Individual characteristics and peer relations of psychiatrically hospitalized aggressive youths: implications for treatment.

OBJECTIVE: This study identified individual and peer-relations problems of inpatient youths who are aggressive, and whether youths who are aggressive in two settings have greater treatment needs than youths who are aggressive in one setting only. METHODS: 85 youths aged 10 to 16 years who were consecutively admitted to a psychiatric facility served as participants. Based on ratings by parents and hospital staff, youths were identified as aggressive in the community only, aggressive in the hospital only, aggressive in both settings, or nonaggressive. Dependent measures consisted of youth self-reports and ratings by parents and hospital staff. RESULTS: Youths who demonstrate aggressive behavior in two settings have more nonaggressive behavior problems, more disturbed peer relations, and more hostile thinking than do nonaggressive youths, and some youths, although they may behave aggressively during hospitalization, have similar treatment needs as nonaggressive youths. CONCLUSIONS: Mental health professionals who work with youths in psychiatric settings need to develop treatment plans that directly address the more severe externalizing problems, hostile thinking, and peer problems of aggressive youths over and above that of nonaggressive youths, and should be aware that youths who behave aggressively during hospitalization may not have problems more severe than those of nonaggressive youths.

Multisystemic treatment of criminality and violence in adolescents.

OBJECTIVE: To discuss the emergent success of multisystemic therapy (MST), a family-based therapeutic approach that has been viewed as a promising treatment for violence and other serious antisocial behaviors in adolescents. METHOD: The empirical underpinnings, theoretical foundation, and clinical features of MST are described, followed by a brief review of studies of MST effectiveness with serious juvenile offenders. RESULTS: The theoretical foundation and clinical features of MST draw upon empirical findings regarding the multidetermined nature of serious antisocial behavior as well as upon social-ecological models of behavior in which the youth and family's school, work, peers, and neighborhood are viewed as interconnected systems with dynamic and reciprocal influences on the behavior of family members. In controlled studies with serious juvenile offenders, MST has demonstrated long-term reductions in criminal activity, violent offenses, drug-related arrests, and incarceration. CONCLUSIONS: The success of MST can be attributed primarily to (1) the match between MST intervention foci and empirically identified correlates/causes of criminality and violence in adolescents (e.g., parental discipline, family affective relations, peer associations, school performance) and (2) the flexible use of well-validated intervention strategies in the natural environment.

Multisystemic treatment of serious juvenile offenders: long-term prevention of criminality and violence.

This article examined the long-term effects of multisystemic therapy (MST) vs. individual therapy (IT) on the prevention of criminal behavior and violent offending among 176 juvenile offenders at high risk for committing additional serious crimes. Results from multiagent, multimethod assessment batteries conducted before and after treatment showed that MST was more effective than IT in improving key family correlates of antisocial behavior and in ameliorating adjustment problems in individual family members. Moreover, results from a 4-year follow-up of rearrest data showed that MST was more effective than IT in preventing future criminal behavior, including violent offending. The implications of such findings for the design of violence prevention programs are discussed.

Characteristics of anger expression in depressed children.

OBJECTIVES: To examine anger expression styles in depressed and nondepressed children and to investigate whether the relation between depression and anger expression was mediated by family variables. METHOD: From a sample of 100 psychiatric inpatient children, 11 depressed children and 11 matched nondepressed psychiatric controls were compared on two self-report measures, the Pediatric Anger Expression Style and the Family Adaptability and Cohesion Evaluation Scales-III-K. RESULTS: Depressed children reported significantly more difficulty maintaining cognitive control of their anger than did nondepressed children who were psychiatric inpatients. Family cohesion and adaptability were not found to have an effect on this relationship. No significant differences were found with respect to the tendency to deny or suppress anger or the tendency to express anger aggressively. CONCLUSIONS: Depressed children experienced more difficulties expressing their anger using a controlled/cognitive style than nondepressed (externalizing) children. The lack of a mediating role of family variables suggests that anger expression styles may be more related to the characteristics of depression in children, a finding that has clinical implications for addressing treatment of depressed children.

Perceived family and social support: impact on children.

OBJECTIVE: The purpose of this study was to investigate the relation of children's perceived family and social support to their behavior and hopelessness. METHOD: Subjects were 100 child psychiatric inpatients who completed a series of self-report measures, including the Social Support Questionnaire-Self Report, the Scales of Independent Behavior, and the Hopelessness Scale for Children. RESULTS: Children who perceived lower levels of family and social support were more withdrawn or inattentive and were more harmful to others, damaging to property, and uncooperative. In addition, children who reported fewer supportive persons in their lives had higher levels of hopelessness. CONCLUSIONS: These data emphasize the connection between social support systems, psychopathology, and hopelessness. These relationships may indicate that children need a sense that they are cared for and supported if they are to avoid serious problems and feelings of hopelessness.

Children's concepts of the family.

The past decade has witnessed increased research emphasis on children's developing conceptions of their social environment. In the present study, 64 children in grades 1 through 6 were interviewed to examine age-related changes in their understanding of the concept of family. The study also explored whether children's developing conceptions of the family were mediated by their own family structures. Results indicated five levels of family concept understanding that reflected a growing (i.e., age-related) facility in children's application of kinship criteria across traditional and nontraditional family groupings. However, the sophistication of children's understanding of the family was not related to the structure of their own families. These findings suggest that children's level of cognitive development is more important for their comprehension of the family than the specific experiences derived from living within their own unique family. Implications of these findings for mental health professionals who work with families in transition are discussed.

The ecology of adolescent maltreatment: a multilevel examination of adolescent physical abuse, sexual abuse, and neglect.

