Journal of Abnormal Child Psychology, VoL 20, No. L 1992

Family Functioning and Psychopathology Among Adolescents with Severe Emotional Disturbances Mark E. Prange, 1,2 Paul E. Greenbaum, 1 Starr E. Silver, 1 Robert M. Friedman, 1 Krista Kutash, 1 and Albert J. Duchnowski I

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-Ill), Diagnostic Interview Schedule for Children-Child Version (DISC-C), and the Self-Derogation Scale. Parents were administered FACES-III1 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 (1) < .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 psychopathology measures: DISC-C conduct disorder (1) < .01), depression (p < .05), alcohol~marijuana (p < .01), and CBCL externalizing symptoms (p < .01). These relationships did not deviate from linearity.

Manuscript received in final form July 29, 1991. 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. 1Research and Training Center for Children's Mental Health, Florida Mental Health Institute, University of South Florida, Tampa, Florida 33612. 2Address all correspondence, including reprint requests, to Dr. Mark E. Prange, Research and Training Center for Children's Mental Health, Department of Epidemiology and Policy Analysis, Florida Mental Health Institute, University of South Florida, 13301 Bruce B. Downs Boulevard, Tampa, Florida 33612-3899. 83

0091-0627/92/0200-0083506.50/09 1992PlenumPublishingCorporation

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During the 1988--1989 school year, the public school system identified a total of 377,295 students as having severe emotional disturbances (U.S. Department of Education, 1990). Independent of the public school system, National Institute of Mental Health sample survey data indicated that 164,024 adolescents (ages 10-17) were treated in either inpatient, partial hospital, or residential treatment centers in 1986 (Burns, 1990). The actual number of adolescents who have severe emotional disturbances, but who have not been identified by public school or mental health systems, is likely to be considerably higher (Knitzer, 1989). Nevertheless, despite the sizable number of children and adolescents identified as having severe emotional disturbances, no research currently exists on the relationship between family psychosocial functioning and adolescent psychopathology among this population (Friedman, 1988). Minuchin's family systems theory has proposed that the emotional boundaries of family members (i.e., cohesion) and family adaptation to developmental and external pressures (i.e., adaptability) are important parameters for evaluating family functioning (Minuchin, 1974). Theoretically, both cohesion and adaptability have been postulated to have a curvilinear relationship with the psychological health of family members such that extremes in either parameter characterize dysfunctional family systems (Minuchin, Rossman, & Baker, 1978). Cohesion has been theorized to reflect the extent to which family members are connected and involved with one another. Highly cohesive family systems are believed to be detrimental in that they promote overidentification with family members. On the other hand, low cohesive family systems also are believed detrimental as they promote limited intimacy. Adaptability refers to the family's capacity to alter its power structure based on developmental changes within the family and the demands of social institutions that impact the family. Extremely high adaptability has been characterized as an absence of social rules, erratic leadership, and inconsistent discipline. In contrast, low adaptability has been typified by families with rigid social rules and authoritarian modes of discipline (Minuchin, Rossman, & Baker, 1978; Olson, Portner, & Lavee, 1985). Olson, Sprenkle, and Russell's (1979) circumplex model of family functioning, using a self-report measure (i.e., Family Adaptability and Cohesion Evaluation Scale, or FACES-III), assessed the constructs of c o h e s i o n and adaptability. C o h e s i o n and adaptability have b e e n hypothesized to have a curvilinear relationship with family functioning for psychologically impaired families, similar to Minuchin's family systems model, but have a direct linear relationship among normal families (Olson, Portner, & Lavee, 1985).

