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Communication


Communicating Effectively with Your Child or Teen

Michael Watts, MSW, RSW
Medical Social Worker: (formerly at) Diabetes and Endocrine Clinics, Alberta Children's Hospital
Assistant Professor: Mount Royal University


In my (then) role as the Medical Social Worker in the diabetes clinic at the Alberta Children’s Hospital, I routinely met with parents to offer emotional support, and to share information and strategies around enhancing, or re-establishing, their ability to parent their children who live with the condition.

Given the myriad responsibilities and worries related to caring for a child with Type 1 Diabetes (all of which can interfere with effective parenting), it’s rational to see why a parent may approach a professional for a “tune up” in parenting skills.

In my time at the diabetes clinic I was afforded the opportunity to interact with parents in clinical sessions and to hear, from their perspective, the daily challenges and stressors they experienced while parenting a child with a chronic illness.

Based on the “education” I have received from parents, I developed a workshop which explores areas to consider while parenting a child with Type 1 diabetes. When I suggest the phrase “areas to consider”, I’m referring to parenting skills that parents once applied, but that they have more recently found it a challenge to apply, due to issues such as:

1.  developmental/transition issues related to the child; 
2.  general stress and frustration; 
3.  parents’ lack of energy; 
4.  ineffective communication between parent and child.


For this article I will focus on one of the more important points to consider: communication.

Communication

communicating about type 1 diabetes



It is well documented in the diabetes literature the importance of communication amongst family members in a family impacted by Type 1 Diabetes. Given the general mental health risks (such as depression and anxiety) for a child living with a chronic illness, it is important the child be afforded an environment in which he feels safe while communicating with other family members.  One way to create this safe environment is to strive to “talk with”, rather than “at” your child.


  

“Talking with” versus “Talking at”

For the purposes of this article, “talking at” a child includes the following: 
    1. not allowing him to tell his side of a story upon being held accountable for something; 
    2. telling a child what she needs to do without providing a context or rationale; or 
    3. dismissing a child’s thoughts, beliefs and/or perceptions about an issue as invalid, then abruptly ending the conversation.
  
Conversely, “talking with” a child includes the following: 
    1. asking for clarification while holding a child accountable for an issue; 
    2. providing an age-appropriate, clear, warm and supportive context and rationale for a child while giving direction for something that needs to be followed through with; 
    3. validating and, if applicable, normalizing a child’s thoughts, beliefs, and/or perceptions about an issue; 
    4. asking open-ended questions to encourage further discussion. 

 
For example, if your child consistently fails to complete blood glucose checks, “talking at” may sound something like this: “I’ve told you a million times to check your sugar before lunch! It doesn’t matter if the other kids think it’s weird- you still have to do it. Now go upstairs and start your homework!”  Alternatively, “talking with” may sound like this: “What got in the way of you testing your sugars at lunch today?  I understand caring for your condition at school makes you uncomfortable.  What can we do to support you?”

I have worked with several parents who are at their wits end when it comes to working with their child or adolescent on diabetes self care.  In some cases, the parents are working harder at their child’s diabetes than the child is willing to work. This dynamic, from my experiences, eventually frustrates the parent and subtly alienates the child from the parent.  Parents who have tried (unsuccessfully) every strategy in their parenting toolbox are at risk of allowing “talking at” their child to dominate their conversations, instead of “talking with” their child.

Sometimes parents feel that the only way to get through to their child is by using what I like to call “threats motivated by love”. I once worked with a parent who disclosed to me she once ended a conversation with her child by saying: “Your gonna go blind and have your feet cut off!” I should note that after meeting with the parent for several sessions, it was clear she loved and cared for her child. It was also clear this parent was frustrated.  This parent allowed the “talking at” monster to dominate the conversations she had with her child.

As part of my clinical work with the parent, I encouraged her to do the following:

    • To Identify the general instances in which she talks at her child: this process provided opportunity for the parent to gain a clear understanding of what triggers her to “talk at” her child (e.g. time of day, other priorities to tend to, etc).
    • To journal her beliefs around what gets in the way of her “talking with” versus “talking at” her child: this process provided opportunity for the parent to identify tangible issues which interfere with her ability to “talk with” her child (e.g. mood, lack of time, lack of patience, need to enhance communication skills, etc).
    • To imagine what the outcomes of subsequent conversations with her child might look like if she were to adopt more of a “talking with” style: After experiencing some success while practicing this strategy the parent commented that she was motivated to continue the process of setting expectations for herself around “talking with” her child more often than she “talks at” her child especially around diabetes self-care tasks.  