This study examined the individual characteristics, family relations, and stress/social support of 50 maltreated adolescents and their mothers. Dyads were divided into 4 demographically similar groups: neglect, physical abuse, sexual abuse, and nonmaltreatment control. Results show that adolescent neglect was primarily associated with extrafamilial difficulties and social isolation. Adolescent physical abuse was linked more with rigidity in family relations, poorer maternal understanding of child developmental skills, and adolescent externalizing behaviors. In contrast, adolescent sexual abuse was related to maternal emotional problems and adolescent internalizing behaviors. In general, each group of maltreated adolescents experienced lower levels of family cohesion, more attention problems, and more daily stress than did their nonmaltreated counterparts. Findings are consistent with an ecological model of adolescent maltreatment.

Use of the Family Adaptability and Cohesion Evaluation Scales in child clinical research.

Although the FACES has become a widely used instrument for assessing children's family relations, the possible linearity vs. curvilinearity of its cohesion and adaptability scales has been treated inconsistently by investigators. This study evaluated whether samples of adolescent repeat offenders, young adult prisoners, and adolescent nonoffenders were discriminated better by a linear or curvilinear treatment of the FACES scores. Between-groups comparisons showed that significant effects were observed for each of the three curvilinear measures (cohesion-curvilinear, adaptability-curvilinear, distance-from-center) and only one of the two linear measures (cohesion-linear). These findings support the superiority of a curvilinear treatment of the FACES. In light of these findings, it is suggested that investigators who use FACES evaluate the linearity of the scales and determine whether a linear or curvilinear treatment of the data produces more meaningful results.

A critical review of psychotherapy outcome studies with adolescents: 1978-1988.

Although interest in identifying effective psychotherapies for adolescent mental health problems has increased dramatically in the last decade, there have been few attempts to summarize and integrate the recent empirical literature on psychotherapy outcomes with adolescents. The present paper reviews the methods and findings of adolescent psychotherapy outcome studies published from 1978 to 1988. Evaluations of individual psychotherapy with adolescents generally reveal positive short-term outcomes, but long-term outcomes are still to be determined. Evaluations of systemic therapies (especially family therapy) with adolescents often reveal positive outcomes that are maintained over extended follow-up periods. Recommendations are presented for improving the methodology of future psychotherapy outcome studies with adolescents.

An investigation of systemic conceptualizations of parent-child coalitions and symptom change.

Two important theoretical assumptions of family therapy were examined: (a) Child behavior problems are associated with cross-generational coalitions, and (b) treatment of these coalitions using family therapy leads to decreases in individual symptomatology. Ss were 45 delinquent adolescents assigned to multisystemic therapy (MST) or individual therapy and 16 well-adjusted adolescents. Pretreatment and posttreatment assessments included measures of observed family relations and self-reported symptoms. Cross-generational coalitions were more evident in families of delinquents vs. families of well-adjusted adolescents. In addition, changes in adolescent and paternal symptoms in the MST group were linked with changes in marital relations. Implications for systemic conceptualizations of symptom maintenance and change are highlighted.

Development of the concept of family in elementary school children.

Two studies were conducted to examine the relation of age, gender, and family structure to children's understanding of the concept of family. In Study 1,387 children in Grades 1 through 6 were asked to classify various groupings of individuals as constituting or not constituting a family. Results showed both age and gender differences in children's conceptions of families: Younger children, especially boys, generally used concrete, absolute criteria for defining a family; younger girls were similar to older children in that they were more likely to employ abstract, relational criteria for family definition. Results also showed that children's own family structure was not related to their family definitions. In Study 2, 64 children from the original sample were given a measure of cognitive ability to examine whether differences in cognitive development or differences in socialization were a likely source of younger girls' more advanced understanding. Gender differences in cognitive ability did not emerge, suggesting that the gender effects in Study 1 reflected differences in the socialization of boys and girls. Implications of the findings for understanding children's reactions to family disruption are discussed.

The family relations of female juvenile delinquents.

This study evaluated the assumption that the family relations of female delinquents are more dysfunctional than those of male delinquents. In a 2 X 2 (gender by delinquency status) design, 32 intact families were matched on demographic variables, and the male and female delinquents were matched on arrest data. Mothers, fathers, and adolescents were administered a self-report personality inventory and were observed during a family interaction task. Consistent with the extant literature, families of delinquents had low rates of facilitative information exchange and delinquent adolescents were more dominant toward their mothers than were well-adjusted adolescents. It was also observed that fathers of delinquents were more dominant toward their wives than were fathers of well-adjusted adolescents. In regard to the primary purpose of the study, it was observed that mother-adolescent dyads and parents in families of female delinquents had higher rates of conflict than their counterparts in families of male delinquents. In addition, the fathers of female delinquents were more neurotic than the fathers of male delinquents. These findings provide some support for the view that the families of female delinquents are especially dysfunctional.

Family interactions in black, lower-class families with delinquent and nondelinquent adolescent boys.

The interaction patterns of 32 black, lower-class family triads (mother-father-son), divided into two equal groups by the son's delinquency status, were assessed across self-report and observational measures of family affect, conflict, and dominance. In support of previous research with white, middle-, and lower-middle class families, the results generally indicated that families with delinquent boys were less warm and more conflictual than families with nondelinquent boys. Relative to parents of nondelinquents, parents of delinquents were more conflictual on expressive family issues than on instrumental issues. In addition, the results showed that the content of the family interaction task (expressive vs. instrumental) influenced observed patterns of intrafamily dominance. The theoretical and practical implications of these findings are discussed.

Models of divorce therapy: an overview.

This paper provides an overview of the rapidly growing area of divorce therapy and describes three models that are currently used by clinicians: psychotherapy only, divorce mediation, and conciliation court intervention. Some tentative conclusions are drawn regarding the efficacy of each of these different models. Potential applications and training recommendations related to this area are also provided.