A Randomized Comparison of Two Psychosocial Interventions on Family Functioning in Adolescents with Bipolar Disorder

Impairments in family functioning are associated with more severe depressive and manic symptoms, earlier recurrences, and more suicidal behaviors in early-onset bipolar disorder. This study examined whether family-focused treatment for adolescents (FFT-A) with BD I or II disorder led to greater increases in family cohesion and adaptability and decreases in conflict over 2 years compared to a briefer psychoeducational treatment (enhanced care, EC). Participants were 144 adolescents (mean age: 15.6 ± 1.4 years) with BD I or II with a mood episode in the previous 3 months. Adolescents and parents were randomized to either FFT-A (21 sessions) or EC (three sessions). Patients received guideline-based pharmacotherapy throughout the 2-year study. Trajectories of adolescent- and parent-rated family cohesion, adaptability, and conflict were analyzed over 2 years. FFT-A had greater effects on adolescent-rated family cohesion compared to EC over 2 years. Participants in FFT-A and EC reported similar improvements in family conflict across the 2 years. In the FFT-A group, low-conflict families had greater adolescent-rated family cohesion throughout the study compared to high-conflict families. High-conflict families in both treatment groups tended to show larger reductions in conflict over 2 years than low-conflict families. Family psychoeducation and skills training may improve family cohesion in the early stages of BD. Measuring levels of family conflict at the start of treatment may inform treatment responsiveness among those receiving FFT-A.     

Examining Relationships Between Ethnic Identity, Family Environment, and Psychological Outcomes for African American Adolescents

Ethnic identity has been linked to a number of healthy psychological outcomes for African American adolescents. The levels of conflict and cohesion in the family environment have also been found to be predictive of adolescent mental health. This study examined whether the ethnic identity and levels of conflict and cohesion in the family environments were related to adolescents’ psychological adjustment. Participants included 61 African American adolescents, ages 10–14 years old, and their parents. Hierarchical regression models were used to determine the cumulative effects of ethnic identity and family functioning on adolescent mental health, specifically adolescent levels of depression, self-esteem, and interpersonal functioning. Results indicated that having a positive ethnic identity and a cohesive family environment were most strongly associated with psychological adjustment. Implications of these results are discussed in terms of family interventions.     

Implications of Family Cohesion and Conflict for Adolescent Mood and Well-Being: Examining Within- and Between-Family Processes on a Daily Timescale

Family-level conflict and cohesion are well-established predictors of adolescent mental health. However, traditional approaches focusing on between-family differences in cohesion and conflict may overlook daily intrafamily variability that might provide important new information. We used data from a 21-day daily diary protocol in a sample of 151 caregivers (95.3% female) and their adolescent child (61.5% female) in two-caregiver families to test whether daily changes in family functioning are associated with daily changes in adolescent well-being and whether adolescent well-being depends on average levels of family functioning. We examined family cohesion and conflict in relation to adolescent angry, depressed, and anxious mood, as well as happiness, life satisfaction, and meaning and purpose in life in multilevel models. Both cohesion and conflict exhibited meaningful daily variation. Adolescent-reported cohesion and conflict had unique within-family associations with all six adolescent outcomes. Models using parent reports of family functioning yielded fewer associations than models with adolescent reports; however, several findings remained. Cross-level interactions indicated that within-family variations in cohesion were only associated with adolescent depression in families with lower average levels of cohesion across days. In sum, this study provides compelling evidence that families exhibit meaningful variability from day to day and that daily variation has important implications for adolescent well-being.     

The Role of Family Functioning in Bipolar Disorder in Families

Investigated the association between family functioning and conflict and their links with mood disorder in parents and with children's risk for bipolar disorder. Participants were 272 families with a child between the ages of 5-17 years. Parents' history of psychiatric diagnoses and children's current diagnoses were obtained via semi-structured interviews. Parent report on the Family Assessment Device and the Conflict Behavior Questionnaire measured family functioning and conflict, respectively. Results revealed a small but significant indirect pathway from parental diagnosis of mood disorder to child bipolar disorder through impaired family functioning, via increased family conflict. Parental mood disorders were also significantly related to other negative outcomes in children, including unipolar depression and oppositional defiant disorder. Associations between parent diagnoses and family functioning changed depending on youth age, but not youth sex.     

