DEVELOPMENTALDEVELOPMENTALTRANSITIONSTRANSITIONS

Jill Weissberg-Benchell, Ph.D., CDEJill Weissberg-Benchell, Ph.D., CDE

DEVELOPMENTAL ISSUES FOR DEVELOPMENTAL ISSUES FOR PRESCHOOLERSPRESCHOOLERS

Learning and DiscoveringLearning and Discovering Magical Thinking and CreativityMagical Thinking and Creativity Want to have Control over their Want to have Control over their

worldworld ““NO’S”NO’S”

EMOTIONAL ISSUES THAT MAY EMOTIONAL ISSUES THAT MAY ARISE FOR PRESCHOOLERSARISE FOR PRESCHOOLERS

Emotions are not well-regulatedEmotions are not well-regulated Communication skills are still Communication skills are still

developing.developing. May develop fears around blood May develop fears around blood

sugar checks, insulin injections site sugar checks, insulin injections site changes.changes.

PARENTS AND PARENTS AND PRESCHOOLERSPRESCHOOLERS

Not allowing diabetes-specific tasks to Not allowing diabetes-specific tasks to become the primary source of attentionbecome the primary source of attention

Balancing Normative Experiences and Balancing Normative Experiences and SafetySafety

Unique challenges of finding Unique challenges of finding babysitting, specialized services and babysitting, specialized services and supportssupports

DEVELOPMENTAL ISSUES FOR DEVELOPMENTAL ISSUES FOR SCHOOL-AGE CHILDRENSCHOOL-AGE CHILDREN

Time Away From Parent Time Away From Parent SupervisionSupervision

Expanding “Known World”Expanding “Known World” Recognizing Differences Among Recognizing Differences Among

PeersPeers Issues of FairnessIssues of Fairness

EMOTIONAL ISSUES FOR EMOTIONAL ISSUES FOR SCHOOL AGE CHILDRENSCHOOL AGE CHILDREN

Roots of Self-Esteem Begin to GrowRoots of Self-Esteem Begin to Grow Pitfalls of Blame and ShamePitfalls of Blame and Shame Miscarried Helping May BeginMiscarried Helping May Begin Peer teasing may beginPeer teasing may begin

PARENTS AND PARENTS AND SCHOOL AGE CHILDRENSCHOOL AGE CHILDREN

Separating Normative Independence Goals Separating Normative Independence Goals From The Non-Normative Task of Managing From The Non-Normative Task of Managing DiabetesDiabetes

Promoting family discussions and family Promoting family discussions and family problem-solvingproblem-solving

Clarifying who is responsible for:Clarifying who is responsible for:• Monitoring suppliesMonitoring supplies• Watching the clockWatching the clock• Checking blood sugarsChecking blood sugars• Carbohydrate countingCarbohydrate counting• Taking insulinTaking insulin

DEVELOPMENTAL ISSUES FOR DEVELOPMENTAL ISSUES FOR ADOLESCENTSADOLESCENTS

Wanting to be the same as peersWanting to be the same as peers Increased problem-solving and abstract Increased problem-solving and abstract

thinking skillsthinking skills Ability to understand goals of treatment Ability to understand goals of treatment

regimenregimen Frustration that adherence doesn’t always Frustration that adherence doesn’t always

lead to improved outcomes, and poor lead to improved outcomes, and poor adherence doesn’t always lead to worse adherence doesn’t always lead to worse outcomes.outcomes.

Desire for increased independence and Desire for increased independence and responsibilityresponsibility

DEVELOPMENTAL ISSUES FOR DEVELOPMENTAL ISSUES FOR ADOLESCENTSADOLESCENTS

Increasing independence often results in Increasing independence often results in decreasing supervision.decreasing supervision.

Schedules are more erratic than younger Schedules are more erratic than younger peers.peers.

Puberty may play a role in diabetes Puberty may play a role in diabetes outcomes.outcomes.

Experimenting in Sex, Drugs, Alcohol.Experimenting in Sex, Drugs, Alcohol. Sense of invulnerability in this age group.Sense of invulnerability in this age group.

DEVELOPMENTAL ISSUES FOR DEVELOPMENTAL ISSUES FOR ADOLESCENTSADOLESCENTS

Understand Sarcasm.Understand Sarcasm. Understand – keenly aware of – Understand – keenly aware of –

HypocrisyHypocrisy Sometimes will not pay attention to the Sometimes will not pay attention to the

risks or consequences of what they dorisks or consequences of what they do

Time-Lapse Imaging Tracks Brain Maturation from ages 5 to 20

•10-year NIH fMRI study•4-21 y.o. participants•Brain continues to Change until mid 20s

EMOTIONAL ISSUES FOR EMOTIONAL ISSUES FOR TEENAGERSTEENAGERS

Pubertal changes Pubertal changes Managing moodsManaging moods Miscarried helping may lead to Miscarried helping may lead to

increased conflictincreased conflict

PARENTS AND TEENAGERSPARENTS AND TEENAGERS

Diabetes is a family diseaseDiabetes is a family disease Avoiding a blame/shame cycleAvoiding a blame/shame cycle Balancing nagging with monitoringBalancing nagging with monitoring Promoting family discussions and Promoting family discussions and

family problem-solvingfamily problem-solving

PARENTS AND TEENAGERSPARENTS AND TEENAGERS Separating normal responsibilities from Separating normal responsibilities from

diabetes-specific responsibilitiesdiabetes-specific responsibilities Encouraging success in normal tasksEncouraging success in normal tasks As with younger children, clarifying who is As with younger children, clarifying who is

responsible for:responsible for:• Monitoring suppliesMonitoring supplies• Watching the clockWatching the clock• Carbohydrate countingCarbohydrate counting• Insulin administrationInsulin administration• Blood sugar checkingBlood sugar checking

Interdependence is KeyInterdependence is Key

No one is truly independent.No one is truly independent. The hallmark of being an adult is The hallmark of being an adult is

knowing when you need help, and knowing when you need help, and asking for it.asking for it.

Normalize feelings of “burn-out” and Normalize feelings of “burn-out” and plan for them. This is not a failure.plan for them. This is not a failure.• Schedule times when responsibility is Schedule times when responsibility is

turned back to parents and then back to turned back to parents and then back to teen.teen.

SURVIVAL ADVICESURVIVAL ADVICE

Self- Care is NOT EASYSelf- Care is NOT EASY Lapses are NOT a sign of failureLapses are NOT a sign of failure

• Life can get in the wayLife can get in the way• Lapses Lapses ≠ going on strike ≠ there’s no point to ≠ going on strike ≠ there’s no point to

trying.trying.• Don’t skip appointmentsDon’t skip appointments

Set goals that are achievable.Set goals that are achievable. Everyone works/learns at a different pace.Everyone works/learns at a different pace.

SURVIVAL ADVICESURVIVAL ADVICE

Sharing ResponsibilitySharing Responsibility• Avoid Excessive Self-Care Avoid Excessive Self-Care

AutonomyAutonomy• Facilitate InterdependenceFacilitate Interdependence• Separate Knowledge from Judgment Separate Knowledge from Judgment

and Maturityand Maturity• Avoid Vicious Cycle of Miscarried Avoid Vicious Cycle of Miscarried

HelpingHelping