An Empirically Derived Typology of Families: I. Relationships with Adult Health

In this report we describe the development and partial validation of an empirically derived typology of families based on 11 family variable composites derived from the California Family Health Project. Our goal was to use the typology to condense and integrate the findings from previous analyses of a large group of family variables and to account for differences in the self-reported health of adult family members. Exploratory and confirmatory cluster analyses conducted separately by gender classified 97% of the sample into four parallel types for husbands and wives: Balanced, Traditional, Disconnected, and Emotionally Strained. A 1-way MANOVA indicated that all 11 family variable composites significantly differentiated the four family types for husbands and wives. Significant differences among the four family types were also found on 10 demographic and other family variables, using ANOVA. Using MANOVA, we compared the four family types on 12 self-reported health and well-being variables by gender. Both husbands and wives from Balanced and Traditional families reported higher health scores than spouses from Disconnected and Emotionally Strained families, but no single profile of health scores was unique to a particular family type. The four family types provide an integrated and comprehensive framework for describing the family in health research.     

Affective and Autonomic Reactivity During Parent–Child Interactions in Depressed and Non-Depressed Mothers and Their Adolescent Offspring

Depression presents risks that are profound and intergenerational, yet research on the association of depression with the physiological processes that might be associated with impaired mental and physical health has only recently been contextualized within the family environment. Participants in this multi-method case–control study were 180 mother-adolescent dyads (50% mothers with a history of depression treatment and current depressive symptoms). In order to examine the association between maternal depression and affective and autonomic reactivity amongst these mothers and their adolescent offspring we collected self-reported measures of positive and negative affect, as well as measures of cardiovascular and electrodermal autonomic activity, during mother-adolescent interaction tasks. Findings indicated that depressed mothers and their adolescent offspring exhibited greater self-reported negative affect reactivity during a problem-solving interaction and blunted (i.e., low) sympathetic activity as measured via skin conductance level across both interaction tasks. These effects remained significant after controlling for a range of potential covariates, including medication use, sex, age, adolescents own mental health symptoms, and behavior of the other interactant, along with correcting for multiple comparisons. Findings indicate that depressed mothers and their adolescent offspring both exhibit patterns of affect and physiology during interactions that are different from those of non-depressed mothers and their offspring, including increased negative affect reactivity during negative interactions and blunted sympathetic activity across both positive and negative interactions. These findings have potential implications for understanding the role of family processes in the intergenerational transmission of risk for depressive disorders.

     

Supportive Non-Parental Adults and Adolescent Psychosocial Functioning: Using Social Support as a Theoretical Framework

Supportive Non-Parental Adults (SNPAs), or non-parental adults who provide social support to youth, are present in the lives of many adolescents; yet to date, a guiding framework for organizing the existing literature on the provision of support provided by multiple types of SNPAS, such as teachers, natural mentors, and extended family members, as well as to inform future research efforts, is lacking. The aim of the current paper is to utilize the well-established lens of social support to integrate, across this broad range of literatures, recent findings regarding associations between SNPAs and four indices of adolescent psychosocial adjustment: academic functioning, self-esteem, and behavioral and emotional problems. Beyond offering an integrative framework for understanding the link between SNPAs and adolescent functioning, the issues reviewed here have potentially far-reaching consequences for adolescents and their families, as well as the professionals working with adolescents and their families in the health care, school, and community settings.     

Military Stressors,Parent-Adolescent Relationship Quality,and Adolescent Adjustment

Elements of military life can create challenges for all family members, including military-connected adolescents, and can have detrimental consequences for their adjustment. Although research with samples of military-connected adolescents has examined the influences of military stressors for adolescent adjustment (e.g., depressive symptoms, anxiety), less research has identified possible mechanisms responsible for these effects, particularly the role of specific familial factors. Drawing from social ecological theory and attachment theory, we examined the associations between military stressors (e.g., parental rank, combat deployments, permanent change of station moves) and self-reported adolescent adjustment (e.g., depressive symptoms, self-efficacy) along with examining adolescents’ perceptions of parent-adolescent relationship quality with both the active duty and civilian parent as a linking mechanism. Using a path analysis, data from 265 Army families were examined to identify the direct and indirect associations between military stressors and adolescent adjustment through parent-adolescent relationship quality. Most military stressors were not significantly related to relationship quality of either parent or indicators of adolescent adjustment. However, parent-adolescent relationship quality with each parent (active duty and civilian parent) was uniquely related to adolescents’ adjustment. Discussion is provided regarding how military stressors and familial factors are conceptualized within the context of military families and implications for future research, family therapy, and policies are suggested.

