Journal of Pediatric Psychology, Vol. 27, No. 5, 2002, pp. 439-450
© 2002 Society of Pediatric Psychology
"Come on, Say Something, Dad!": Communication and Coping in Fathers of Diabetic Adolescents
University of Mainz
All correspondence should be sent to Inge Seiffge-Krenke, Department of Psychology, Johannes Gutenberg University of Mainz, Staudinger Weg 9, D-55099 Mainz, Germany. E-mail: seiffge{at}mail.uni-mainz.de .
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Abstract |
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Objective: To investigate fathers' coping and communication behavior in families with a healthy or a diabetic adolescent.
Method: Fathers of diabetic adolescents and healthy adolescents (N = 134) were investigated longitudinally with respect to their non-illness-specific coping behavior, their perceptions of family climate, and communicative behavior in solving a joint family task. Data were obtained through questionnaires and content analysis of recordings of verbal communication activity.
Results: Based on questionnaire data, few differences were found between diabetic and healthy adolescents' fathers' styles of coping with non-illness-specific family problems over time. However, several significant differences emerged, both with respect to the fathers' perceptions of family climate and to aspects of family communication, as observed by independent raters. The findings revealed the overall low communicative activity and initiative of diabetic adolescents' fathers, despite the diabetic adolescents' frequent efforts to involve their fathers in solving a joint task.
Conclusions: Counseling and related support services for families of chronically ill adolescents should endeavor to reinstate or increase the father's involvement in the family, thereby encouraging him to exercise his distinctive parental functions.
Key words: fathers of chronically ill adolescents; coping behavior; communication behavior; distinctive role of fathers; longitudinal study.
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Introduction |
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Developmental changes that occur in the child during adolescence require the qualities of parenting to change in terms of greater flexibility, responsiveness, and less supervisory activity (Holmbeck, Paikoff, & Brooks-Gunn, 1995
). In addition, families with a chronically ill adolescent
must achieve a balance between adapting to the illness and encouraging their
adolescent's age-typical development. In this regard, fathers assume a
distinctive role. This article explores the role that diabetic adolescents'
fathers play in this process. More specifically, the questions of if and how
fathers can help adolescents to achieve autonomy and
independence—despite their chronic illness—are addressed. Special
emphasis is devoted to examining fathers' communication and coping behavior
when confronted with everyday problems in the family.
Research in developmental psychology has shown that the father's role in
his child's development is uniquely important. Two meta-analyses conducted on
a total of 326 studies of fathers and their children
(Russell & Saebel, 1997;
Siegal, 1987) revealed that,
compared to mothers, fathers interact with their children in qualitatively
different ways. Compared to mothers, fathers' behavior was characterized by
(1) emphasizing play and leisure-time activities, especially with respect to
those demanding physical activity; (2) encouraging the child's development of
self-reliance and individuation; and (3) accentuating stereotypical gender
roles in the child. The father's distinctive role in his child's development
has been demonstrated to be of particular importance during adolescence
(Shulman & Seiffge-Krenke,
1997). Research suggests that fathers provide lasting support
during adolescents' process of becoming independent, thus helping them to
solve a most important developmental task of this age group. A great
proportion of the time adolescents spend with their fathers is devoted to
leisure and recreational activities, similar to the trends found in childhood
(Youniss & Smollar, 1985).
Compared to mothers, fathers perceive their adolescents as being more
independent, express more support, and show more interest in their children's
suggestions (Hauser et al.,
1986). Fathers consider their 12-year-old children to be as
independent and self-reliant as mothers of 16-year-olds do
(Shulman & Seiffge-Krenke,
1997). Fathers' behaviors also reveal a greater sensitivity to the
physical changes that their offspring undergo
(Salt, 1991). The distinct
emphasis that fathers place on sports and leisure-time activities, their
focusing on the child's body, and their support for the child's independence
thus continue to be important during adolescence and are particularly
important for those adolescents who suffer from chronic physical illness. Yet
more research is necessary to explore whether fathers of chronically ill
adolescents do indeed assume these important functions and to identify
contributions they make toward helping their child achieve independence and
cope with everyday problems, despite the illness.
In this article, findings are presented from a study in which families with
a diabetic adolescent were compared with families with a healthy adolescent.
