Reducing and Preventing Internalizing and Externalizing Behavior Problems in Children With Type 1 Diabetes: A Randomized Controlled Trial of the Triple P-Positive Parenting Program

Pediatr Diabetes. 2015 Nov;16(7):554-63. doi: 10.1111/pedi.12205. Epub 2014 Aug 29.


Background: Children with type 1 diabetes are at increased risk of mental health problems, which in turn are associated with poor glycemic control, diabetes-related complications, and long-term psychiatric morbidity. We tested the efficacy of the Triple P-Positive Parenting Program in reducing or preventing mental health problems and improving glycemic control in children with type 1 diabetes in a randomized controlled trial.

Methods: Participants were recruited from the Diabetes Clinic, Royal Children's Hospital, Melbourne, Australia, and randomized to Triple P or standard diabetes care. The primary outcome was child internalizing and externalizing behavior problems 3 and 12 months postrandomization. Secondary outcomes were glycemic control, parent mental health, parenting skills, and family functioning at 3 and 12 months, and glycemic control at 24 months.

Results: A total of 76 participants were randomized (38 to intervention and 38 to control), 60 completed 3-month, and 57 completed 12-month assessments. Benefits of Triple P were evident at 3 months for parent mental health, parenting skills, and family functioning (p < 0.05), but not for child mental health or glycemic control, with little effect at 12 months. Prespecified subgroup analyses for children with pre-existing internalizing or externalizing behavior problems indicated greater improvements in child mental health, parent mental health, parenting skills, and diabetes family conflict (p < 0.05), but lower parenting self-efficacy at 3 months. Improvements in parent mental health and parenting competency associated with Triple P were sustained to 12 months for children with pre-existing mental health problems.

Conclusions: This study provides some support for the efficacy of Triple P in improving parent and family outcomes, and reducing child internalizing and externalizing behavior problems primarily in children who have pre-existing mental health problems.

Keywords: child behavior; parent mental health; parenting; type 1 diabetes.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Child
  • Child Behavior / psychology*
  • Child Behavior Disorders / prevention & control*
  • Child Behavior Disorders / psychology
  • Diabetes Mellitus, Type 1 / blood
  • Diabetes Mellitus, Type 1 / complications
  • Diabetes Mellitus, Type 1 / psychology
  • Diabetes Mellitus, Type 1 / therapy*
  • Education, Nonprofessional
  • Family Relations / psychology
  • Female
  • Follow-Up Studies
  • Health Knowledge, Attitudes, Practice
  • Hospitals, Pediatric
  • Humans
  • Hyperglycemia / prevention & control*
  • Hypoglycemia / prevention & control*
  • Male
  • Outpatient Clinics, Hospital
  • Parenting / psychology*
  • Patient Dropouts
  • Psychiatric Status Rating Scales
  • Psychology, Child / education*
  • Psychology, Child / methods
  • Self Efficacy
  • Victoria