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Additionally, Olson, Russell, and Sprenkle (1979) have divided cohesion and adaptability into four discrete levels that when permeated form 16 circumplex model types. These 16 family types have been further grouped into three basic family system types (i.e., balanced, midrange, extreme). Balanced family systems are moderate on both dimensions, midrange families are moderate on only one dimension, and extreme families are extreme on both dimensions (Olson, Portner, & Lavee, 1985). Although the circumplex model assumes two curvilinear dimensions of family functioning, researchers have assessed these dimensions both in a curvilinear and linear fashion, sometimes blurring the distinction between linear and nonlinear relationships (Henggeler, Burr-Harris, Borduin, & McCallum, 1991). Research, assuming a curvilinear model, has explored associations between balanced, midrange, and extreme family types and adolescent psychosocial functioning. Specifically, families with runaway adolescent girls and mother-son dyads from father-absent families were less likely to have balanced family types than control families (Bell, 1983; Rodick, Henggeler, & Hanson, 1986). Given the confusion over the linear vs. curvilinear models of cohesion and adaptability, several recent investigations tested both models in relation to conduct disorder behavior in adolescents and young adult prisoners. In two studies, cohesion and adaptability did not deviate significantly from linearity (Blaske, Bourdin, Henggeler, & Mann, 1989; Tolan, 1988). Both studies found low family cohesion was associated with adolescent conduct disorder behavior. In a third study, significant effects were obtained for each of three curvilinear measures and only one of two linear measures (Henggeler, Burr-Harris, Borduin, & McCallum, 1991). Other work assessing dimensions similar to cohesion and adaptability have found family functioning associated with childhood psychopathology: parent-child bonding, family communication (Gove & Crutchfield, 1982; Patterson, 1982; Stewart & Zaenglein-Senger, 1984), time spent with child (Canter, 1982), type of parental discipline (Gove & Crutchfield, 1982; Patterson, 1982; West & Farrington, 1973) and adequacy of parental supervision (Jensen & Eve, 1976). Additional evidence from detailed analyses of parental monitoring and discipline in homes of conduct disorder offenders has suggested that both parental rejection and lack of parental monitoring existed - qualities similar to low cohesion and low adaptability (Paterson & Bank, 1986). The purpose of this study was to explore the relationship between family psychosocial functioning and psychopathology among adolescents classified as severely emotionally disturbed by school and public mental

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health systems. Specifically, the role of family cohesion and adaptability from both adolescent and parent perspectives was investigated in relation to normative nonclinical families, adolescent psychiatric symptoms, and self-esteem.

METHOD

Subjects Subjects studied were 353 dyads of adolescents with severe emotional disturbances (SED) and one of their parents, usually a biological mother. These subjects were a subset of participants in the National Adolescent and Child Treatment Study (NACTS). NACTS is a longitudinal study of 812 children and adolescents, ages 8-18 years, with SED served in the public mental health and education systems. Study sites were identified by school and mental health facility administrators. Approximately half of the adolescents (54%) were enrolled in public school-based programs in accordance with public law 94-142. The remaining subjects resided in mental health facilities supported at least in part by public funds. Participants were recruited from six states: Colorado, Wisconsin, New Jersey, Alabama, Mississippi, and Florida. States were selected to represent the four geographic regions of the country. The study gathered in-depth information on adolescents' family characteristics, psychological functioning, services received, and outcomes over time (for a m o r e detailed description of NACTS methodology, see Greenbaum, Prange, Friedman, & Silver, 1991). All subjects were volunteers, who after being informed of the study's purpose agreed to participate. Interviews were conducted at the adolescents' placement site by trained interviewers with clinical or educational experience in interviewing. Adolescents and parents (or legal guardians) were paid for participating. Only adolescents who were 12 years and older were administered the FACES-III measure. Additionally, adolescents in residential placements who either had limited contact with their family in the previous 6 months or were not able to c o m p r e h e n d the questions after r e p e a t e d examples were not administered the FACES-III measure. In this study (N = 353), adolescents ranged in age from 12 to 18 years old with a mean age of 14 years, 9 months (SD = 1.73). Seventy-four percent of the sample were male. There were no significant age differences between males and females IF(l, 351) = 0.47, p > .05]. Sixty

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percent of the sample were enrolled in public school-based programs. The racial composition of the sample was 71% white, 19% black, 7% Hispanic, and 3% other minority (Native American, Asian American). Thirty-eight percent of the respondents were from families at or below the poverty level. Eighty-five percent of the sample lived in urban counties; 27% lived with both biological parents. Among parent respondents, 68% were biological mothers, 20% stepmothers, 7% biological fathers, and 5% stepfathers. Procedure

During 1985-1986, the first year of the NACTS study, all children were administered a series of standardized instruments. Parents or legal guardians were interviewed by telephone. Mothers were the respondent of choice for the phone interview. If there was no mother living in the home, the father or other parent figure (e.g., stepparent, foster parent) was interviewed. Instruments

Several standardized instruments were administered to adolescents and parents. Adolescents completed the following: (a) the Family Adaptability and Cohesion Evaluation Scale (FACES-Ill; Olson, Portner & Lavee, 1985); (b) the Diagnostic Interview Schedule for Children-Child Version (DISC-C; Revised June 1985; Costello, Edelbrock, Dulcan, Kalas, & Klaric, 1984); (c) and the Self-Derogation Scale (Kaplan & Pokomy, 1969). Parents completed the Child Behavior Checklist (CBCL; Achenbach & Edelbrock, 1983) and the FACES-III measure. The DISC-C is a structured interview schedule that contains 846 items reflecting the presence of current and past symptoms, emotions, and behaviors which correspond to DSM-III diagnostic criteria. Not all DISC-C items were administered to each subject because nonresponse to key items in a symptom domain required the interviewer to skip to the next section of the interview. The DISC-C yields 33 Axis I DSM-III diagnoses, except adjustment reactions. Additionally, the DISC-C generates 22 standardized symptom scores that reflect the extent and type of symptoms reported. The authors also have created combined symptom scores reflecting six broad symptom categories (i.e., conduct disorder, substance abuse, hyperactivity/attention deficit, schizophrenic, anxious, depressive). The self-derogation scale is a 10-item, 5-point Likert scale in which respondents indicated the degree to which self-statements (e.g., "I am a person