Type 1 diabetes is the most frequently occurring endocrine disorder for
children and adolescents, with a prevalence of 1.8 in 1,000 individuals from
birth to age 20 (Hauser, Jacobson, Benes,
& Anderson, 1997). Compared to other chronic illnesses, such
as cancer or juvenile arthritis, diabetes does not result in serious physical
handicaps or outwardly manifest stigmata. Yet successful management of type 1
diabetes requires the patient to adhere to a structured regimen involving a
series of complex activities (daily injections, blood and urine testing, diet,
physical exercise), most of which can be carried out independently by the age
of 12 years. Diabetic children's mothers typically show far more involvement
in the supervision of the illness management than fathers do
(Kovacs et al., 1990;
Hauser et al., 1997).
According to Seiffge-Krenke
(2001), only between 4% and 7%
of mothers report receiving support from their husbands in caring for the
diabetic adolescent. Fathers are also usually less informed about their
child's illness (Hanson, Henggeler,
Harris, Burghen, & Moore, 1989) and also report less distress
than mothers (Quittner et al.,
1998).
Research has shown that a family climate that is particularly conducive to
promoting good medical adjustment to diabetes is not only marked by a high
degree of cohesion, flexibility, and organization but also emphasizes personal
growth and the pursuit of leisure-time activities
(Hanson, DeGuire, Schinkel, Henggeler,
& Burghen, 1992; Sargent,
1985; Wolman, Resnick, Harris,
& Blum, 1994). A family climate that is supportive yet able to
grant freedom is equally important for ensuring age-appropriate development
during adolescence (Holmbeck et al.,
1995). While the conditions that promote an optimal development in
adolescence are essentially the same for healthy and diabetic adolescents, one
can assume that these conditions are considerably more difficult to establish
in families with a diabetic adolescent
(Wysocki, 1993). Findings
obtained in studies of family functioning and attainment of developmental
tasks in families with a healthy or diabetic adolescent indeed suggest that
the highly structured and controlled family climate observed in families with
diabetic adolescents (Seiffge-Krenke,
1998b) is detrimental to other aspects of adolescent development,
such as achieving autonomy or developing close relationships with friends and
romantic partners (Seiffge-Krenke,
1998a).
Little is known about how fathers deal with the diverging challenges introduced by having a chronically ill adolescent, especially in the case of diabetes, where illness-specific and adolescence-specific challenges may be diametrically opposed. Do fathers of chronically ill adolescents continue to support —as those in families with healthy children do—their child's individuation and autonomy-achieving processes? Are they able to assume the father-typical functions of encouraging leisure-time activities? Do they accentuate their child's gender, a distinctive function of fathers, as frequently demonstrated in the literature?
In studies of pediatric patient populations, little attention has been
devoted to fathers. In a study of parents of children with cancer, Cook
(1984) identified a variety of
typical problems, for example, the father's simultaneous responsibilities to
the family and income-generating work, the father's exclusion from the family,
and the mother's overinvolvement with the ill child. Studies on coping
behaviors have typically focused exclusively on how mothers or the individual
patients cope with the illness (Cole &
Reiss, 1993), thereby neglecting the father's role as a model in
dealing with illness or non-illness-related problems in the family. Studies
comparing how mothers and fathers cope with their child's illness have been
commonly based on the assumptions that fathers can or should perform similar
functions of caring and coping, as mothers do, and that their inability to do
so may be considered as being inadequate or deficient
(Eiser, Havermans, Kirby, Eiser, &
Pancer, 1993). No study to date has investigated how fathers
actually behave with respect to solving non-illness-specific family problems
and encouraging leisure activities. This is a significant yet unfortunately
neglected issue; although the illness is one salient aspect of an ill
adolescent's life, it is not necessarily the most important. This is
particularly true for the diabetic adolescent, who, given good illness
management, may attend school regularly and pursue leisure activities. Thus,
the questions of how fathers try to cope and how they communicate with their
children in solving general, non-illness-related problems are important.
Fathers' coping behaviors in solving non-illness-related family problems may
serve as a model for their children's own efforts to competently and
independently solve age-typical challenges. Furthermore, fathers'
communication behavior might indicate how they support their children's
independence. In one of the rare studies in this field, Hauser et al.
(1986) found that compared to
healthy adolescents' fathers, diabetics' fathers communication behavior was
more constraining (e.g., judgmental, indifferent, devaluing). Case studies
have shown that in some two-parent families with a diabetic adolescent, an
overly close, dependent-symbiotic relationship develops between the ill child
and the mother (Seiffge-Krenke,
1997). This may suggest that diabetic adolescents' fathers do not
nurture the development of their child's independence in the same manner as
healthy adolescents' fathers do.