     

Adolescent Self-Reports of Social Anxiety: Can They Disagree with Objective Psychophysiological Measures and Still Be Valid?

We examined self-reported and parent-reported adolescent social anxiety symptoms and objective baseline measures of psychophysiological flexibility in 62 families. Measures completed by 31 adolescents referred for a clinical screening evaluation for social anxiety were compared to an age- and gender-matched community control sample of 31 adolescents (total sample: age range 14 to 17?years; 22 boys and 40 girls; M?=?15.32?years; SD?=?1.1). Clinic referred adolescents reported significantly fewer social anxiety symptoms than parents reported about adolescents. Further, for all adolescents, self-reported social anxiety symptoms exhibited low correspondence with objective psychophysiological measures. Yet, both measures uniquely discriminated between adolescents on whether they were clinic referred for a social anxiety screening. Further, adolescent self-reported social anxiety symptoms exhibited high levels of internal consistency and convergent validity. Findings indicate that researchers and practitioners should refrain from using disagreements between adolescent self-reports and other measures (e.g., parent report, objective measures) as indicators of the veracity of adolescent self-reports.     

Parent-Offspring Transmission of Internalizing and Sensory over-Responsivity Symptoms in Adolescence

Reactions to sensory experiences are an overlooked correlate of affective regulation, despite the importance of bodily states on psychological processes. Children who display sensory over-responsivity (i.e., adverse reactions to typical sensations) are at greater risk for developing affective disorders. We extended this literature to adolescents and their middle-aged parents. Participants in a birth record-based study of families of adolescent twins (N = 506 families; 1012 adolescents; 53% female) completed a subset of items from the Adult Sensory Profile. We derived adolescent self-reported internalizing disorder symptoms and parent affective diagnoses from structured diagnostic interviews. Structural equation models tested the relationship between parent sensory over-responsivity symptoms and affective diagnoses and their adolescent offspring’s sensory over-responsivity and internalizing symptoms. Adolescent sensory over-responsivity symptoms were correlated with internalizing disorder symptoms. Parents with a diagnosis of anxiety or depression (mothers only) reported more frequent SOR symptoms than parents without a diagnosis. Parent depression was significantly related to adolescent sensory over-responsivity symptoms, over and above parent sensory over-responsivity symptoms (β = 0.26, p < 0.001 for mothers; β = 0.13, p = 0.004 for fathers). Father alcohol abuse/dependency also predicted offspring sensory over-responsivity symptoms. Offspring of parents with affective disorders were at additional risk for sensory dysregulation via parents’ influence on offspring internalizing problems.     

Behavioral Problems Reported by Adolescents and Parents from HIV Affected Families in China

This study examined the influence of various factors on the behavioral problems of adolescents affected by HIV while considering the agreement between adolescent and parent reports on problem behaviors. A total of 136 families each with one parent living with HIV (PLH) and one child aged 13–18 were included. Structural equation modeling was used to explore relationships between selected family measures and adolescent’s problem behaviors. The correlation between the PLH and adolescent-reported behavioral problem measures was low (β?=?0.11). PLH-reported adolescent problem behaviors were negatively related to PLH-reported parental bonding (β?=??0.39), family routines (β?=??0.26), and positively associated with family conflict (β?=?0.21). Adolescent-reported family participation was associated with self-reported problem behaviors (β?=??0.35). Our study reported discrete perceptions of adolescent problem behaviors from parents’ and adolescents’ points of view. Future intervention efforts should emphasize family contextual factors to improve behavioral outcomes in adolescents affected by HIV.     

Lives in a balance: perceived family functioning and the psychosocial adjustment of adolescent cancer survivors.

Childhood cancer patients have a greater likelihood of long-term survival than ever before. This study examined both the perceived family functioning of adolescents who had successfully completed treatment for pediatric cancer and the relationship between family functioning and post-treatment adjustment. Eighty-eight adolescent survivors of hematologic malignancies were assessed regarding their family functioning, mental health, self-esteem, global competence, and problem behaviors. Contrary to expectations about the influence of cancer on these families, adolescent cancer survivors reported lower levels of family cohesion than the normative sample of healthy adolescents and their families. While current age, gender, age at diagnosis, and time since treatment completion were generally not associated with adolescents' adjustment, perceived family cohesion and adaptability were strongly related to post-treatment psychological adjustment.     

