A multicentre randomized controlled trial of an empowerment-inspired intervention for adolescents starting continuous subcutaneous insulin infusion : a study protocol

Background. Continuous subcutaneous insulin infusion (CSII) treatment among children with type 1 diabetes is increasing in Sweden. However, studies evaluating glycaemic control in children using CSII show inconsistent results. Omitting bolus insulin doses using CSII may cause reduced glycaemic control among adolescents. The distribution of responsibility for diabetes self-management between children and parents is often unclear and needs clarification. There is much published support for continued parental involvement and shared diabetes management during adolescence. Guided Self-Determination (GSD) is an empowerment-based, person-centred, reflection and problem solving method intended to guide the patient to become self-sufficient and develop life skills for managing difficulties in diabetes self-management. This method has been adapted for adolescents and parents as Guided Self-Determination-Young (GSD-Y). This study aims to evaluate the effect of an intervention with GSD-Y in groups of adolescents starting on insulin pumps and their parents on diabetes-related family conflicts, perceived health and quality of life (QoL), and metabolic control. Here, we describe the protocol and plans for study enrolment. Methods. This study is designed as a randomized, controlled, prospective, multicentre study. Eighty patients between 12-18 years of age who are planning to start CSII will be included. All adolescents and their parents will receive standard insulin pump training. The education intervention will be conducted when CSII is to be started and at four appointments in the first 4 months after starting CSII. The primary outcome is haemoglobin A1c levels. Secondary outcomes are perceived health and QoL, frequency of blood glucose self-monitoring and bolus doses, and usage of carbohydrate counting. The following instruments will be used to evaluate perceived health and QoL: Disabkids, 'Check your health', the Diabetes Family Conflict Scale and the Swedish Diabetes Empowerment Scale. Outcomes will be evaluated within and between groups by comparing data at baseline, and at 6 and 12 months after starting treatment. Results and discussion. In this study, we will assess the effect of starting an insulin pump together with the model of Guided Self-Determination to determine whether this approach leads to retention of improved glycaemic control, QoL, responsibility distribution and reduced diabetes-related conflicts in the family. Trial registration: Current controlled trials: ISRCTN22444034

Children's Vocabulary Development : The role of parental input, vocabulary composition and early communicative skills

The aim of this thesis is to examine the early vocabulary development of a sample of Swedish children in relation to parental input and early communicative skills. Three studies are situated in an overall description of early language development in children. The data analyzed in the thesis was collected within a larger project at Stockholm University (SPRINT- “Effects of enhanced parental input on young children’s vocabulary development and subsequent literacy development” [VR 2008-5094]). Data analysis was based on parental report via SECDI, the Swedish version of the MacArthur-Bates Communicative Development Inventories, and audio recordings. One study examined parental verbal interaction characteristics in three groups of children with varying vocabulary size at 18 months. The stability of vocabulary development at 18 and 24 months was investigated in a larger study, with focus on children’s vocabulary composition and grammatical abilities. The third study examined interrelations among early gestures, receptive and productive vocabulary, and grammar measured with M3L, i.e. three longest utterances, from 12 to 30 months. Overall results of the thesis highlight the importance of early language development. Variability in different characteristics in parental input is associated with variability in child vocabulary size. Children with large early vocabularies exhibit the most stability in vocabulary composition and the earliest grammatical development. Children’s vocabulary composition may reflect individual stylistic variation. Use of early gestures is associated differentially with receptive and productive vocabulary. Results of the thesis have implications for parents, child- and healthcare personnel, as well as researchers and educational practitioners. The results underscore the importance of high quality in adult-child interaction, with rich input fine-tuned to children’s developmental levels and age, together with high awareness of early language development.