Taken together, research findings seem to suggest that diabetic adolescents' fathers do not fulfill the distinctive function of promoting their child's independence. Yet not enough research has been carried out on this topic. In addition, little attention has been devoted to topics that may be important for the developing adolescent, for example, how fathers deal with other, non-illness-specific problems that might arise in the family. This article explores the role that diabetic adolescents' fathers play in the process of promoting their child's independence; special emphasis is devoted to examining communication and coping behaviors of fathers in dealing with everyday problems and activities in the family. I expected diabetic adolescents' fathers would be less active and less involved in coping with non-illness-specific family problems, compared to healthy adolescents' fathers. Furthermore, I hypothesized that diabetic adolescents' fathers would contribute less to the family communication than healthy adolescents' fathers would, and, more specifically, that they would not support the adolescent's independence when negotiating a joint family task. Whereas healthy adolescents' fathers discriminate strongly between sons and daughters in their coping and communication behaviors, I expected that diabetic adolescents' fathers would not focus as much on their child's gender. Because father's behaviors depend on the overall family climate, their perceptions of the possibilities for independence granted to each family member were also assessed.
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Method |
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Sample
The data presented here on 134 fathers of diabetic and healthy, non-diabetic adolescents were obtained in a 4-year longitudinal study of families with healthy and diabetic adolescents. The sample of diabetic adolescents was recruited from diabetic treatment centers and clinics; healthy adolescents and their families were recruited from schools. The diabetic sample was recruited first; parallel sub-samples of healthy adolescents and their families were then recruited to match the diabetic sample according to essential comparative characteristics of age, sex, and socioeconomic class, marital status of the parents, and nationality (for details, see Seiffge-Krenke, 2001
). The
dropout rate for families for the entire investigation was low (families with
a diabetic adolescent: 17%, families with a healthy adolescent: 13%) and not
selective. Complete data sets were obtained from 91 diabetic adolescents (45
females and 46 males), 107 healthy adolescents (55 females and 52 males), and
their 306 parents (91 mothers of healthy adolescents, 81 mothers of diabetic
adolescents, 76 fathers of healthy adolescents, and 58 fathers of diabetic
adolescents).
Table I summarizes the
demographic characteristics of the samples of families with a healthy or
diabetic adolescent. Most of the adolescents were being raised in two-parent
families. Most of the fathers were employed. More than half of the diabetic
adolescents' mothers were unemployed, but only a third of the healthy
adolescents' mothers were unemployed (
2 = 6.192; df =
2, p =.045). In the following, I report results on the 134 fathers of
two-parent families. There were no differences between the diabetic and
healthy adolescents' fathers with respect to age, marital status, number of
children in the family, employment status, level of schooling, or nationality.
At the beginning of the study, over 90% of the diabetic adolescents (mean age
13.9 years, SD = 1.2; average duration of affliction with diabetes
5.4 years) performed their own insulin injections and were responsible for
observing their diet and conducting blood and urine checks. The diabetic
adolescents' medical adaptation was assessed by the HbA1-value,
which reflects the average state of a diabetic patient's metabolic control
over the preceding 4 to 8 weeks. Seventy-three percent of the sample obtained
good to satisfactory metabolic control (HbA1-values from less than
7.6 to 9.5), and 27% of the sample had poor metabolic control
(HbA1-values > 9.5).
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Measures
Fathers' coping behaviors were measured with the F-Copes
(McCubbin & Patterson,
1982), which assesses the manner in which families react to
family-related problems and crises according to 29 items belonging to one of
five scales. The fathers had to indicate to which extent a certain coping
strategy best matched their own behavior, based on a 5-point scale (from 1 =
"doesn't apply" to 5 = "fully applies"). Scale 1
(acquiring social support) included items pertaining to the active searching
for social support among relatives, friends, or neighbors and the willingness
to accept this support (sample item: "We share family problems with
relatives"). Scale 2 (reframing) contained items relating to the
cognitive efforts to redefine stressful events in such a way that they might
be better managed and coped with (sample item: "We accept stress as a
part of our lives"). Scale 3 (seeking spiritual support) included items
related to the search for help and support in church-related or other
religious institutions or organizations (sample item: "We seek advice
from our priest/pastor"). In Scale 4 (mobilizing the family to acquire
and accept help), items describing attempts to obtain help or seek distraction
through social interaction, for example, by joining in outings with relatives,
were consolidated with strategies of consulting professionals (sample item:
"We ask our neighbors for help and support"). Finally, scale 5
(passive appraisal) included strategies related to attempts to deny or repress
the problem as well as other passive strategies, such as watching television.
