Examined perceptions of the family environment in a cross-regional sample of 90 families who had children with diabetes and 89 controls. Families were classified as either traditional (intact) or nontraditional (single-parent or blended families). Parents of children with diabetes reported less family expressiveness, which was a predictor of clinically higher levels of child behavior problems than controls. Parents in nontraditional families reported lower levels of organization, less emphasis on active-recreational pursuits, and more child behavior problems than traditional families. An additive effect of diabetes and nontraditional family structure was found for children with diabetes from nontraditional families, who reported substantially less cohesion than all other groups. Nontraditional family structure was more disruptive for children with diabetes than for controls; it was the best predictor of behavior problems and was related to poorer metabolic control.

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