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of worth") were true. FACES-III is a 20-item self-report instrument measuring cohesion (e.g., emotional bonding, family boundaries, time spent together) and adaptability (e.g., leadership, discipline, negotiation, roles). Respondents indicated on a 5-point scale how well each item descn'bed their family. Cohesion and adaptability scores were obtained by summing items that load on these factors. Cohesion and adaptability discrepancy scores between parents and adolescents and between current and ideal scores also were calculated. 3 Olson et al. (1985) have suggested that differences between parent and adolescent ratings be analyzed separately as discrepancy scores. Additionally, based on normative data (Olson, Portner, & Lavee, 1985) adolescent and parent adaptability and cohesion scores were independently grouped into Olson's four cohesion and adaptability levels. FACES-III, DISC-C, and the self-derogation measure were administered to adolescents as part of a personal interview lasting approximately 1.5 to 2 hours. This interview included additional questions about their perceived problems, and the types of school and mental health services they received. The CBCL and FACES-III were administered to parents as part of a telephone interview that focused on the adolescents' problems and services.

Statistical Analyses A number of different analyses were used to explore family psychosocial functioning and its relationship to adolescent psychopathology. First, chi-square and analysis of variance (ANOVA) tests were performed to evaluate possible differences in sample characteristics between NACTS' subjects who were 12 and older and had complete data (n = 353) vs. those with missing data (n = 261). Second, to determine if among subjects with complete data there were differences by placement (residential/school), sex, family income level, race (white/other), on either cohesion or adaptability, a four way factorial (2 • 2 • 2 • 2) analysis of covariance (ANCOVA) was performed for each dependent variable with IQ and age as continuous covariates. Third, orthogonal polynomial ANOVAS were conducted on eight measures of adolescent psychopathology to evaluate if a linear or curvilinear treatment of the data was more appropriate. Fourth, the cor3Adolescents and parents were asked to report on both the ideal and perceived levels of family functioning so that four scores were obtained (cohesion, current and ideal; adaptability, current and ideal). There was little variability between ideal cohesion and adaptability scores; all scores were at the extreme high end. For these reasons, only analyses of perceived scores were reported.

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respondence between adolescent and parent reports of family functioning were examined by chi-square tests for matched samples and correlations were compared in a multitrait-multisource matrix. Fifth, a chi-square test for independent samples compared this study's results with normative data (Olson, McCubbin, Barnes, Larsen, Muxen, & Wilson, 1983). Sixth, Pearson product-moment correlations among adaptability and cohesion, and parent-child measures of adolescent problem behavior were calculated. Finally, hierarchical multiple regressions were used to predict adolescent problem behaviors using demographic variables, self-derogation, and cohesion/adaptability scores as predictors.

RESULTS

Missing Data Comparisons Four separate chi-square tests evaluated differences between subjects who had missing data (n = 261) and those who had complete data (N = 353) for gender, race (white/other), family income (at or below/above poverty level), and placement (residential/school). Significantly different relative frequencies were found for placement [~2 (N = 613, 1) = 44.5, p < .001] with the present sample having more school placed adolescents than those excluded from the sample (60% vs. 33%). One-way ANOVAs were also used to assess sample differences in IQ and age due to missing data. IQ scores demonstrated a significant difference IF(l, 613) = 39.2, p < .001], with the present sample having significantly higher IQs (M = 88.7, SD = 15.2 vs. M = 80.1, SD = 18.5). The observed significant sample differences for placement and IQ were consistent with the exclusion rules for administering the FACES-III measure.

