Aspectos a tener en cuenta en la enseñanza del tiro:

4.3.1 Maternal psychological functioning

Previous findings of increased psychological symptoms in mothers (Berg et al., 2007; Schmidt, 2007) having an effect on child patients’

adjustment were confirmed in the current study. It is understandable that signs of distress may result from a parent’s heightened awareness and perception of their child’s vulnerability due to their diagnosis. Managing a chronic medical condition is potentially difficult and stressful for families (Whittemore et al., 2003). If psychological symptoms persist in the mother as primary carer of the patient, then there may be an increase of risk for poor adjustment in the patient in the long term.

There are three principal reasons why the psychological functioning of mothers of children with diabetes is so important. The first is that their level of adjustment is likely to affect their child’s adjustment (Crawford & Henry, 2003). A mother’s adjustment also influences the effect of diabetes on quality of life for her adolescent child (12-18 years), as confirmed here and in a previous study (Whittemore et al., 2003). It could be argued that even children and adolescents, who may not have been at risk of poor adjustment predating the condition, might become more vulnerable in the care of a mother suffering from psychological problems who is confronted by a stressor which is potentially traumatic in nature (Landolt, Vollrath, Laimbacher, Gnehmand, & Sennahauser, 2005).

Second is the effect psychological functioning may have on parenting characteristics and the subsequent parent-child relationship. These aspects were considered in the mothers of the very young patients of the current study with results showing slightly higher levels of parental protectiveness (0-8 years) and maternal separation anxiety (0-6 years). Given the correspondence between current results of the relatively poor level of maternal adjustment and poor levels on these two parenting characteristics of patient mothers, the parent-child relationship could be altered after the onset of diabetes. Some

support for this idea has been provided by previous studies of mothers of children with chronic conditions (e.g., Mullins et al., 2004; Berg et al., 2007).

A further related reason is that parenting needs to change in order to facilitate the child’s growth across developmental stages. For example, the normal expected struggles of adolescence (Ingersoll, 1989; Lewandowski & Drotar, 2007) may be expressed in conflict between mothers and their adolescents around diabetes management. Current results of both the somewhat poor adjustment of mothers and the influence of this variable on patient adjustment may be indicative of maternal stress in relation to a difficulty coping (Kelley et al., 1994) with the situational changes involved in managing diabetes. Psychological distress in mothers is likely to lead to some vulnerability in the adolescent’s normal psychological development due to the difficulty the parent may have in adapting to the changes expected to occur as the child matures.

4.3.2 Possible effects on parenting

Previous studies have demonstrated a link between maternal

psychological adjustment and collaborative involvement between mothers and young adolescents (Berg et al., 2007) and greater autonomy and reduced conflict in the mother/adolescent (13-18 years) relationship (Lewandowski & Drotar, 2007). Mothers may have more difficulty in adjusting to normal

developmental changes, leading to an exacerbation of the normal conflict that can be typical of this stage. The prediction of an effect of diabetes quality of life by adolescents’ and mothers’ adjustment at 12 months post-diagnosis indicates a link between mother/adolescent functioning and the impact of diabetes, which could be reflecting a maladaptive coping style in the relationship.

For younger children mothers may inadvertently prolong the child’s dependence on the parent. The hypothesised increase in PPS and MSAS scores from Time 1 to Time 2 (H7) was not confirmed. The mother’s difficulty in being separated from her child with diabetes and the need to protect this child did not increase over the study period. However the levels of parental

characteristics soon after diagnosis were already higher than normal and stayed above normal 12 months later. It seems reasonable to suggest that the onset of the child’s condition may have resulted in a change to the mother’s parenting with implications for the continuing development of the child in terms of delaying autonomy and individuation (Thomasgard & Metz, 1999).

The parenting characteristics of overprotective behaviour and maternal separation anxiety share similar qualities in that highly anxious mothers are reported to be enmeshed with or ‘overprotective’ of their own children, limiting their child’s growth toward independence (Hock & Schirtzinger, 1992). The stability of the current results on levels of parental protectiveness and

maternal separation anxiety over time raises a question about enduring styles of parenting. Thomasgard and Metz (1999) described the construct of parental protectiveness as a stable pattern of specific parenting behaviours variously associated with factors in the history of the parent.

Hock and colleagues (1989) explain that maternal separation anxiety is neither a trait nor a state, but a parenting disposition affecting the parent-child relationship. It could be that some parents are predisposed to separation anxiety or overprotective behaviours without them becoming problematic, until there is a precipitating circumstance such as coping with the onset of their very young child’s diabetes.

Mothers of children with diabetes must undertake medical tasks for their child frequently throughout each day, often requiring the assistance of others, including kindergarten and schoolteachers. Some mothers may have more difficulty in negotiating the daily management of their child’s diabetes in the context of their child’s activities away from home, leading to parenting issues of overprotection and separation anxiety. The mother’s worry about her child and the subsequent separation anxiety they may experience could

impact upon their child’s experience of dealing with normal events in the absence of their mother.

It is reasonable to assume that mothers may be more protective of their child when they perceive them to be more vulnerable than a child without the same condition, however the effect of the mother’s ‘extra’ concern on the parenting of her child may lead to long-term patterns of separation anxiety that impairs the normal development of the young patient. While these issues have been examined in very young children (Thomasgard & Metz, 1999; Mullins et al., 2004) it might be expected that parenting by an overprotective and