After engaging in the homework I offered the parent, and with some additional personal self-reflection, the parent was able to see how “talking with” her child (especially in conversations related to diabetes self-care) could make subsequent conversations with her child more pleasant and more effective. By changing her communication habits with her daughter, she was able to accomplish her goal of having her child participate in her own diabetes self-care without experiencing the unnecessary stress related to being talked at.

   

When parents “talk at” their child when they are frustrated, they put themselves at risk of ‘uttering threats motivated by love’, similar to the threat the parent verbalized to her child above.  If you believe you “talk at” your child more often than you “talk with”, especially around diabetes self care, I encourage you to address this by asking yourself the following questions:

communicating ineffectively about type 1 diabetes

    • What gets in the way of me “talking with” my child? (e.g. frustration or grief related to my child living with diabetes, general frustration with my child, lack of patience, need to enhance my communication or problem solving skills, etc)
    • Does my “talking at” behavior interfere with my relationship with my child? (e.g. does your child avoid you or ignore your cues to engage in self-care when you “talk at”?)
    • What might conversations with my child look like if I were to “talk with” him more often than I “talk at”? 
    • Would it help to speak with a professional about how I talk with my child?

 
The next step is to make a plan to minimize the numbers of times you “talk at” your child. An effective plan will include concrete examples of what you (not your child) will do differently to remove those things that “get in the way”. Your plan may include a commitment to replace directions (“You need to do xyz!”) with questions (“What stops you from doing xyz?”). Your plan may involve postponing discussions with your child until after supper, when there are fewer demands competing for your time. Your plan may involve talking with a good friend, joining a parent support group, or seeing a professional to process your feelings of anxiety or grief.

communicating effectively about type 1 diabetes

When parents “talk with” their children they build relational trust and respect. At the same time, the child’s self concept and overall confidence in communicating with adults is enhanced.  Furthermore, when parents “talk with” their children, there is more opportunity to provide your child with normalization (e.g. ‘its normal to feel frustrated when you have to test your blood sugars at lunch time) and validation (e.g. I understand why you forgot to test your blood sugars at lunch, let’s make a plan to help you remember to test at lunch). Validation, in particular, is needed by children to help them navigate the day-to-day rigors of dealing with a chronic illness. 

As a parent, I understand there are certainly instances in which we need to “talk at” our children. If far too many cues have been offered to a child and the child has not followed through with an expectation, a parent may need to get more directive. Also, when you need to give specific instructions to preserve the safety of a child, “talking at” would be appropriate. For example, if I’m playing baseball with my son and he does not realize the ball is going to hit him, I won’t “talk with” him and say “Son, you may want to get out of the way because the ball is going to hit you in the head in 1.5 seconds”; I will “talk at” him and say, “Duck, Son!”).

I hope that this article has helped illustrate the multiple relational benefits associated with “talking with” your child.  If you believe the “talking at” style of communication dominates conversations with your child, I encourage you to seek proper support around managing the issue: speak with your local diabetes clinic’s psychosocial team to obtain support on an as-needed basis.  It is important for parents who care for a child to feel supported and to know they do not have to figure things out on their own.

For more information on parenting, see my next article on the Stages of Change model and its relevance in parenting older children and adolescents who live with Type 1 diabetes.
  

In addition to being a Medical Social Worker, Michael is also an Assistant Professor (part time) at Mount Royal University, within the Department of Child and Youth Studies.



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The above information was reviewed for content accuracy by clinical staff of the Alberta Children’s Hospital Diabetes Clinic.

This material has been developed from sources that we believe are accurate, however, as the field of medicine (in particular as it applies to diabetes) is rapidly evolving, the information should not be relied upon, as it is designed for informational purposes only. It should not be used in place of medical advice, instruction and/or treatment. If you have specific questions, please consult your doctor or appropriate health care professional.


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