Demographic and Placement Differences Among the 353 subjects with complete data, six separate four-way factorial (2 x 2 x 2 • 2) ANCOVAs were performed for each dependent variable with IQ and age as covariates. These analyses examined differences by placement (residential/school), gender (male/female), family income (at or below/above poverty level), and race (white/other), for cohesion, adaptability, and parent and adolescent difference scores. The analysis of parent and adolescent cohesion scores revealed significant effects for IQ and age as covariates IF(2, 350) = 6.31, p < .01; F(2, 350) = 5.38, p < .01, respectively]. Older, more intelligent adolescents viewed their family as more dis-

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engaged (i.e., low cohesion) in comparison to younger, less intelligent adolescents. No other main effects or interactions were significant among either parent, adolescent, or parent and adolescent cohesion difference scores. The analysis of parent adaptability scores revealed a significant interaction between gender and race [F(1, 352) = 7.06, p < .05]. Subsequent Neuman-Keuls analysis of the Gender • Race interaction indicated that parents of white female adolescents showed significantly higher adaptability scores (M = 27.32, SD = 5.34) in comparison to parents of nonwhite female adolescents (M = 24.74, SD = 6.57). None of the other cell means were significantly different from each other. The analysis of adolescent adaptability scores revealed a significant effect for IQ as a covariate IF(l, 352) = 16.87, p < .001] and a Placement • Family Income interaction [F(1, 352) = 4.16, p < .05]. Followup Neuman-Keuls analysis of the interaction indicated that school placed adolescents who were at or below the poverty level (M = 26.69, SD = 6.35) viewed their families as more structured in comparison to schoolplaced adolescents who were above the poverty level (M = 24.45, SD = 5.73). The analysis of parent and adolescent adaptability difference scores (i.e., parent-adolescent scores) revealed a significant effect for IQ as a covariate IF(l, 352) --- 12.15, p < .001] and a Gender x Race interaction IF(l, 352) = 5.09, p < .05]. Post hoc Neuman-Keuls analysis of the interaction indicated that white female adolescents had significantly higher adaptability difference scores (Mr = 2.08, SD = 6.74) in comparison to nonwhite female adolescents (M = -1.40, SD = 8.14). For IQ, greater adaptability difference scores were associated with higher IQs. There were no other significant differences associated with either parent or adolescent adaptability scores. Contrasting Linear vs. Curvilinear Treatment of Cohesion and Adaptability

Olson et al.'s (1979) circumplex model assumes that adaptability and cohesion are related curvilinearly rather than linearly to adolescent problem behaviors. To test if a curvilinear relationship existed, eight separate one-way orthogonal polynomial A N O V A S were conducted on each of Olson's four levels of adaptability and cohesion. These A N O V A S compared the four cohesion and adaptability levels on six DISC-C measures of adolescent psychopathology (i.e., conduct disorder, anxious, depression, schizophrenia, attention deficit, and alcohol/marijuana symptoms), and internalizing and externalizing CBCL scores. Only in predicting hyperac-

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Family Functioning and Psychopathology Table I. Relative Frequencies of Cohesion and Adaptability Levels Be-

tween Adolescents and Parentsa Relative frequency Adolescents Cohesion level Disengaged Separated Connected Enmeshed Adaptability level Rigid Structured Flexible Chaotic

Parents

42.2% 27.5% 21.8% 8.5%

> = <
and < indicate direction of significant differences (p < .0125) as tested by chi-Square tests for matched samples (N = 353). tive/attention deficit symptoms was a significant quadratic effect for adolescent adaptability IF(l, 352) = 4.75, p < .05] found. Planned followup contrasts revealed no significant mean differences for levels 1 vs. 4, 2 vs. 3, and a significant mean difference for levels 2 and 3 vs. levels 1 and 4 IF(l, 352) = 4.71, p < .05]. These cell mean differences support a curvilinear association between adolescent adaptability and hyperactivity/attention deficit symptoms. No other main effects showed significant deviations from linearity among parent and adolescent adaptability/cohesion scores. Additionally, when a Bonferroni (p < .006) adjustment was used to control for simultaneous testing, the overall quadratic effect for adolescent adaptability was not significant. Therefore, comparisons between balanced, midrange, and extreme family types were viewed as inappropriate.

Matched Group Comparisons Between Parents and Adolescents Chi-square tests for correlated samples were used to analyze parent's and adolescent's ratings of their families (Fleiss, 1981). Comparison of Olson et al.'s (1979) four cohesion levels (see Table I) revealed a significant difference between parent and adolescent family ratings [ 2 (N = 353, 3) = 21.35, p < .001]. The Bonferroni adjustment was used to control for simultaneous multiple testing. Thus, only comparisons at p < .0125 were considered significant. A significant difference between cohesion levels for adolescents and parents was found for disengaged [ 2 (N = 353, 1) = 26.88, p < .001]. Slightly more than 42% of the adolescents viewed their family as disengaged while only 24.4% of the parents viewed their family in this

