The project's long-term goal is the longitudinal study of memory and learning skills in children with insulin-dependent diabetes --- mellitus (IDDM). As children progress through school, information acquisition becomes increasingly visual at the same time that adolescents with diabetes begin to experience central visual processing anomalies. Visual memory and learning is virtually unstudied in youth with diabetes even though difficulties with verbally based acquisition skills have been documented. Problems remembering or learning to accurately implement the diabetes treatment regimen can affect metabolic control and compromise both further cognitive functioning and long-term health status. This application proposes to ascertain the functional impact of memory and learning skills on daily self care behaviors of children. A group of adolescents, ages 12-15, will be followed longitudinally as they enter a crucial developmental transition from parental management of their diabetes to increasing self-care responsibility. Approximately 120 adolescents from Children's National Medical Center in Washington, D.C. will be evaluated initially to provide baseline documentation of their memory and learning skills, their academic achievements as well as their diabetes self-care behaviors. Children will be evaluated every year for a total of 4 assessments over the course of 4 years. An accelerated longitudinal design with growth curve analyses will be used to evaluate the achievement and self-care outcomes related to memory and learning skills. It is hypothesized that visual memory will decrease over time in a linear fashion because the visual system is particularly vulnerable with longer disease duration, even though acuity remains intact. It is hypothesized that verbal memory should remain relatively unchanged over time except for adolescents who experience episodes of severe hypoglycemia, which disrupts left hemisphere medial temporal/hippocampal functioning; modality specific learning patterns over time should follow these memory patterns and better memory should relate to better achievement scores and self-care behaviors, independent of the effect of general intelligence.
