How can a psychologist help support my child with diabetes?
Behind the diagnosis: A parent’s guide on the important role of psychology as part of your child’s diabetes treatment team
If you have concerns about your child’s health, diagnosis, or diabetes treatment, please contact your child’s physician for support. Diabetes specialists can help provide you with the in-depth and tailored medical information needed for your child’s care. Within the scope of practice as a psychologist specializing in pediatric diabetes, this blog is intended to help you understand basic information about the diagnosis, but more importantly, why psychological well-being should be a main component of treatment.
Diabetes is a chronic medical diagnosis that adversely impacts a person’s ability to produce or utilize necessary levels of insulin. This is important as insulin is a hormone that is needed to regulate the sugar our body uses for energy. Having your child be diagnosed with diabetes is the start of treatment that addresses the short and long term effects that this chronic illness can have on children, adolescents, and families. The immediate and on-going treatment of diabetes is often managed effectively under the care of a comprehensive diabetes treatment team, which consists of a range of different health care professionals, including an endocrinologist, physicians, nurses, dieticians, therapists, and of course…the parents. However, the impact that diabetes has on the short and long term psychological well-being of children is not often addressed unless there are mental health professionals involved on these treatment teams. This does not mean that the medical providers managing diabetes do not have adequate expertise in supporting your child’s health, but the focus is on the medical and physical components of the diagnosis. Many endocrinologists and physicians consult with mental health professionals and/or refer out if there is not a pediatric psychologist as part of the team. Why? Emotional well-being is an essential component to the physical management of diabetes. Psychologists, especially those trained in health psychology, pediatric psychology, and/or diabetes treatment, play a vital role in the adjustment and day-to-day coping with diabetes.
Before highlighting the impact that diabetes has on mental health and treatment options, here are a few important details
Type 1 Diabetes (insulin-dependent)
Type 1 occurs when the body is unable to produce insulin. Essentially, our body breaks down carbohydrates we eat into sugar (blood glucose) which ultimately gives us energy to function. Our pancreas produces a hormone called insulin that our body needs in order to process this blood sugar and help the body’s cells utilize this energy. Individuals can be diagnosed with Type 1 Diabetes at any age, regardless of your race, ethnicity, lifestyle, size, or shape. Type 1 Diabetes is typically diagnosed in children and young adults. While there are not many known risk factors, family history can play a role. Individuals with a family member of diabetes may be at increased risk. Type 1 Diabetes is managed by taking insulin, medication, and/or a combination of both.
Type 2 Diabetes (insulin-resistant)
Type 2 is the most common form of diabetes in the United States. Rather than your pancreas not being able to produce insulin, Type 2 Diabetes occurs when your body is unable to produce enough insulin and/or is unable to use it efficiently. Type 2 Diabetes is typically diagnosed in adults, however the rate of Type 2 Diabetes in youth is on an alarming rise. There are several risk factors for Type 2 Diabetes, including family history, unhealthy diet or eating habits, inactivity, or obesity. Type 2 Diabetes differs than Type 1 Diabetes in that it may not require insulin injections and can often be controlled and managed with healthy lifestyle changes and/or medication.
The American Diabetes Association (ADA) states that emotional support “while not often initially considered, plays a key role in diabetes care.” Maintaining mental and emotional health is necessary for adequate management of diabetes, and your child’s overall well-being. While we tend to immediately think about the physical aspects of health when managing diabetes, we tend to overlook how emotionally draining it can be to feel good about yourself and take good care of yourself, every-single-day. Lifestyle changes, planning meals, exercising, monitoring blood glucose levels, counting carbohydrates, dosing insulin, managing alarms and alerts with continuous glucose monitors, medication, finger pricks….. the list goes on. It is normal for there to be an adjustment period throughout many stages of Type 1 and Type 2 onset and ongoing management.
Psychologists and mental health providers are not here to replace the care of all of the wonderful professionals who support your child’s diabetes treatment, but rather to enhance and complete the level of support to encourage overall well-being.
Here are a few mental health concerns that children/adolescents with diabetes and their families may experience
Medical trauma related to complications, hospitalizations, or health concerns prior to diagnosis
Adjustment to diagnosis and the loss of identity
Anxiety about future health/wellness and the pressure of learning about diabetes management
Stress related to the daily maintenance, procedures, and precautions
Talking about the diagnosis with peers, peer conflict, and/or adjustment to navigating the diagnosis around peers without diabetes
Frustration, withdrawal, opposition, or burn out with complying to diabetes treatment regimens
The impacts of blood glucose levels (high, low) on mental health, attention, mood, sleep, and energy
Anxiety or fear associated with procedures
Family conflict related to responsibilities throughout development
Here are a few ways a psychologist can support your child with diabetes
A psychologist can help support the child and family’s adjustment to diagnosis.
As a parent, you may or may not have experience with diabetes, and even if you do, it can feel different when you are caring for your child(ren). Learning about a diagnosis of diabetes can be overwhelming. Not only are you learning to adjust to a chronic health concern, but your brain is also trying to process how this will impact current lifestyle, daily habits, and day-to-day life with your child. Psychologists can help with lifestyle changes, coping, and help the child and family process prior hospitalizations or medical trauma.
A psychologist can help improve adherence to diabetes treatment regimen.
