Diabetic control, behavioural symptoms and self-evaluation were assessed in 25 children with IDDM who were in poor metabolic control (P group), before and subsequent to one of two treatment conditions: family therapy and conventional treatment (C). In addition, data were collected from 12 patients in optimal control (O group). Prior to treatment the patients in poor control were rated higher than those in the O group for symptoms indicating somatization and internalization of conflict and showed a gloomier self-image. The O group patients had fewer behavioural symptoms and a more positive self-image than non-diabetic reference groups. Diabetic control improved after family therapy only. Furthermore, the family therapy group improved on a combined measure of behavioural symptoms and one aspect of self-evaluation (relations to parents and family). The results suggest that IDDM may either interfere with or foster the child's development towards autonomy, depending on family interaction patterns which affect the child's behaviour and self-esteem. Family therapy is a treatment option which can mediate improved diabetic control by changing family relationships to allow for a better balance between parental and self-care of the child with poorly controlled IDDM.

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Test measures of field-dependence-independence and impulsiveness-control were obtained from two groups of diabetic children and their parents, the children being in optimal (0, n=12) or poor (P, n=27) metabolic control and, according to the judgment of clinicians, showing optimal or poor psychological adaptation. Children of the 0-group scored lower in impulsiveness and higher in realistic functioning than those of the P-group. Differences which parallelled these were found between the two groups of fathers. The P-group fathers were decidedly more field-dependent than their wives, while the opposite was found for the 0-group. Group differences of the kind obtained were seen as possible determinants of disturbed family interaction or emotional stress in the child in the P-group and of autonomy and self-reliance in the child in the 0-group. It is concluded that the role of fathers of diabetic children has been underestimated. Key words: juvenile diabetes mellitus, IDDM, psychosocial factors, personality, family.Various psychological factors relevant to family functioning can be assumed to be important in influencing the adaptation to the treatment and the metabolic control of insulin-dependent diabetes mellitus in childhood. Particular attention has been directed in this connection to disturbances in the mother-child relationship (1-3) and in family interaction (4-7) which have been found to be linked to poor metabolic control of the diabetes.Two factors that have recurrently been suggested to determine familial patterns associated with good metabolic control are 1) that the parents are able to balance in a constructive way the age-appropriate independence of the child with control of the child's behaviour (8, 9) and, 2) that both the parents and the child show a realistic adjustment to the diabetic condition and a lack of wishful and impulsive behaviour (2, 10). Thus it seems promising to investigate dependence-independence and impulsiveness-control in the search for the characteristics of children and their families related to the adaptation to and the metabolic control of diabetes.Clearly, both the individual degree of dependence-independence and the capacity for impulse control can be expected to correlate with family patterns. Thus, individual and family analyses should be complementary rather than contradictory in character.The present study is part of a larger investigation concerning the outcome of family therapy and also of the individual and family characteristics of possible relevance to how successfully the family adapts to the treatment of childhood diabetic mellitus. The aim was to explore the psychological dimensions of dependence-independence and impulsiveness-control as possible factors associated with poor versus optimal psychological adaptation and metabolic control.