A short-term longitudinal examination of young adolescent functioning following divorce: The role of family factors

The purposes of this study were to examine young adolescent functioning over a 2-year period after divorce and to assess the role of two family factors, interpersonal conflict and the parent-adolescent relationship, in predicting such functioning. One hundred and twelve young adolescents, their mothers, and their social studies teachers served as participants. One-half of the adolescent were from recently divorced families and one-half were from married families. Mothers completed measures concerning interparental conflict and the parent-adolescent relationship, adolescents completed a measure of the relationship, and teachers completed measures assessing four areas of adolescent functioning. The results indicated that adolescents from divorced families were functioning less well than those from married families. There were no changes in adolescent functioning and the parent-adolescent relationship from the first to second year postdivorce. High levels of interparental conflict in divorced families were associated with more parent-adolescent relationship problems. In turn parent-adolescent relationships problems served as the best predictor of concurrent and subsequent difficulty in adolescent functioning.This study was supported, in part, by the William T. Grant Foundation and the University of Georgia's Institute for Behavioral Research.     

Family Ritual and Routine: Comparison of Clinical and Non-Clinical Families

Research demonstrates that the constructive use of family rituals is reliably linked to family health and to psychosocial adjustment. This study explores the relationship between family rituals and child well-being. Two samples participated: 21 families whose adolescent was receiving psychiatric treatment and 21 families in which the adolescent was a public school student. A parent and the adolescent were individually interviewed regarding family rituals and completed standardized measures of adolescent and family functioning. Analyses demonstrated that, in addition to significant sample differences in the expected direction on measures of functioning, the non-clinical families scored significantly higher on the index of family rituality than did the treatment families; this is additional evidence that family rituals are a correlate of child well-being. Further analysis of the data pointed to “people resources” as a robust dimension in its association to adolescent functioning. The role family ritual and routine plays in defining family relationships, both within the nuclear family and with other important adults, was significantly related to clinical status. This work may point to an important, yet overlooked, dimension of family ritual life, the relational qualities of rituals and routines.     

The Family Rorschach with families of schizophrenics: replication and extension

Using a modified version of procedures outlined by Shapiro and Wild (9), this study evaluates the use of a Family Rorschach technique as a means of distinguishing families of schizophrenic patients from those of psychiatrically hospitalized, nonschizophrenic individuals. The patients were diagnosed using Research Diagnostic Criteria, and families were matched for age, intelligence, and socioeconomic characteristics. Results showed that the families with schizophrenic offspring scored significantly lower (that is, they had more communication and attentional difficulties) than those with nonschizophrenic offspring; offspring gender and family constellation had little effect on scores. Subsequent analyses indicated that lower scores were not simply a reflection of the psychoticism of the patient. These findings suggest that families of schizophrenics have interpersonal communication difficulties that compromise their ability to maintain a shared focus of attention. The findings are consistent with the suggestion that deviant patterns of family communication in interaction with genetic vulnerability in an offspring may result in the development of a schizophrenic disorder.     

Parental employment status and adolescents’ health: The role of financial situation,parent-adolescent relationship and adolescents’ resilience

The paper deals with parental employment status and its relationship to adolescents’ self-reported health. It studies the role of the financial situation, parent–adolescent relationship and adolescent resilience in the relationship between parental employment status and adolescents’ self-rated health, vitality and mental health. Multiple regression analyses were used to analyse questionnaire data obtained from 2799 adolescents (mean age 14.3) in 2006. The results show a negative association of the father’s, but not mother’s unemployment or non-employment with adolescents’ health. Regression analyses showed that neither financial strain nor a poor parent–adolescent relationship or a low score in resilience accounted for the relationship between the father’s unemployment or non-employment and poorer adolescent health. Furthermore, resilience did not work as a buffer against the negative impact of fathers’ unemployment on adolescents’ health.     

In-Home Treatment of Families with Seriously Disturbed Adolescents in Crisis

This article describes an innovative Adolescent In-Home Treatment Program that was designed as a hospital alternative for families with adolescents in serious crises. Using multiple-impact, in-home, and in-office techniques, a mental health team systemically intervenes with families to assist them in resolving this major developmental event. Since the program's inception, over 160 high-risk adolescents have completed the 90-day course of treatment. Preliminary data gathered from an early group of families and clinicians suggest the potential of significant improvements in family and adolescent functioning, and the attainment of clinical goals among the majority of families served.     