Psychologist’s trained in barriers to diabetes treatment adherence can help your child learn developmentally appropriate techniques and strategies to improve adherence. By working with the family and endocrinology providers, the psychologist can help teach techniques designed to explore and/or begin to resolve any of your child/teen’s ambivalence, fear, or barriers impacting adherence and health goals. For some families, this may mean learning strategies to remember to check blood sugars, helping with healthy habit routines, or increase motivation for patients of any age who are resistant to managing diabetes.
A psychologist can provide behavior management training for parents who would like support and assistance with getting their child to comply with diabetes treatment regimen.
By learning parent strategies that are designed to support our child, it may reduce the frustrating, anxiety provoking, and negative interactions that can occur when trying to support your child’s health. By improving the skills and overall relationship, your child can better accept that diabetes adherence is not because it is something “forced” by mom and/or dad and rather something that is needed to help them reach their goals.
A psychologist can provide coping, relaxation, and acceptance strategies for newly diagnosed children, teens, and/or their families who are struggling with adjusting to manage diabetes.
Stress can have an impact on anyone’s overall health, but for individuals with diabetes, significant or prolonged stress can be dangerous to overall health. Why? When we are under stress, our body communicates with our nervous system and glands to produce hormones and other signals throughout our body. This is a survival mechanism for us. When these hormones are released other parts of our body respond. Stress hormones can lead to increased glucose into our blood stream and for individuals with diabetes, increased blood sugars can be dangerous to overall health. When individuals with diabetes are better able to manage stress, they can have better control over blood sugar levels and vice versa. Therefore, regulating stress levels is not only important for mental health, but also is an important component to treating diabetes.
A psychologist can help teach families distraction, pain management, and/or coping techniques.
It is not natural nor innate to get used to finger sticks or insulin needles. A psychologist can help children and teens cope with utilizing these tools and provide more intensive supports for those who have anxiety of needles and/or other testing and administration procedures.
A psychologist can help assess and monitor any co-existing mental/behavioral health or academic concerns that may arise.
Managing diabetes as a child, teen, or adult can feel overwhelming and consuming, particularly when balancing other aspects of being a typical student. A psychologist trained in diabetes treatment can help your child find balance and develop routines, coping strategies, and utilize other resources to help diabetes feel more like an aspect of their identity and not all encompassing.
A psychologist can help your child become more aware of the impacts on mental health, as well as treat co-morbid anxiety, depression, and other behavioral concerns.
Individuals with diabetes can be up to twice as likely to develop mental health concerns than individuals without diabetes. Symptoms like fatigue, feelings of worthlessness, withdrawal, and sadness can lead to unhealthy habits that can impact overall health and adherence. In collaboration with your child, their caregivers, and diabetes treatment team, a psychologist can help your child understand how some symptoms may relate to blood glucose levels and how to recognize indicators of symptoms in order to intervene and cope.
A psychologist with diabetes training and knowledge of school systems can help provide specific recommendations for Individualized Education Programs (if eligible) or 504 plans so that your child can feel safe and supported in school.
Psychologists can provide tailored recommendations, as well as psychoeducation to parents and teachers on the impact of diabetes care on student functioning and how to utilize strategies. They can work directly with your child to find language to help explain their needs in the school setting and access supports.
A psychologists can refer or provide formal outpatient psychological or neuropsychologist assessment.
If your child or adolescent would benefit from gaining awareness of their learning strengths and weaknesses to tailor strategies for diabetes management, a comprehensive assessment can help. By identifying your child’s learning and academic strengths, a psychologist can better help them understand how functioning can be impacted by high or low blood sugars.
A psychologist can provide outpatient therapy services and support adjustment throughout the lifespan.
It is common for adherence and/or coping with diabetes management to change throughout adolescence and development, even if a child successfully and adequately managed their diabetes for years prior. Adjusting and maintaining adequate adherence can be difficult for teens.
A psychologist who has expertise in working with children and adolescents with diabetes, as well as the families and providers that support them, are sensitive to the unique demands and implications that this diagnosis has on children and teens.
For example, your child may have been diagnosed with diabetes at a young age and with your support, has navigated management and treatment regiments with ease. However, when they start to navigate the pressure of adolescence they may experience a change in mood, compliance, and overall motivation to navigate their care. During this already stressful time of identity, physical, and social development, managing diabetes can be a huge trigger that helps them connect with peers, themselves, or other adults.
Pediatric diabetes support at Behind the Behavior Psychology, PLLC
Dr. Carly Bobal at Behind the Behavior Psychology, PLLC is a licensed psychologist and a health services psychologist. She specializes in coordinating with your child’s providers to ensure that all treatment is tailored to your child’s needs. As a psychologist in private practice, Dr. Bobal hopes to enhance your child’s adjustment, coping, and on-going health goals to help you and your family understand how diabetes relates to healthy mental, behavioral, and academic functioning. By teaming up with families, Dr. Bobal enjoys teaching children how to identify the impacts of blood glucose levels on mental and behavioral health, as well as ways to better cope, manage, and advocate for their needs. In addition, Dr. Bobal specializes in developing individual and family strategies to help create and maintain day-to-day lifestyle habits that improve or maintain adherence throughout your child’s developmental stages.
*For more information about mental health and diabetes treatment or to schedule an appointment contact Behind the Behavior Psychology today!