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Prange et al. Table II. Cohesion and Adaptability Multitrait-Multisource Correlation Matrixa Respondent FACES-III measures Adolescent Cohesion Adaptability Parent Cohesion Adaptability

Adolescent

Parent

Cohesion

Adaptability

Cohesion

Adaptability

(.89)

.36b (.78)

.23b .05

-.06 .I 1c

(.92)

.19b (.83)

aNote: Values

on the diagonal are coefficient alphas. FACES-II! = Family Adaptability and Cohesion Evaluation Scale. bp < .01.

cp < .05. way. Additionally, adolescents had lower levels of connected and enmeshed when compared to ratings of their parents [X2 (N = 353, 1) = 5.19, p < .01; X2 (N = 353, 1) = 7.68, p < .01, respectively]. The distribution of Olson et al.'s (1979) four adaptability levels was not significantly different between adolescents and parents (see Table I). Given that the earlier A N C O V A analysis of parent and adolescent adaptability difference scores revealed a significant Gender x Race interaction, the distribution of Olson's four adaptability levels between parents and adolescents also was assessed separately for each gender by the two race categories. There were no significant differences with the Bonferroni adjustment (p < .0125) in the distribution of parent and adolescent adaptability levels.

Multitrait-Multisource Matrix of Cohesion and Adaptability A m u l t i t r a i t - m u l t i s o u r c e c o r r e l a t i o n matrix of p a r e n t s ' and adolescents' cohesion and adaptability scores is shown in Table II. Parent and adolescent cohesion scores were positively correlated (r = .23, p < .01). A positive, but weaker, relationship also was found for their adaptability scores (r = .11, p < .05). No significant correlations occurred between cohesion and adaptability if the source (i.e., parent vs. adolescent) differed. However, if the source was the same, adaptability and cohesion were positively correlated (adolescent, r = .36, p < .01; parent, r = .19, p < .01). The average heterotrait-same source correlation was significantly higher than the average same trait-heterosource correlation (p < .01). Mul-

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Table ElL Relative Frequencies of Cohesion Levels Among Clinical and Normative Adolescents and Parentsa Relative frequency Cohesion level

SED

Normativeb

Adolescents

Disengaged Separated Connected Enmeshed

(N = 353) 42.2% 27.5% 21.8% 8.5%

> = <
= < =

(N = 2224) 15.0% 31.0% 39.0% 15.0%

Parents

Disengaged Separated Connected Enmeshed

(N = 353) 24.4% 31.7% 28.9% 15.0%

aNote. The > and < indicate direction of significant differences (p < .0125) as tested by chi-Square tests. SED = serious emotional disturbances. bFrom Olson et al., 1983.

titrait-multisource correlations suggest a low level of agreement between adolescent and parent reports of family functioning, stronger evidence for source vs. trait variance, and acceptable internal consistency for both dimensions.

Independent Group Comparisons Between NACTS and Normative Samples Relative frequencies among the four cohesion levels were tested between normative data for nonclinical samples (Olson, et al., 1983) and NACTS' clinical sample. These comparisons were conducted using chisquare tests for independent groups with a Bonferroni adjustment (p < .0125). Table III shows relative frequencies of the four cohesion levels for normative and NACTS parents and adolescents. The distribution of the four cohesion levels was significantl); different between the two groups IX2 (N = 774, 3) = 47.08, p < .001]. Adolescents with SED had higher levels of disengaged and lower levels of connected and enmeshed compared to Olson et al.'s normative sample [~2 (N = 774, 1) = 40.22, p < .001; ~2 (N = 774, 1) = 18.82, p < .001; ~ (N = 774, 1) = 5.74, p < .01, respec-

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Table IV. Relative Frequencies of Adaptability Levels Among Clinical and Normative Adolescents and Parentsa Adaptability level

Relative frequency SED

Normativeb

Adolescents Rigid Structured Flexible Chaotic

(N = 353) 15.9% 29.5% 34.0% 20.7%

= = = =

(N = 421) 18.0% 32.0% 30.0% 20.0%

< = = >

(N = 2224) 16.0% 34.0% 34.0% 16.0%

Parents Rigid Structured Flexible Chaotic

(N = 353) 9.9% 29.5% 37.7% 22.9%

aNote. The > and < indicate direction of significant differences (p < .05) as tested by chi-Square tests. SED = serious emotional disturbance. bFrom Olson et al., 1983.