The Relation Between Parental Mental Illness and Adolescent Mental Health: The Role of Family Factors

Children of parents with a mental illness are often found to be at high risk of developing psychological problems themselves. Little is known about the role of family factors in the relation between parental and adolescent mental health. The current study focused on parent–child interaction and family environment. This cross-sectional questionnaire study included 124 families with a mentally ill parent and 127 families without a mentally ill parent who at the time of the study had children aged 11–16 years old. Parents completed questionnaires about their mental health, parent–child interaction (i.e., parental monitoring and parental support), and family environment (i.e., cohesion, expressiveness, and conflict). Adolescents reported their internalizing and externalizing problems. Path analyses were used to examine the direct associations between parental mental illness and adolescent problems as well as the indirect relations via parent–child interaction and family environment. The results showed that interaction between parents with a mental illness and their child was significantly worse compared to parents without a mental illness. The family environment of parents with mental illness was also more negative. Mentally ill parents monitored their adolescents less, which in turn related to more externalizing problems of the adolescents. No factors mediated the relation between parental mental health and adolescent internalizing problems. Moreover, no direct effects of parental support, family cohesion, and family expressiveness with externalizing problems were found. These findings imply that parental monitoring should get a specific focus of attention in existing interventions designed to prevent adolescents with a mentally ill parent from developing problems.     

Differences in family functioning in grandparent and parent-headed households in a clinical sample of drug-using African American adolescents

Grandparents play a critical role in African American families, providing support and important leadership functions. Little is known, however, about family functioning in grandparent-headed households with a drug-using adolescent. Such knowledge is particularly salient for researchers and therapists who work with drug-using adolescents and their families. Using a clinical sample of convenience, analyses were conducted to identify similarities and differences in adolescent substance use and behavior problems, family relationships, and family social ecology relationships between African American grandparent-headed (n=12) and parent-headed (n=54) households. Results indicated that adolescents from the 2 household types reported similar levels of problem behaviors, but that grandparents reported less delinquency with peers than did parents. Primary caregivers in grandparent-headed households reported less monitoring and supervision of peers and less within-family conflict. Implications for treatment are discussed.     

Parent and child MMPI responses: Characteristics among families with adolescents in inpatient and outpatient settings

The relationship of parent personality to child psychopathology has been investigated in numerous MMPI studies over the past three decades. Very few of these studies, however, have directly analyzed MMPI response patterns of both parents and offspring. The current study included the MMPI responses of 199 families with adolescents entering inpatient and outpatient psychiatric setting (N = 542). Inpatient parents and adolescents had significantly higher mean scores across a variety of MMPI scales than did their outpatient counterparts. The linear combination of adolescent and maternal MMPI scale data, in a stepwise discriminative function analysis, resulted in accurate classification of 75% of all children in inpatient treatment and 74% of all children assigned to outpatient treatment. Findings were discussed in terms of salient MMPI differences between inpatient and outpatient families and shared psychopathological characteristics among family members with offspring in psychiatric treatment settings.     

Factors associated with the mental health of adolescents when a parent has cancer

This study explored factors associated with the mental health in adolescents (ages 11-17; n = 54) within 12 months after a parent had been diagnosed with cancer. A control group was included (ages 11-17; n = 49). A demographic questionnaire, the SF-8 Health Survey, the Youth Self Report and the McMaster Family Assessment Device were used. Similar levels of psychological distress and healthy family functioning were reported in the clinical and the control group. No effect of gender of the ill parent and that of the adolescent was found. A negative correlation was found between the physical health of the ill parent and the mental health of the adolescent. Healthy family functioning correlated with less psychological distress in adolescents with a parent with cancer. Open communication, flexible problem solving and appropriate affective involvement were significant predictors for less psychological distress in the adolescents. The study concludes that a healthy family functioning facilitated the adolescent's adjustment to parental cancer.     

Differential Outcomes of Adolescents with Chronically Ill and Healthy Parents

Approximately 10% of children grow up with a parent who has been diagnosed with a chronic medical condition (CMC) and seem to be at risk for adjustment difficulties. We examined differences in behavioral, psychosocial and academic outcomes between 161 adolescents from 101 families with a chronically ill parent and 112 adolescents from 68 families with healthy parents, accounting for statistical dependence within siblings. Children between 10 and 20 years and their parents were visited at home and filled in questionnaires. Multilevel analyses showed that 20–60% of the variance in most adolescent outcomes was due to the family cluster effect, especially in internalizing problem behavior, caregiving variables and quality of parent attachment. Conversely, the variance in stress and coping variables and grade point average (GPA) was mainly due to individual characteristics. Adolescents with parents affected by CMC displayed more internalizing problems than the comparison group and scored higher on frequency of household chores, caregiving responsibilities, activity restrictions, isolation, daily hassles and stress. In addition, their grade point average was comparatively worse. No group differences in externalizing problems, coping skills and quality of parent attachment were found. In conclusion, the family cluster effect largely explains adolescent outcomes and should be accounted for. Adolescents with parents affected by CMC are subject to an increased risk for internalizing problems, adverse caregiving characteristics, daily hassles, stress and a low GPA. According to a family-centered approach, school counselors and health care practitioners should be alert to adjustment difficulties of children with a chronically ill parent.