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This study was design to determine the efficacy of intensive individual play therapy as a method of intervention for children diagnosed with insulin-dependent diabetes mellitus. The purpose of this study was designed to study the effectiveness of an intensive play therapy intervention in: a) reducing symptoms of childhood depression in children with IDDM; b) reducing symptoms of anxiety in children with IDDM; c) reducing the overall behavior difficulties in children with IDDM; d) increasing healthy adjustment in children with IDDM; e) increasing diabetic's children's adherence to their diabetic regime; and f) impacting these emotional and behavioral symptoms over time. The 15 children in the experimental group received 12, daily play therapy sessions while attending a summer camp for children with diabetes. The control group, consisting of 15 children who attended the diabetic summer camp, received no play therapy. Children and parents in both groups completed pretest, post-test and three-month follow-up data, consisting of: the Children's Depression Inventory, the Revised Children's Manifest Anxiety Scale, the Filial Problems Checklist and the Diabetes Adaptation Scale. Analysis of covariance revealed that the children in the experimental group significantly improved their adaptation to their diabetes following intensive play therapy as reflected by the Diabetes Adaptation Scale. No other hypothesis were retained, although statistical trends noted increased improvement in the experimental group in the areas of behavior difficulties and adherence behavior. Possible explanations for these results include a lack of symptoms reported at the time of pretesting and the validity of these instruments for a chronically ill population. The results of this study indicate that intensive play therapy may be an effective intervention for children diagnosed with IDDM. Qualitative observations and progress noted in therapy reveal that young children with IDDM have the capability to address and resolve issues of anxiety, depression and other emotional issues related to their diabetes in play therapy. Preventative approaches such as play therapy for children with IDDM are particularly important for this population as current behavior patterns and treatment adherence are highly correlated with long-term medical and psychological health.

The aim of this study was to assess the dietary intake, diet-related knowledge and metabolic control in children with Type 1 Diabetes Mellitus between the ages of 6-10 years attending the Paediatric Diabetic Clinics at Grey’s Hospital, Pietermaritzburg and Inkosi Albert Luthuli Central Hospital, Durban, KwaZulu-Natal. This was a cross sectional observational study that was carried out in a total of 30 subjects out of a possible 35 subjects that qualified for inclusion in the study from both the Grey’s Hospital clinic (n=8) and IALCH clinic (n=22). The dietary intake was assessed in a total of 25 subjects using a three day dietary record (n=20) and a 24 hour recall of the third day of the record (n=16). Diet-related knowledge was assessed using a multiple choice questionnaire. Metabolic control was assessed using the most recent HbA1c and the mean HbA1c results over the previous 12 months from the date of data collection. Height and weight measurements were also carried out. Information on socioeconomic status and education status of the caregivers was obtained from 22 caregivers through follow-up phone calls. All measurements except for dietary intake were obtained from all subjects participating in the study. The mean percentage contribution of macronutrients to total energy was very similar to the International Society for Pediatric and Adolescent Diabetes (ISPAD) Consensus Guidelines (2002). The mean percentage contribution of macronutrients to total energy from the 3 day dietary records and the 24 hour recalls were as follows: carbohydrate (52% and 49%); sucrose (2% and 2%); protein (16% and 17%); fat (32% and 34%). Micronutrient intake was adequate for all micronutrients except for calcium and vitamin D which showed low intakes. The mean diet-related knowledge score for the sample was 67% with significantly higher scores in children older than 8 years of age. The latest HbA1c for the sample was 9.7% and the mean HbA1c over the previous 12 months from the date of data collection was 9.6%. There was a significant positive correlation between age of the participant and the latest HbA1c (r = 0.473; p=0.008) and a significant negative correlation between the education level of the caregivers and the latest HbA1c (r = - 0.578; p=0.005) and the mean HbA1c over 12 months (r = - 0.496; p=0.019). Significant differences were found between African and Indian children respectively for HbA1c, with higher values in African children. There was no correlation between BMI for age and latest HbA1c (r = 0.203, p=0.282) or mean HbA1c over 12 months (r = 0.101, p=0.594). Z score for BMI for age was also not correlated with latest HbA1c (r = 0.045, p=0.814) or mean HbA1c over 12 months (r = - 0.012, p=0.951). Children from the Grey’s Hospital Clinic were found to have higher HbA1c values (p=0.001) and lower diet-related knowledge scores as compared to the children from the IALCH Clinic (p=0.038). It should be noted that the ethnic and racial composition of the children attending these two clinics differed. In conclusion the macronutrient intake in this sample was found to be similar to the ISPAD Consensus Guidelines (2002) while calcium and vitamin D intakes were low. Overall this sample displayed good diet-related knowledge while metabolic control was found to be poor. / Thesis (M.Sc.)-University of KwaZulu-Natal, Pietermaritzburg, 2007.