tively]. Table III also shows the relative frequencies of the four cohesion levels between normative and NACTS parents. The distribution of cohesion was significantly different between the two groups [~2 (N = 2577, 3) = 24.10, p < .001]. Parents of adolescents with SED had higher levels of disengaged and lower levels of connected when compared to Olson et al.'s (1983) normative sample [~2 (N = 2577, 1) = 18.10, p < .001; X2 (N = 2577, 1) = 19.74, p < .001, respectively]. T a b l e I V shows the relative f r e q u e n c i e s o f the f o u r adaptability levels a m o n g adolescents and p a r e n t s f r o m the O l s o n et al. (1983) and N A C T S samples. T h e distribution o f adaptability was n o t significantly different b e t w e e n the two a d o l e s c e n t g r o u p s [z2(N = 774, 3) = 1.98, p > .05]. H o w e v e r , the distribution o f adaptability was significantly diff e r e n t for p a r e n t r e p o r t s [X2 ( N = 2577, 3) = 19.35, p < .001]. T h e p a r e n t s o f a d o l e s c e n t s with S E D h a d h i g h e r f r e q u e n c i e s o f c h a o t i c a n d lower f r e q u e n c i e s o f rigid c o m p a r e d to the n o r m a t i v e s a m p l e [X2 ( N = 2577, 1) = 10.42, p < .01; X2 ( N = 2577, 1) = 11.02, p < .01, respectively].

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T a b l e V. C o r r e l a t i o n s B e t w e e n C o h e s i o n / A d a p t a b i l i t y a n d M e a s u r e s o f P s y c h o p a t h o l o g y a Respondent Adolescent Psychopathology symptom measures Externalizing Internalizing Self-derogation Conduct disorder Anxious Depression Schizophrenia A t t e n t i o n deficit Alcohol/marijuana

Parent

Cohesion

Adaptability

Cohesion

Adaptability

-.17 b -.23 b -.38 t' -.26 b -.13 b -.10 c -.28b

.11 c -.14d --

-.24 b -.10 c _.~5 b --.09 c -

--.12 c ---

-.19 b

-

aNote: O n l y c o r r e l a t i o n s t h a t are significant at p < .05 are shown. bp < .01. ~Th< .05. is v a l u e was c a l c u l a t e d w i t h a c u r v i l i n e a r t r a n s f o r m a t i o n o f a d a p t a b i l i t y scores.

Correlations and Hierarchical Multiple Regressions Among Family Functioning Ratings, Demographic Variables, and Psychopathology Measures Pearson product-moment correlations among adolescent problem behaviors, self-derogation, cohesion, and adaptability are reported in Table V. 4 Discrepancy scores were not reported for the correlational analyses because they had similar, but weaker, relationships as did cohesion and adaptability scores with the measures of psychopathology. Conduct disorder symptoms had the strongest relationship to adolescent and parent cohesion scores (r = -.38, p < .001, r = -.25, p < .001, respectively). For both parents and adolescents, correlations with cohesion suggest that low cohesion was associated with more conduct disorder, depressive, alcohol/marijuana, and CBCL externalizing symptoms. Additionally, among adolescents' cohesion scores, there was a significant (27 < .01) relationship with self-derogation and schizophrenic symptoms; greater adolescent self-derogation and schizophrenia was associated with lower family cohesion. In turn, parent cohesion scores were significantly correlated with CBCL internalizing symptoms. In contrast, parent and adolescent adaptability scores were only significantly correlated with conduct disorder 4Initial c o r r e l a t i o n s w e r e c a l c u l a t e d w i t h e a c h o f the 22 D I S C - C s y m p t o m scores. R e s u l t s f r o m t h e s e a n a l y s e s w e r e c o n s i s t e n t w i t h t h e six o v e r a l l D I S C - C s y m p t o m factors, as r e p o r t e d in T a b l e V. F o r p u r p o s e s o f brevity o n l y the c o r r e l a t i o n s w i t h the six D I S C - C s y m p t o m s u m s are reported.

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Table VI. Hierarchical Regression of Demographic Variables, Serf-Derogation and Cohesion/Adaptability on Psychiatric Symptom Scoresa Independent variables

Adjusted Beta

t

Dependent variable: DISC-C conduct disorder symptoms Age Parent with substance abuse problem Adolescent cohesion score Parent cohesion score

.19 .10 -.31 -.15

4.0b 1.9c --6.2b --3.0b

.21

Dependent variable: DISCoC alcohol/marijuana symptoms Age Female gender Adolescent cohesion score Parent cohesion score

.25 .10 -.22 -.13

4.9b 2,1 c --4.2t' -2.5 b

.17

Dependent variable: DISC-C depression symptoms Self-derogation symptoms Female gender Adolescent cohesion score

