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Youngsters with diabetes face numerous, daily challenges associated with their treatment. Previous research has examined coping in relation to global medical adjustment. However, the role that coping with diabetes-specific stressors plays in adherence to different treatment components, and child responsibility for these components, is not well understood. The present study examined the contribution of coping strategies to medical adjustment (i.e., metabolic control, treatment adherence) and level of child responsibility for treatment among children (n = 27) and adolescents (n = 29) with diabetes. Youngsters reported coping strategies in response to three diabetes-related situations (social, diet, fingerprick). Coping strategies accounted for a significant proportion of the variance in predicting most adjustment and responsibility variables, above and beyond the effects of relevant background variables (i.e., age, duration of diabetes, diabetes knowledge). Higher levels of approach-coping strategies related to better adherence to diet. Higher levels of avoidance-coping strategies related to poorer metabolic control and adherence to fingerpricks and higher levels of child responsibility for diet. These findings suggest that the role that coping strategies play in youngsters' medical adjustment is best understood within the context of diabetes-specific situations. J Dev Behav Pediatr 15:327–335, 1994. Index terms: diabetes, coping, adherence, treatment responsibility.