These strategies represented a lack of initiative to actively deal with the
problem (sample item: "We trust that the problems will solve themselves
if we wait long enough"). Internal consistencies for the scales ranged
between 
=.62 and.87.
Fathers' perceptions of family climate were assessed via the Family
Environment Scale (FES) (Moos & Moos,
1981), which measures how the family climate is perceived
according to the following scales: (1) cohesion, (2) expression, (3) conflict,
(4) independence, (5) achievement-orientation, (6) intellectual-cultural
orientation, (7) orientation to leisure-time activities, (8) moral-religious
orientation, (9) organization, and (10) control. The 10 scales can be
consolidated into three general dimensions, namely, interpersonal
relationships (scales 1 to 3; sample item: "There is a kind of
togetherness in our family"); personal growth (scales 4 to 8, sample
item: "Our family encourages independence"); and system
maintenance (scales 9 and 10, sample item: "In our family it is very
important to follow certain rules"). In this study, the fathers'
perceptions of the family climate as measured according to the three general
dimensions were analyzed. Internal consistencies for the 10 scales ranged from
=.72 to.85.
Fathers' communication behavior was evaluated by the Family Interaction
Task (FIT) (Gotevant & Cooper, 1985). Families are requested to plan a
3-week vacation together, for which unlimited funds are at their disposal. The
task is designed to elicit active participation from all family members and to
provide an opportunity to assess the adolescent's contribution to the family's
decision. Each family must solve the task independently (the interviewer is
not present) within a time period of 20 minutes or less. Results of
evaluations of the FIT with respect to the balance of individuality and
connectedness for the participating families have been reported elsewhere
(Fentner & Seiffge-Krenke,
1997). Findings relating to specific aspects of communicative
behavior of diabetic and healthy adolescents' fathers are presented here.
Transcriptions of the family conversations were made according to the
procedures outlined by Condon, Cooper, and Grotevant
(1984). Before the transcripts
were coded, each conversational contribution was divided into units, or
"chunks." A chunk is defined as an independent clause together
with any dependent clauses connected to it (e.g., Father: "Why should I
be planning something?," Christian: "Man, you have no fantasy at
all. You're so uncreative!"). Based on the transcripts of the families'
discussions, 19 independent communication strategies were determined. The
following seven categories pertained to fathers' communicative behavior in
direct response to their child's suggestions for solving the family task: (1)
responds to adolescent's request (e.g., "We could do that, but we might
have to worry about immunizations"); (2) replies to adolescent and ask
questions (e.g., "And what would you like to do in America?"); (3)
refers to financial limitations (e.g., "That could get
expensive!"); (4) interrupts adolescent (direct interruption while
adolescent is speaking); (5) agrees with adolescent (e.g., "Good idea!
We'll go to San Diego!"); (6) disagrees with adolescent (e.g., "Oh
no, not Italy again!"); and (7) encourages adolescent to assert
himself/herself (e.g., "And you, where would you like to go?"). In
addition, the fathers' own communicative contributions to solve the family
task could be assigned to one of the following nine categories: (1) makes
suggestions for solving task (e.g., "Let's go to Australia"); (2)
develops own contributions (e.g., "Then we could travel from Sydney by
car. No, even better would be to go with a mobile home. That would be
great!"); (3) explains reason for contribution (e.g., "No, I don't
want to stay in hotels anymore; it's so cramped there!"); (4) repeats
relevant suggestions for solving task (e.g., "So, I think we should go
to Sydney"); (5) voices opinion (e.g., "I think that if we have so
much money to use, we should do something special"); (6) names
alternative suggestions for solving task (e.g., "Either we go to Sydney
or we go skiing"); (7) makes an undifferentiated suggestion for solving
task (e.g., "I would sure like to travel again"); (8) repeats
undifferentiated suggestions for solving task; and (9) makes irrelevant
suggestions for solving task ("With all that money we could buy a
house!"). Finally, three different strategies that the fathers used in
order to moderate the family conversation were found: (1) summary of
contribution(s) (e.g., "Okay, you want to go to San Diego in the first
week, and you'd prefer to go to the mountains"); (2) clarifies
conditions of task with respect to money (e.g., "You heard that money
doesn't matter!"); (3) qualifies nature of the task (e.g.,
"Remember that we all together have to plan a three-week
vacation"). Two independent raters evaluated the fathers' communication
strategies; the coders were blind to the research questions and the
adolescents' health status. Mean kappas for the seven categories of
fathers' direct responses to their child's suggestions, the fathers' nine own
communicative contributions, and the three categories describing fathers'
attempts to moderate the family communication amounted to.78,.80, and.76,
respectively.