.27

5.5 b

.28 -.18

5.8b -3.6 b

.22

Dependent variable: CBCL externalizing symptoms Age Self-derogation symptoms Parent with substance abuse problem Parent cohesion score Parent adaptability

-.12 .15 .14 -.28 -.14

-2.2 c 2.8b 2.6b --5.3b -2.6 b

.13

aNote: n = 311. DISC-C = Diagnostic Interview Schedule for Children-Child Version; CBCL = Child Behavior Checklist. bp < .01. Cp < .05.

and anxiety symptoms. Finally, an adaptability-curvilinear score was calculated by computing the absolute difference between the subject's raw score and the mean score for the normative sample. The adolescent adaptabilitycurvilinear score was significantly correlated with attention deficit symptoms. Hierarchical multiple-regression analyses were used to test the relative contribution of cohesion and adaptability scores in predicting adolesc e n t p s y c h o p a t h o l o g y w h e n d e m o g r a p h i c c h a r a c t e r i s t i c s and self-derogation scores were controlled. In these analyses, independent variables were blocked into two sets (i.e., set 1 included demographic characteristics and self-derogation; set 2 included cohesion and adap-

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tability). The demographic set was entered into the regression equation first because of temporal priority, and because this provided for a more conservative test of the unique associations of cohesion/adaptability scores with adolescent psychopathology. The demographic set consisted of IQ, age, family composition (single biological mother/both biological parents/biological mother and step-father/biological father and stepmother), parent(s) or step-parent with past or present problems (substance abuse, mental illness, learning disability, criminal violations, or incarceration), and family income level (below or at poverty level). Among the present sample (N = 353) not all subjects had complete data on demographic and psychopathology measures. Four separate chisquare tests were performed to evaluate demographic differences between subjects (n = 311) who had complete data on measures of psychopathology vs. those who did not (n = 42). Specifically, gender, race (white/other), family income (at or below/above poverty level), and placement (residential/school) were analyzed. Significantly different relative frequencies were found only for gender [~2 (N = 353, 1) = 5.75, p < .01] with the present sample having more males than those excluded from the sample (77% vs. 61%, respectively). Separate one-way ANOVAs for IQ and age showed no significant differences among these variables. Hierarchical regression analyses were performed on six DISC-C symptom scores and internalizing and externalizing CBCL scores. After demographic variables and self-derogation scores were allowed to step into a model predicting adolescent psychopathology, four out of eight analyses showed significant effects for either cohesion or adaptability scores. Table VI summarizes the results for final regression models that included either cohesion or adaptability scores as independent variables. In the final model predicting conduct disorder symptoms, age, parental substance abuse, and parent and adolescent cohesion scores accounted for 21% of the total variance, adjusted for shrinkage. Low cohesion scores from both parents and adolescents were predictive of conduct disorder symptoms after age and parental substance abuse variance was removed. In contrast to cohesion scores, both age and parental substance abuse were positively associated with conduct disorder symptoms. In a second analysis predicting alcohol/marijuana symptoms, a similar final model was obtained except that gender replaced parental substance abuse as a predictor. The total adjusted variance accounted for with this model was 17%. In turn, for depression symptoms, 22% of the variance was accounted for by adolescent cohesion scores, gender, and self-derogation scores. Finally, in predicting CBCL externalizing symptoms, 13% of the variance was accounted for by age, selfderogation, parental substance abuse, and parental cohesion and adaptability scores. The regression beta weights for age, cohesion, and

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adaptability were negative. Both low adaptability and cohesion were associated with greater externalizing symptoms after age, self-derogation, and parental substance abuse variance was controlled.

DISCUSSION One of the primary purposes of this study was to describe cohesion and adaptability, two important dimensions of family functioning, among families with adolescents who have a severe emotional disturbance. The results demonstrated significant differences between parents and adolescents with SED and their normative nonclinical counterparts. On the cohesion dimension, both parents and adolescents with SED perceived their family relations more frequently as distant and lacking in emotional support than did their normative nonclinical counterparts. Specifically, adolescents with SEE) and their parents rated their families as more disengaged and less connected than normals did. In contrast, on the adaptability dimension, only parents of adolescents with SED reported less leadership, structure, and control over family activities than normative families did. Specifically, within normative families, parents reported more rigid and less chaotic levels than parents of adolescents with SED did. These results show that adolescents with SED have more discordant family relations, relative to their normative peers, suggesting that school and mental health systems need to be responsive to problems in family relations when providing services to these adolescents. Additionally, the field of family therapy has maintained the necessity of going beyond individually focused psychological treatments when attempting to address child and adolescent behavior problems. Consistent with this family systems approach, both school and mental health-based programs for adolescents with SEE) may be more efficacious when parents participate in the treatment process, and when family relations problems are addressed as needed. Indeed, there is empirical corroboration for this assumption (Mann, Borduin, Henggeler & Blaske, 1990). A secondary purpose of the study was to assess the relationship between cohesion/adaptability and adolescent psychopathology. Pearson correlations showed a significant relationship between adolescent and parent low family cohesion and externalizing, conduct disorder, depression, and alcohol/marijuana symptoms. For adaptability scores, parent and adolescent scores demonstrated weak, but significant, relationships with anxiety and conduct disorder symptoms. In an evaluation of linear or curvilinear treatment of FACES scores, only 1 out of 32 comparisons demonstrated that cohesion and adaptability deviated from linearity. In support of Olson et

