Copyright © 2016 Eman S Ahmed et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. International Journal of Advanced Nursing Studies, 5 (2) (2016) 250-255 International Journal of Advanced Nursing Studies Website: www.sciencepubco.com/index.php/IJANS doi: 10.14419/ijans.v5i2.6947 Research paper Emotional, behavioral and social difficulties among children with type 1 diabetes mellitus Eman S Ahmed 1 *, Eman M. M. Monazea 2 , Amera E Abdel- El Naser 3 , Safaa A M Kotb 4 1 Pediatric Nursing, Faculty of Nursing, Assiut University, Egypt 2 Public Health department, Faculty of Medicine, Assiut University, Egypt 3 Pyschiatric Nursing, Faculty of Nursing, Assiut University, Egypt 4 Community Health Nursing, Faculty of Nursing, Assiut University, Egypt *Corresponding author E-mail: emansayed44@aun.edu.eg, emansayed44@yahoo.com Abstract Background: Children and adolescents with diabetes are at a greater risk for emotional and behavioral problems. Aim of the study was to assess behavioral, emotional and social difficulties of diabetic children and examine the association of these difficulties with demographic and disease related variables. Subjects and method: A cross sectional study of 423 diabetic children attended Sidy Galal health insurance outpatient clinic in Assuit city – Egypt was conducted. A similar number of healthy children matched for age, sex and socioeconomic status were included in the study as a control group used for comparison. Strength and Difficulty Questionnaire (SDQ) was used as a screening tool. The SDQ is a screening instrument consisting of five separate 5-item subscales for emotional symptoms, conduct problems, hyperactivity-inattention, peer problems, and prosocial behavior. Results: Most of diabetic children (92.9%) were in the abnormal group of the total score compared to 20.6% of the controls. In all SDQ subscales except prosocial, diabetic children had significantly higher percentages of abnormal indices than in controls (p value <0.001). Emotional, hyperactivity and conduct problems were significantly associated with age and sex of the child. Prolonged duration of illness was significantly associated with peer relationship problems. Glycemic control was not a significant risk factor for any problem. Conclusion: Many of diabetic children had behavioral and psychosocial problems. Age and sex of the child and duration of the disease were important determinants for these problems. Recommendation: Diabetic children need to be screened by psychologist and social worker to identify and manage any behavioral or emotional problems. Keywords: Behavioral; Children; Emotional; Social; Type 1 Diabetes. 1. Introduction Type 1 diabetes mellitus (T1DM) is a lifelong metabolic disorder that is treated with a complex regimen of insulin injections, diet and exercise, and can greatly affect the lives of the diabetic chil- dren and their family (Orsillo & Roemer, 2005). Egypt is on top of all the countries in the Middle East and North Africa (MENA), with a prevalence of diabetes 15.27% in adult and 12.6% under the age of 15 years (Soltesz et al. 2010, The International Diabetes Federation 2013). Diabetes impacts the life style, personality and overall emotional and physical well-being of the child (Orsillo & Roemer, 2005). Living with a chronic disease can increase the risk of experiencing psychological, emotional and behavioral difficulties. (Hysing et al. 2007, Pinquart & Shen, 2011). Children with diabetes were more likely to experience behavioral problems than comparison groups (Reynolds & Helgeson, 2011). They has a stigma of being ill, feeling to be different from others, and having to struggle against the general population's lack of knowledge and wrong ideas about diabetes (Rubio Zarzuela et al. 2010). Chisholm (2003) stated that children with diabetes usually have great concerns about their illness and its effect on peer relations. In addition, Guthire et al. 2003 reported that peer support has been found important not only in adjusting to diabetes but also in controlling blood glucose. A substantial research base developed over the past decades pro- vides evidence for the significant role of psychosocial factors in the management of type 1 diabetes in children and adolescents (WINKLEYK et al. 2006 and Kakleas et al. 2009). Personal, fami- ly, or environmental conditions present before the onset of diabe- tes may compound the delicate balance needed to maintain good glycemic control. Therefore, there is a great need, especially at the time of initial diagnosis, to assess the developmental, behavioral, and psychosocial aspects of diabetic children and their families and support these aspects to prevent long term consequences relat- ed to poor management (Guthrie et al. 2003, Davidson et al. 2004). For children and adolescents, there is a need to identify psycho- logical disorders associated with diabetes and to intervene early to minimize its impact over the course of development. (Wherrett et al. 2013). However, the psychological aspect of the disease is often missed with whole/most of the emphasis given on the strict maintenance of blood glucose. Diabetic care providers especially nurses and health educators need to be trained and experienced with behavioral and emotional needs of diabetic children and ado- lescents to provide the support and useful problem solving strate-