Academic Self-Efficacy,School Engagement and Family Functioning,Among Postsecondary Students in the Caribbean

A neglected area of study in adolescent development is family functioning in relation to adolescents’ sense of self and academic success. This study investigates students’ perceptions of their levels of family functioning (cohesiveness and adaptability) as it relates to their academic self-efficacy and school engagement, and answers the following questions: (1) Are there any significant differences in the academic self-efficacy beliefs and school engagement of Caribbean adolescents based on levels of family cohesion and family adaptability? (2) To what extent does the combination of family cohesion and family adaptability predict the academic self-efficacy and school engagement of Caribbean adolescents? Data were collected from a sample of 523 adolescents (197 males and 326 females) aged 17–19 years, enroled in postsecondary institutions in two Anglophone Caribbean countries (Barbados and St. Lucia). Results indicated that adolescents from families with balanced cohesion held significantly higher academic self-efficacy beliefs and school engagement levels than those from families with low cohesion. Regression analyses indicated that the family functioning model significantly predicted academic self-efficacy and school engagement. Interpretation of these results are discussed.     

Family structure and family processes in Mexican-American families

Despite increases in single-parent families among Mexican Americans, few studies have examined the association of family structure and family adjustment. Utilizing a diverse sample of 738 Mexican-American families (21.7% single parent), the current study examined differences across family structure on early adolescent outcomes, family functioning, and parent-child relationship variables. Results revealed that early adolescents in single-parent families reported greater school misconduct, conduct disorder/oppositional deviant disorder, and major depressive disorder symptoms, and greater parent-child conflict than their counterparts in 2-parent families. Single-parent mothers reported greater economic hardship, depression, and family stress. Family stress and parent-child conflict emerged as significant mediators of the association between family structure and early adolescent outcomes, suggesting important processes linking Mexican-American single-parent families and adolescent adjustment.     

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.     

Adolescents’ Perceptions of Family Connectedness,Intrinsic Religiosity,and Depressed Mood

Using a sample of 248 ninth and tenth grade students at public high schools, we examined adolescents’ perceptions of family connectedness, intrinsic religiosity, and adolescents’ gender in relation to depressed mood and whether intrinsic religiosity and gender moderated the association of aspects of family connectedness to adolescent depressed mood. Using hierarchical multiple regression analyses we tested models separately for three forms of family connectedness (overall family cohesion, mothers’ support, and fathers’ support), intrinsic religiosity, and depressed mood. In each model, family connectedness was negatively associated with depressed mood. Intrinsic religiosity was not significantly associated with depressed mood. However, in the mothers’ support model, both a two-way interaction (mothers’ support × intrinsic religiosity) and a three-way interaction (adolescents’ gender × mothers’ support × intrinsic religiosity) were significantly related to depressed mood. In the two-way interaction, higher intrinsic religiosity was a moderator, strengthening the association between mothers’ support and depressed mood. In the three-way interaction, gender differences were found. For boys, high intrinsic religiosity strengthened the association between mothers’ support and depressed mood. Among girls, when mothers’ support was low, intrinsic religiosity provided an additional source of connectedness in protecting against depressed mood. Our findings show that connectedness in overall family systems, mother–adolescent subsystems, and father–adolescent subsystems are all important to emotional resilience in adolescents by protecting against depressed mood. Future studies of adolescent religiosity may benefit from including diverse forms of family connectedness in understanding the protective processes provided by aspects of religiosity in promoting adolescents’ emotional resilience.     

Adolescent culture brokering and family functioning: a study of families from Vietnam

In immigrant families, culture brokering (CB) refers to the ways in which children and adolescents serve as mediator between their family and aspects of the new culture. This study focused on the debate in the literature about whether CB implies "role reversal" in the family and "adultification" of the adolescent or whether CB is better understood as simply one of the many ways that immigrant children contribute to family functioning. Results indicated a mixed picture with respect to this debate. Greater amounts of adolescent CB were indeed related to higher adolescent reports of family conflict, but also to greater family adaptability. In addition, the amount of CB was unrelated to family satisfaction and family cohesion. Secondary questions centered on the relationship of CB to adolescent and parent demographic and acculturation variables. Here, CB was related to parent acculturation patterns but not those of adolescents. Implications for future research on the CB role are discussed.     

On being sad and evasive: Affective influences on verbal communication strategies in conflict situations

Does mood influence people’s tendency to engage in evasive, equivocal communication when facing conflict situations? Based on recent affect-cognition theories and research on verbal communication, this experiment predicted that negative mood should increase, and positive mood decrease the level of verbal evasiveness in conflict situations, and that high situational conflict should magnify these mood effects. Participants underwent a happy or sad audiovisual mood induction, and then produced verbal responses to low- and high-conflict situations using structured as well as open-ended responses. Results indicated that affect and conflict severity had an interactive influence on evasiveness and equivocation: negative affect produced significantly more evasiveness than positive affect, and these effects were greater in high than in low-conflict situations. These results are discussed in terms of the cognitive strategies that mediate mood effects on verbal communication. The implications of the findings for everyday communication situations, and for current affect-cognition theorizing are considered.     