Procedure
The fathers were requested to complete the F-copes and the FES. Then, each
family was requested to carry out a joint task. Whereas the questionnaires
were to be completed each year, the FIT was carried out only twice, at Time 1
and Time 3, in order to avoid memory effects. In the following, results are
presented on fathers' coping and their perceptions of family climate, measured
over 4 consecutive years, and fathers' communication behavior, measured by the
FIT at Time 1.
Statistical Analyses
To analyze the effects of the adolescent's health status (diabetic/
healthy), adolescent gender, and time on fathers' coping behavior and their
perceptions of family climate, 2 (Child's Health Status) x 2 (Child's
Gender) x 4 (Time) MANOVAs were conducted on the data sets of the
F-Copes and the FES, followed by post-hoc comparisons. Next, the FIT
discussions were transcribed, and broken down into chunks (as defined above).
The mean number of chunks amounted to M = 145.55 (SD =
79.79) in families with a healthy adolescent and M = 125.15
(SD = 80.08) for families with a diabetic adolescent (T =
2.13, p =.033). In order to standardize length of communication, only
the first 100 chunks were coded for each family. Two independent, trained
raters coded the chunks according to the 19 categories; interrater reliability
was determined (see above). Finally, differences in the fathers' communicative
behavior, depending on the health status and gender of their child, were
determined via two-factor ANOVAs for the 19 communication categories. Maternal
employment status was used as a covariate in all analyses.
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Results |
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Fathers' Coping With General Family Problems
Table II presents the means and standard deviations for fathers' coping with general family problems. For acquiring social support, three-factor MANOVAs revealed a significant main effect only for time, F(3, 399) = 10,231, p <.0001; over the course of 4 years, all of the fathers increasingly sought social support among friends and relatives (t1 < t2, t3, t4; p =.04,.001, and.001, respectively; t2 < t3; p =.032). With respect to the reframing coping dimension, an interaction effect of time and health status emerged, F(3, 399) = 3,312, p =.020. Post hoc comparisons revealed that healthy adolescents' fathers tended to show less reframing from the time of the first measurement to the third measurement (t1 > t3, p =.03), whereas diabetic adolescents' fathers used reframing increasingly more often during this time (t1 < t3, p =.04). The fathers' attempts to mobilize the family to seek social support changed significantly over time, F(3, 399) = 4,339, p =.005; all of the fathers became more active in mobilizing their families over time (t1 < t3, p =.01). Taken together, the analyses of fathers' coping behavior showed that although the fathers became more active in some dimensions over time, this was not dependent on their child's health status or gender. Only diabetic adolescents' fathers used the reframing of problems more often over time.
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The Fathers' Perspectives of Family Relationships
Means and standard deviations for fathers' perceptions of family climate,
based on the three dimensions of the FES, are detailed in
Table II. Three-factor MANOVAs
revealed a main effect of time for the interpersonal relationships dimension,
F(3, 396) = 18,091, p =.0009; a main effect of adolescent
gender, F(1,132) = 5,541, p =.020; a significant interaction
effect of time and adolescent gender, F(3,396) = 3,920, p
=.009; and a significant threeway interaction effect of time, adolescent
gender, and health status, F(3,396) = 3,050, p =.029. From
the fathers' perspectives, the quality of interpersonal relationships in the
family deteriorated over time (t1 > t2, t3,
t4; p =.001,.001,.001, and.001, respectively). In general,
fathers with daughters perceived their family relationships to be better than
fathers with sons did (p =.02). Post hoc tests further revealed that
compared to the other three groups, the fathers of healthy sons perceived the
strongest decrease in the quality of family relationships over time
(p =.03; see Figure
1). Altogether, the results show that the interpersonal
relationships in the family—despite a general decrease in perceived
quality—remained at a higher level in families with daughters, compared
to families with sons.
