Family Interaction Styles of Children with Depressive Disorders, Schizophrenia-Spectrum Disorders, and Normal Controls

Family interaction processes during a problem-solving task were examined in children with depressive disorders, children with schizophrenia-spectrum disorders, and a normal control group of community children screened for the absence of psychiatric disorder. Major findings were: a) children with depressive disorders were more likely than children with schizophrenia-spectrum disorders and children with no psychiatric disorder to direct guilt-inducing comments toward their parents; and b) parents of children with schizophrenia-spectrum disorders were more likely to direct harsh critical comments toward the child than were parents of depressed children or parents of normal controls. In addition, children\u27s and mothers\u27 use of benign criticism was linked, while children\u27s harsh criticism was associated with intrusion from the father, and children\u27s self-denigrating comments were related to specific paternal criticism. Implications of these results for understanding transactional processes associated with childhood-onset depressive and schizophrenia-spectrum disorders are discussed

Family-Expressed Emotion, Childhood-Onset Depression, and Childhood-Onset Schizophrenia Spectrum Disorders: Is Expressed Emotion a Nonspecific Correlate of Child Psychopathology or a Specific Risk Factor for Depression?

Expressed emotion (EE) was examined, using the brief Five Minute Speech Sample measure, in families of (1) children with depressive disorders, (2) children with schizophrenia spectrum disorders, and (3) normal controls screened for the absence of psychiatric disorder. Consistent with the hypothesis of some specificity in the association between EE and the form of child disorder, rates of EE were significantly higher among families of depressed children compared to families of normal controls and families of children with schizophrenia spectrum disorders. Within the depressed group, the presence of a comorbid disruptive behavior disorder was associated with high levels of critical EE, underscoring the need to attend to comorbid patterns and subtypes of EE in future research

A randomized clinical trial comparing family-focused treatment and individual supportive therapy for depression in childhood and early adolescence

OBJECTIVE: Despite the morbidity and negative outcomes associated with early-onset depression, few studies have examined the efficacy of psychosocial treatment for depressive disorders during childhood. Integrating family in treatment could have particularly salutary effects during this developmental period. This trial compared immediate posttreatment effects of family-focused treatment for childhood depression (FFT-CD) with those of individual supportive psychotherapy (IP) for children 7 to 14 years old with depressive disorders. METHOD: Children were randomized to 15 sessions of FFT-CD (n = 67) or IP (n = 67) over 4 months. The primary treatment outcome was adequate clinical depression response, defined as at least a 50% decrease in score on the Children's Depression Rating Scale-Revised (CDRS-R). Additional outcomes included patient-centered outcomes (parent- and child-reported treatment satisfaction), remission (defined as CDRS-R score ≤28), change in continuous CDRS-R score, and change in child and parent reports of depressive and non-depressive symptoms and social adjustment. RESULTS: Significant improvement was evident across groups for depressive and non-depressive symptoms, global response, and functioning and social adjustment. Compared with children randomized to IP, children randomized to FFT-CD showed higher rates of adequate clinical depression response (77.7% versus 59.9%; number needed to treat = 5.72; odds ratio 2.29; 95% CI 1.001-5.247; t = 1.97, p = .0498). Across treatments, families reported high satisfaction; compared with IP families, FFT-CD families reported greater knowledge and skills for managing depression. There were no significant differences between treatment arms on secondary outcomes. CONCLUSION: Results support the value of psychosocial intervention, emphasize the important role that families play, and highlight the potential for FFT-CD for supporting recovery in children with depression. Clinical trial registration information-Systems of Support Study for Childhood Depression; http://clinicaltrials.gov; NCT01159041.R01 MH082856 - NIMH NIH HHS; R01 MH082861 - NIMH NIH HH

Family-focused treatment for childhood depression: model and case illustrations

Although the evidence base for treatment of depressive disorders in adolescents has strengthened in recent years, less is known about the treatment of depression in middle to late childhood. A family-based treatment may be optimal in addressing the interpersonal problems and symptoms frequently evident among depressed children during this developmental phase, particularly given data indicating that attributes of the family environment predict recovery versus continuing depression among depressed children. Family-Focused Treatment for Childhood Depression (FFT-CD) is designed as a 15-session family treatment with both the youth and parents targeting two putative mechanisms involved in recovery: (a) enhancing family support, specifically decreasing criticism and increasing supportive interactions; and (b) strengthening specific cognitive-behavioral skills within a family context that have been central to CBT for depression, specifically behavioral activation, communication, and problem solving. This article describes in detail the FFT-CD protocol and illustrates its implementation with three depressed children and their families. Common themes/challenges in treatment included family stressors, comorbidity, parental mental health challenges, and inclusion/integration of siblings into sessions. These three children experienced positive changes from pre- to posttreatment on assessor-rated depressive symptoms, parent- and child-rated depressive symptoms, and parent-rated internalizing and externalizing symptoms. These changes were maintained at follow-up evaluations 4 and 9 months following treatment completion.K23 MH101238 - NIMH NIH HHS; R01 MH082856 - NIMH NIH HHS; R01 MH082861 - NIMH NIH HH

Social, Academic, and Behavioral Competence of Depressed Children: Relationship to Diagnostic Status and Family Interaction Style

This study compared the social adjustment and academic peifonnance of 15 psychiatrically hospitalized children with depression to 14 children with schizophrenia spectrum disorders and 20 nonnal community children, ages 7-14. The relationship between children\u27s interpersonal and academic competence and the quality of direct family interactions was also examined. Analyses revealed an association between children\u27s adaptive functioning and both diagnostic status and family transactional processes, as assessed by two 10-minute conflict-solving tasks. Major findings were as follows: (a) depressed children and children with schizophrenia spectrum disorders received similarly low ratings of social competence in comparison to normal controls; (b) academic peifonnance of depressed children was similar to nonnal controls and better than children with schizophrenia spectrum disorders; and (c) children with poorer social competence and more behavioral problems were more likely to have parents who showed negative affect during family problem-solving tasks. The implications of these results for understanding the relationship between psychiatric impairment and children\u27s social and academic development were discussed

Children with Schizophrenia-spectrum Disorders: Thought Disorder and Communication Problems in a Family Interactional Context

Thought disorder and communication patterns during an interactional task were examined in families of children with schizophrenia-spectrum disorders (schizophrenia and schizo typal personality disorder), depressed children, and normal controls. Children with schizophreniaspectrum disorders showed significantly more thought disorder than their normal peers; levels of thought disorder among depressed children fell between those observed in the other two groups but did not differ significantly from either of them. Similarly, mothers of children with schizophrenia-spectrum disorders showed more thought disorder than mothers of normal control children but did not differ from mothers of depressed children. Children with schizotypal personality disorder did not differ from children with schizophrenia. These findings demonstrate that the thought disorder present in childhood-onset schizophrenia and schizotypal personality disorders is manifest in an important social context, the family