 1 diabetes Adolescence is a time when children and their parents work toward a new type of relationship as adolescents experience socio-emotional and cognitive developments (Steinberg & Silk, 2002). As a consequence, adolescents and their parents frequently view the family (Carlson, Cooper, & Spradling, 1991) and their relationship in discrepant ways (Tein, Roosa, & Michaels, 1994). A key parent-child discrepancy involves views of adolescents' competence and independence (Holmbeck & O'Donnell, 1991), with adolescents perceiving themselves as more competent and independent than do parents. In this paper, we examine discrepancies between the adolescent's and the parent's views of the adolescent's competence and independence with respect to diabetes management. We utilize a developmental and transactional perspective that views the parent-child relationship as a dynamic one where both parent and adolescent develop Kim, Conger, Lorenz, & Elder, 2001). We examine how discrepancies across multiple metrics of independence and competence ...

Research indicates that the quality of the adherence assessment is one of the best predictors for improving clinical outcomes. Newer technologies represent an opportunity for developing high quality standardized assessments to assess clinical outcomes such as patient experience of care but have not been tested systematically in pediatric sickle cell disease (SCD). The goal of the current study was to pilot an interactive web-based tool, the Take-Charge Program, to assess adherence to clinic visits and hydroxyurea (HU), barriers to adherence, solutions to overcome these barriers, and clinical outcomes in 43 patients with SCD age 6–21 years. Results indicate that the web-based tool was successfully integrated into the clinical setting while maintaining high patient satisfaction (>90%). The tool provided data consistent with the medical record, staff report, and/or clinical lab data. Participants reported that forgetting and transportation were major barriers for adherence to both clinic attendance and HU. A greater number of self-reported barriers (P < .01) and older age (P < .05) were associated with poorer clinic attendance and HU adherence. In summary, the tool represents an innovative approach to integrate newer technology to assess adherence and clinical outcomes for pediatric patients with SCD.

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