Children with involved parents tend to fare better across almost all areas of development—academically, emotionally, behaviorally, and socially (Schiffrin et al. 2013)—whereas the converse is also true: children with uninvolved parents tend to do worse (e.g., Pomerantz et al. 2007). The National Longitudinal Study of Adolescent Health (Resnick et al. 1997) found that parent involvement in adolescence was the strongest predictor of risky behavior such as substance use and unprotected sex.

The same patterns hold for children with chronic illness. When parent involvement decreases, and children take on primary responsibility for illness management, adherence and illness control can suffer (Kahana et al. 2008; Chaps. 7 and 10). Reduced parent involvement/lack of monitoring is also associated with increased risk for serious acute complications such as DKA in diabetes patients and organ transplant loss. Other research suggests that adolescents’ perception of parent involvement is also important, with greater perceived involvement (especially around coping with stress) being associated with better adherence (Wiebe et al. 2005).

However, as noted by many authors, not all involvement is equal. Research indicates that certain aspects of parenting and parent involvement are actually associated with worse outcomes. This occurs when parents’ involvement is perceived as overly controlling, intrusive, or negative (Schiffrin et al. 2013; Seiffge-Krenke et al. 2013; Wiebe et al. 2005), or conflict results (Hood et al. 2007). In such circumstances, adherence can suffer. In the words of Weissberg-Benchell et al. (2009), “the manner in which parents demonstrate involvement in diabetes management is more important than the specific amount of responsibility taken by the parent.”

The classic contemporary model of parenting, developed by Diana Baumrind (1971), identified two dimensions of parenting (control versus warmth/acceptance) that in turn yield four different parenting styles .

In general, authoritative parenting has been associated with the best outcomes, both in terms of general development and child functioning (Barber et al. 2005), and with regards to adherence and chronic illness control both in younger children (e.g., Davis et al. 2001; Monaghan et al. 2012) and adolescents (e.g., Shorer et al. 2011). Parental warmth, support, and acceptance (all aspects of authoritative parenting) are incontrovertibly associated with positive child outcomes in almost every area examined, and at any age, and this includes adherence (Butler et al. 2007; Davis et al. 2001; Monaghan et al. 2012). In contrast, parenting that is overly negative and critical (Armstrong and Streisand 2011) is strongly associated with worse psychological outcomes, lower adherence, and worse illness control.

The results for parental control are more complicated, depending on the developmental stage of the child (Butler et al. 2007), how control is defined, and especially how it is perceived (Wiebe et al. 2005).

Positive aspects of parent control include providing appropriate limits and monitoring children’s and youth’s behaviors, both to ensure that adherence behaviors get done and that risk-taking behaviors are minimized. However, parents can attempt to exert too much control, giving their children little say and limiting them even from developmentally appropriate activities Overly controlling behavior has been associated with increased behavior problems among children, although whether this is cause or effect or an interaction has been debated—for example, parents may become more controlling in response to child behavior problems, as an attempt to reign the behaviors in, or children may escalate their behavior in the face of parent control, as a way of asserting their own autonomy .

Two types of parental control have been distinguished in the literature: behavioral control and psychological control. These types of control have been shown to have very different effects on child outcomes.

Behavioral control, which involves parental monitoring and limit-setting, and is seen as being oriented toward socialization and behavioral regulation (Silk et al. 2003). Parental behavioral control has generally been shown to be associated with positive child outcomes (Barber et al. 1994), although it may begin to have negative effects when youth reach early adulthood (Helgeson et al. 2014; Schiffrin et al. 2013). Surprisingly, most studies examining behavioral control on chronic illness outcomes have found negative effects (Butler et al. 2007; Davis et al. 2001; Wiebe et al. 2005), although this probably has to do with control was operationalized in these studies (e.g., Weibe et al.: “mother told the child what to do or was too involved”; Butler et al.: parent ‘‘insists that you must do exactly as you are told’’; Helgeson et al.: “Do you feel as though your parents control everything in your life?” “Do you feel that your parents demand to know everything?”). These constructs of “excessive firm control” or “strictness” differ from the sort of limit-setting typically associated with the authoritative parenting style. Parental monitoring, arguably a less excessive form of limit-setting, has consistently been found to be associated with better regimen adherence (e.g., Ellis et al. 2007).

Psychological control involves manipulative parent behaviors focused on using guilt, shame, and contingent love and acceptance to pressure a child into conforming with parent expectations (Barber 1996), or efforts to control the child’s thoughts and feelings (Butler et al. 2007). In contrast to behavioral control, psychologically controlling behavior has consistently been found to be detrimental to children’s general well-being (e.g., Barber et al. 2005). Studies have supported the negative effects of psychological control on chronic illness outcomes as well (e.g., Weissberg-Benchell et al. 2009).

There is also evidence that parental control may have different effects for children with and without a chronic illness. A recent study by Helgeson and colleagues (2014) examined whether perceptions of parent support and control in early adolescence were predictive of risk behavior and health outcomes in emerging adulthood in youth with and without type 1 diabetes. Consistent with other studies, they found that excessive parent control was associated with a range of negative outcomes, including increased risk for smoking and reduced likelihood of attending college. Excessive control also predicted increased risk for depression in youth without diabetes. However, in youth with diabetes, the results were dramatically different. Parental controlling behavior in adolescence was associated with reduced risk for depressive symptoms and clinical depression in emerging adults with diabetes, and better diabetes self-care.

Why would parent control have such different effects for youth with and without a chronic illness? Helgeson et al. note the importance of parent involvement for good illness care, and speculate that for youth with diabetes (and presumably other chronic illnesses), “parent controlling behavior may reflect parent involvement.” The implication is that youth with chronic illness “may expect a higher level of parental involvement than other youth and be more likely to construe a lack of parental control as a lack of involvement in their lives.” Thus, parent behaviors that may seem overly controlling to many youth might instead be seen as necessary guidance and input by youth burdened with a chronic illness.

Of course, control is also somewhat in the eye of the beholder: what one person perceives as controlling, another will view as necessary support (Wiebe et al. 2005). Other factors such as the parent’s positive or negative affect, warmth, and communication style likely influence whether involvement is perceived as supportive or controlling. When involvement is coupled with criticism, for example, an adolescent may be made to feel incompetent (Pomerantz and Eaton 2000), reducing her sense of self-efficacy and her motivation to participate in her care (Wiebe et al. 2005). When parent involvement is coupled with negative affect, a pattern of parent-child conflict may also result.

It should also be kept in mind that parenting is often a response to child behaviors, and not necessarily the initial cause. For example, lower child engagement in school, which has been postulated to result from over-involved parenting (e.g., Padilla-Walker and Nelson 2012), may actually precipitate greater parent involvement and attempts at control.

In fact, this is a pattern we frequently see in families of children with a chronic illness. It often goes something like this: A 14 year-old with type 1 diabetes is given primary responsibility for illness management with little parent oversight. Over time, his adherence behaviors and metabolic control decline. When his mother discovers that his A1c has climbed to 10 %, she steps back in and steps up her efforts to help, typically with some comments to the effect that she is disappointed and had expected her son to do better. Rather than accept her renewed involvement, however, the son tries to shut her out, sullenly saying he “can do this on his own.” This concerns his mother, who begins to nag and cajole him to take better care of his diabetes, but this backfires further, as her son becomes more resistant to complying as a way to preserve his sense of freedom and control. This is a well-documented pattern that has been termed miscarried helping .