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For the personal growth dimension, significant main effects were found for time, F(3, 396) = 3,193, p =.024, and health status, F(1, 132) = 7,682, p =.006. The possibility for personal growth in the family was perceived by all of the fathers as decreasing (t2, t3 < t1, p =.012 and.028, respectively). Healthy adolescents' fathers, however, reported higher scores for personal growth than diabetic adolescents' fathers did at all times (p =.006). For system maintenance, a significant main effect was found for health status, F(1, 132) = 7,025, p =.009. Diabetic adolescents' fathers perceived the family climate to be more structured than healthy adolescents' fathers did (p =.008).
Fathers' Communicative Behavior
Based on a content sample of 100 chunks, significant differences between
healthy adolescents' and diabetic adolescents' fathers were found for 12 of
the 19 analyzed communication strategies.
As illustrated in Table III, the healthy adolescents' fathers were clearly inclined to moderate the family discussion in that they involved all the conversational partners and repeatedly clarified the nature of the task. In addition, they dealt more actively with their child's contributions and ideas. The healthy adolescents' fathers explored the adolescents' contributions and agreed with their ideas most frequently. They also interrupted the adolescents or vehemently contested their suggestions, although this occurred less frequently than agreeing, encouraging, and replying to the adolescent. In contrast, the contributions of the diabetic adolescents' fathers to their family discussions were less energetic and goal-oriented. In particular, these fathers made fewer of their own suggestions for solving the task, developed fewer of their own contributions, and named fewer alternative suggestions for a joint solution. In addition, they responded less frequently to their children's requests, agreed with them less often, but also interrupted them less frequently, compared to healthy adolescents' fathers. Furthermore, they made fewer efforts to clarify the task and to summarize the discussion process that had been developed thus far.
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Main effects of gender were found in 7 of the 19 communication categories. In general, compared to fathers of daughters, fathers of sons showed more initiative and activity with respect to the goal of solving the joint family task. More specifically, fathers of sons replied more frequently to their child's contributions, asked more questions related to the task, and clarified the nature of the task more frequently. They were also more active in introducing and asserting their own ideas. In addition, fathers encouraged their sons to assert themselves more frequently than they did with daughters. Two interaction effects of health status x gender showed that fathers of healthy sons interrupted and disagreed with their sons more frequently than fathers of diabetic sons did, whereas fathers of daughters did not show any differences in their communication with their daughters in the task with respect to their child's health status.
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Discussion |
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This study explores how fathers of diabetic and fathers of healthy, nondiabetic adolescents cope with and communicate about non-illness-specific family problems. An important finding of this study was that diabetic adolescents' fathers, in contrast to healthy adolescents' fathers, assumed a less active role in encouraging the adolescent's individuation process by supporting the adolescent's independence in family discussions.
Similar to healthy adolescents' fathers, however, they seem to provide a
good model for their children for coping with non-illness-related family
issues. Over time, all of the fathers showed significant increases in two
scales of the F-Copes that pertained to the seeking of social support and the
mobilization of the family to obtain help in cases of family problems. This
increase in coping efforts was evident irrespective of the adolescent's health
status or gender and suggests that, as the adolescents became older, their
fathers were increasingly able to provide a good coping model for their
children in dealing with non-illness-related family problems. Although the
diabetic adolescents fathers' were indeed less involved in the management of
their child's illness, as found in an earlier study on this sample
(Seiffge-Krenke, 2001), they
showed just as much involvement in general family matters as healthy
adolescents' fathers did.
