Children requiring repeated injections might develop behavioral disturbances despite the use of topical anesthetic (e.g. EMLA). Behavioral distress disrupts injections, quality of life and parent-child relationships. Various medical protocols prescribe parent-administered injections, but the effects on child and parent behavior are poorly understood. Ninety-nine parent-child dyads will be studied across two contexts: (1) parent performs injections, and (2) nonmedical parent-child activities. A group experimental design with repeated measures (baseline, post-treatment module 1, post-treatment module 2, and follow-up) will be used to study the effects on parent and child of behavioral parent training. The three experimental groups will include (1) Behavioral Intervention Sequence A (General Behavior Management Training First, N = 33), Behavioral Intervention Sequence B (Training in Procedural Distress Reduction Strategies First, N=33), and (3) Usual Care Control (N=33). Children aged 4-7 years requiring repeated parent administered injections (with EMLA preparation) for diabetes mellitus will participate. Experimental groups will be stratified by child age, gender, baseline distress, length of time receiving injections, diabetes control hemoglobin A]c level at baseline) and parent years of education. Between groups comparisons will be conducted using Multivariate Analysis of Covariance (MANCOVA) for repeated measures. The moderating effects of both parent and child characteristics on parent use of recommended child management tactics and child distress and compliance will be studied using Multiple Regression. Parent characteristics will include (1) parent self-competence (2) parent-perceived consequences of child noncompliance, and (3) parent anxiety about harming the child. Child Characteristics will include (1) externalizing behavior, (2) medical approach-avoidance behavior and (3) pain sensitivity. The impact of these variables on intervention effects will be analyzed across injection and non-medical situations. The predictive validity of brief, parent-report measures of child characteristics (externalizing behavior, medical approach-avoidance behavior, pain sensitivity) and parent characteristics (performance anxiety, self-competence) also will be tested. The results will help to: (1) identify variables influencing parent-child interactions during injections, (2) guide future selection of interventions for child/parent distress during injections, (3) contribute knowledge needed to achieve greater treatment effectiveness, economy, durability, and (4) facilitate identification of children and parents most in need of behavioral intervention.