Family Climate of Adolescents with and Without Type 1 Diabetes: Longitudinal Associations with Psychosocial Adaptation

Family climate is theorized to influence psychosocial functioning of adolescents both with and without type 1 diabetes. Family system theory considers adolescent behavior as a function of the dynamic interactions between family members. In the present multi-informant longitudinal study, we used two-step cluster analysis to empirically derive family climates based on four family dimensions (i.e., cohesion, conflict, organization, and control) at baseline and we related these climates to longitudinal assessments of adolescent psychosocial functioning. Analyses were conducted on a total of 220 adolescents (102 with diabetes, 118 healthy controls), 217 mothers, and 168 fathers. Cluster analysis on the four FES subscales revealed the following four family climates: a cohesive (moderately high on cohesion and moderately low to low on the other dimensions), balanced (high on cohesion and organization, low on conflict), conflictual (high on conflict, low on organization and cohesion), and controlling (high on control, moderately high on conflict and organization, moderately low on cohesion) climate. Adolescents with diabetes were somewhat overrepresented in the balanced climate, and underrepresented in the cohesive and conflictual climate as compared to their healthy peers. Consistent with hypotheses, we found that adolescents raised in cohesive or balanced climates fared better in terms of internalizing symptoms, externalizing symptoms, and self-concept as compared to adolescents raised in conflictual or controlling climates. Additionally, family climate was not associated with differential changes in outcome variables over time. These finding were consistent across informants and across time. Finally, these associations were not moderated by having type 1 diabetes. Suggestions for future research and practical implications are discussed.     

Family functioning and psychopathology among adolescents with severe emotional disturbances

Family psychosocial functioning and its relation to psychopathology among adolescents with severe emotional disturbances (SED) was assessed. Subjects were 353 adolescents with SED, ages 12–18, and their parents. During a semistructured interview, adolescents were administered Family Adaptability and Cohesion Evaluation Scale (FACES-III), Diagnostic Interview Schedule for Children-Child Version (DISC-C), and the Self-Derogation Scale. Parents were administered FACES-IIII and the Child Behavior Checklist (CBCL) in a phone interview. Results indicated that on the FACES-IIII cohesion dimension, both parents and adolescents perceived their family relations as more disengaged and less connected than did normative families (p < .001). In contrast, only parent FACES-IIII adaptability scores were significantly more extreme than a normative sample (p < .01). Additionally, both parent and adolescent cohesion scores were significantly correlated with adolescent psyehopathology measures: DISC-C conduct disorder (p < .01), depression (p < .05), alcohol/marijuana (p < .01), and CBCL externalizing symptoms (p < .01). These relationships did not deviate from linearity. We gratefully acknowledge Eric C. Brown, Sue Greer, and Sharon P. Lardieri for assistance in data management of this project. Preparation of this article was supported by grant H133B90004-01 from the National Institute on Disability Rehabilitation Research and the National Institute of Mental Health.     

Parent-adolescent communication, family functioning, and school performance

This paper presents the results of a test of theoretical postulates proposed by Olson, Russell, and Sprenkle (1983) using a matched set of adolescents and their parents. One set of families (n = 40) consisted of adolescents who had been unsuccessful in public school and were attending alternative schools, while the other (n = 52) was a matched group of public school adolescents and their families. Results showed predicted differences in the direction of greater balanced functioning (i.e., optimal cohesion and adaptability) and more positive communication in the public school families. Public school families also perceived greater congruence between perceived and ideal family functioning. Congruence and differences between adolescent and parent perceptions, the importance of positive communication for optimal functioning, and implications for family treatment are discussed.     

Observed maternal responses to adolescent behaviour predict the onset of major depression

Two mechanisms have been proposed regarding relations between parental responses to adolescent affective behaviours and the development of depression: the elicitation of parental negativity and the suppression of parental aggression. This study aimed to investigate the boundary conditions under which these two mechanisms operate in relation to the prospective prediction of Major Depressive Disorder (MDD) onset in adolescence. A community sample of 159 adolescents (aged 11–13 years) with no history of MDD completed a family interaction assessment with their mothers, and were followed-up with a diagnostic interview 2–3 years later. Results showed that onset of MDD was prospectively predicted by the elicitation of maternal aggression in response to adolescent aggression (in girls only) and maternal dysphoria in response to adolescent aggression, as well as the suppression of maternal aggression and dysphoria in response to adolescent dysphoria. Thus, support was obtained for both the elicitation of negativity mechanism in relation to maternal responses to adolescents’ aggressive behaviours, and the suppression of aggression mechanisms in relation to maternal responses to adolescents’ dysphoric behaviours. Mothers’ responses to adolescents’ aggressive and dysphoric behaviours may differentially influence the risk of MDD onset for adolescents over time.     