This positive and favorable finding was, however, corrected by the results
of evaluations of the family communication task. An earlier study on family
communication processes (Fentner &
Seiffge-Krenke, 1997) showed that the diabetic adolescents and
their mothers dominated the communicative interaction, whereas the fathers
assumed a distant and inactive position, despite the attempts of their
children to involve their fathers in the discussion. The results of this
analysis clearly showed that the diabetic adolescents' fathers' contributions
to the conversation were not only few in number but markedly vague and
generalized. These fathers made significantly fewer suggestions and
articulated fewer opinions, compared to healthy adolescents' fathers. Given
their overall low communicative activity and initiative, they not only
contributed fewer of their own ideas to solving the family task but also did
not support the adolescents' initiatives. In addition, due to their low
discussion-moderating activity, they did little to advance the process of
solving the joint task. In contrast, the healthy adolescents' fathers
exhibited a very active role in the family communication. They moderated the
family discussion by involving all of the conversational partners, by
repeatedly clarifying the nature of the task, and by commenting on the
negotiating process. In addition, they dealt more actively with their child's
contributions and ideas while at the same time bringing in their own
contributions. Healthy adolescents' fathers offered both praise and criticism,
yet precisely and clearly made their wishes known to the others. As such, the
healthy adolescents' fathers reinforced the parental function of supporting
their child's development of independence directly by supporting and
negotiating with their child, but also indirectly by clarifying what they
would suggest as a solution. In contrast, based on the observations of
communication in families with a diabetic adolescent, it became apparent how
passive the fathers were and how difficult it was for them to promote their
child's independence, for example, by supporting and attaching worth to their
child's contribution to solving the family task.
These findings should be evaluated according to the context of the fathers'
perceptions of family climate. In this study, the diabetic adolescents'
fathers perceived the family climate as being less favorable for encouraging
independence and as showing a low orientation to leisure-time activities,
which resulted in significantly lower scores in personal growth in their
families, compared to families with a healthy adolescent. Because the majority
of the diabetic adolescents had shown satisfactory to good medical adaptation
to the illness and carried out the management of the illness very
independently (Seiffge-Krenke,
2001), it would not only have been very desirable but also
appropriate for the fathers to show greater initiative in exercising their
normal parental role of supporting independence and encouraging recreational
activities.
Noteworthy, too, were the differences in family climate and communication
behavior depending on the child's gender, an issue about which Russell and
Saebel (1997) have elaborated
in their thesis of parental reinforcement of child gender. In the present
study, fathers of daughters reported overall more positive emotional and
interpersonal relationships in the family. In addition, fathers of sons were
more active with own contributions and ideas for solving a joing task, but
also showed more support for their sons' ideas, compared to their daughters'.
Significant interactions of health status and gender further showed that
interruption and disagreement was particularly polarized in families with
sons, such that fathers of healthy sons demonstrated more aggressive behavior
in their communicative interactions with their sons than fathers of diabetic
sons did.
This study further illustrates the reinforcement of the father's
"breadwinner-function" (Gyolay,
1978) in families with a diabetic adolescent. In this study,
significantly fewer diabetic adolescents' mothers than healthy adolescents'
mothers were employed. This illustrates that in the families with a diabetic
adolescent, the mothers' and fathers' roles had become more traditionally
defined; that is, the father generated income, and the mother assumed the
responsibility for managing the day-to-day care of the family and the
household. Finally, these findings converge with results of earlier studies,
particularly with respect to the shorter duration of discussions observed in
families with a diabetic child, compared to families with a healthy child
(Carlson et al., 1993) and to the more indifferent communication behaviors
displayed by diabetic adolescents' fathers
(Hauser et al., 1986). In
addition, other investigators employing the FIT have found that healthy
adolescents' fathers express more relevant comments, request more actions, and
provide answers in response to requests for actions
(Grotevant & Cooper,
1985).
Future analyses are needed to determine whether the communication behavior exhibited by 14-year-old diabetic adolescents' fathers prevailed over time and, as such, whether such behavior continued to have a developmentally inhibiting effect. Furthermore, future analyses of changes in mothers' and fathers' communication behaviors as well as the influence of their parenting behaviors on the adolescents' outcome with respect to both medical and psychological adaptation are necessary. This study lends support to the notion that fathers with a diabetic adolescent, even those who report adaptive family functioning and good to moderate metabolic adaptation in their children, may require assistance in developing a repertoire of coping and communication skills for dealing with non-illness-specific problems at home. Counselors and health care professionals must explore to what extent a family with a chronically ill child or adolescent can achieve the goal of promoting father involvement. This should not only be encouraged so that the mother is less burdened but so that more attention is devoted to fostering the special and unique contribution that fathers usually make in families with healthy children and adolescents. Some families with a diabetic adolescent may not understand the importance of father involvement in dealing with non-illness-related family matters and may focus too much on issues related to his involvement in the illness management. The father's activity must, of course, take into account the extent of limitations introduced by the illness. Yet it should become apparent to all that in addition to the illness, the father can and should exercise his distinctive role in promoting the development of his children and thus contribute to improving their medical adaptation as well.
Received January 26, 2001; revision received July 10, 2001; accepted November 29, 2001
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