Parent–Teen Interactions as Predictors of Depressive Symptoms in Adolescents with Headache

This study investigated parent–adolescent conflict, family functioning, and adolescent autonomy as predictors of depressive symptoms in adolescents with primary headache. Frequent headaches during adolescence can have a negative impact on activity levels and psychological functioning. Depression is particularly prevalent in adolescents with headache but little research has examined the role of parent–teen interactions in predicting depressive symptoms. Thirty adolescents diagnosed with migraine or chronic daily headache completed self-report measures of pain intensity, parent–adolescent conflict, family functioning, and depression. Adolescents and their parents also participated in three videotaped interaction tasks, scored by independent raters to assess adolescent autonomy. Regression models revealed that pain intensity, parent–adolescent conflict, and autonomy predicted depressive symptoms. Higher levels of conflict, poorer family functioning and lower levels of autonomy were associated with more depressive symptoms. This study highlights the association between parent–teen interactions and psychological functioning in adolescents with primary headache. Implications for intervention are discussed.     

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.     

Reciprocal influences between parents' marital problems and adolescent internalizing and externalizing behavior

The present study examines reciprocal associations between marital functioning and adolescent maladjustment using cross-lagged autoregressive models. The research involved 451 early adolescents and their families and used a prospective, longitudinal research design with multi-informant methods. Results indicate that parental conflicts over child rearing predicted adolescent depressive symptoms and delinquency. In turn, these adolescent problems exacerbated parental conflicts over child rearing. Furthermore, conflict over child rearing served as the nexus through which more generalized marital dissatisfaction and adolescent adjustment problems were reciprocally interrelated. This research replicates earlier observations that marital problems intensify adolescent maladjustment and extends the literature by demonstrating that adolescent problems also predict marital conflict and ultimately marital dissatisfaction. In sum, the present study demonstrates that marital dissatisfaction, conflict over child rearing, and early adolescent adjustment difficulties are interwoven in a dynamic family system marked by reciprocity along these dimensions.     

Coping and Positive Affect in Adolescents of Mothers With and Without a History of Depression

The adolescent children of depressed mothers are at increased risk for depression, but little is known about protective factors for these children. Maintenance of positive affect in a stressful context may be an important marker of resilience. Mothers with (n = 34) and without (n = 38) a history of depression and their adolescent children completed questionnaires regarding adolescents’ coping and depressive symptoms and engaged in a 15 min videotaped interaction about family stress. Adolescents’ observed behaviors were coded using the Iowa Family Interaction Rating Scales. No significant differences emerged in observed behavior between adolescents of mothers with and without a history of depression. Higher levels of primary and secondary control coping and lower levels of disengagement coping were related to higher levels of observed positive mood and fewer depressive symptoms in adolescents. Observed positive mood was related to fewer depressive symptoms in adolescents, even after accounting for maternal history of depression and current maternal depressive symptoms. Results suggest the importance of considering positive affect in the context of family stress as a marker of resilience in adolescents at risk for depression. The current study provides evidence for coping as a protective factor, related to higher levels of positive affect and fewer depressive symptoms, in adolescents exposed to maternal depressive symptoms.     

Custodial mothers' perceptions of visitation and payment of child support by noncustodial fathers in families with low and high levels of preseparation interparent conflict

The purposes of this study were (a) to compare families with low (n = 47) and high (n = 44) levels of preseparation interparent conflict on mothers' report of paternal involvement (frequency, regularity, and length of visitation as well as regular payment of child support), children's adjustment, and mothers' level of stress; (b) to intercorrelate the four dimensions of paternal involvement; and (c) to relate the four dimensions of paternal involvement to children's age, children's gender, length of parental separation, children's adjustment, mothers' stress, paternal investment in the children, degree of environmental change, and children's level of interpersonal understanding. Children's mean age was 10.24 years, and parents had been separated a mean of 13.15 months. Compared to fathers in low-conflict families, fathers in high-conflict families visited less regularly and were less regular in their payment of child support. Mothers reported more adjustment problems for children in high-conflict families. All four dimensions of paternal involvement were intercorrelated only for high-conflict families. For both low- and high-conflict families, paternal involvement was related to paternal investment in the child but was unrelated to children's age, children's gender, and length of separation. Paternal involvement was most frequently related to children's adjustment in high-conflict families. For low-conflict families, paternal involvement was related low environmental change and children's well-developed interpersonal understanding skills.