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al.'s (1979) circumplex model, adolescent adaptability-curvilinear score showed a weak relationship with attention deficit/hyperactivity scores. Hierarchical regression analyses were also used to assess the relationship between adolescent psychopathology and cohesion/adaptability. These analyses demonstrated that after controlling for demographic variables and self-derogation, cohesion and adaptability add unique variance in predicting adolescent problem behaviors. Regression analyses on conduct disorder scores indicated that low parent and adolescent cohesion scores were associated with greater conduct disorder symptoms after age and parental substance abuse variance was controlled. Similarly, in predicting alcohol/marijuana symptoms, a final model with the same structure was obtained except that gender replaced parental substance abuse as a predictor. Both analyses support the view that the amount of difference between parent and adolescent perceptions of cohesion is uniquely related to conduct disorder and substance abuse problems (Cohen & Cohen, 1983). Additionally, adolescent cohesion was a significant predictor of depression symptoms, after gender and self-derogation variance was controlled. Finally, both low parental cohesion and adaptability were associated with greater CBCL externalizing symptoms after age, self-derogation, and parental substance abuse variance was controlled. The marked tendency among adolescents with conduct disorder or externalizing symptoms to describe their family relations as emotionally distant was consistent with prior work involving self-reported family functioning (Blaske et al., 1989; Henggeler, et al., 1991; Tolan, 1987). The relationship between depression and alcohol/marijuana symptoms, and cohesion scores was also not surprising given the comorbidity of depression, substance abuse, and conduct disorder diagnoses (Greenbaum et al., 1991). Nevertheless, it is not clear whether the low levels of cohesion observed were the results of problems involved in having an adolescent with behavior problems in the family or whether the low cohesion existed prior to the development of adolescent problems. In the assessment of cohesion and adaptability, noteworthy discrepancies have been found between different family members (Cole & Jordan, 1989). Matched group comparisons have demonstrated that adolescents perceive their families as having significantly less cohesion than do their parents. Interestingly, both normative and adolescents with SED view their family as more disengaged or less cohesive than their parents do. This adolescent-parent difference may reflect adolescents' striving for independence from the family unit (Olson et al., 1983). Unexpectedly, for clinical families, this difference in perception did not vary with age of the adolescent, whereas age as well as IQ were significantly related to lower cohesion scores for both parents and adolescents. Additionally, adaptability

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difference scores revealed a significant interaction, indicating that white female adolescents had significantly higher adaptability difference scores (parent-adolescent) than did nonwhite female adolescents. "Possibly, this may reflect ethnic differences in how family structure is defined and perceived. Additionally, the multitrait-multisource correlations indicated a low level of agreement between adolescent and parent reports of cohesion and adaptability. The average heterotrait-same source correlation was significantly greater than the average same trait-multisource correlation, demonstrating stronger evidence for source vs. trait variance. As used in this study, self-report ratings of the entire family rather than of family member dyads may have weakened the agreement between parent and adolescent scores because it forced the respondent to report the average amount of cohesion or adaptability for the family as a whole (Skinner, 1988). Parent and adolescent ratings at a dyad level may show better correspondence (Cole & Jordan, 1989). Nevertheless, global assessments of family functioning still have merit because they distinguished between clinical and nonclinical families and were found to significantly relate to adolescent problem behavior. The lack of strong agreement between parent and adolescent selfreports is further complicated by therapists' tendency to characterize families of adolescents with conduct disorder problems as enmeshed (Friedman, Utada, & Morrissey, 1987). From a family therapy perspective, it is possible for an adolescent to perceive an absence of emotional involvement, for a parent to report a low level of emotional connectedness within the family, and for therapists, focusing on personal boundaries, to perceive an enmeshed family structure. Clearly, future assessments of cohesion and adaptability will likely depend on who is being asked, and how these dimensions are being interpreted and assessed.

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Cohen, J., & Cohen, P. (1983).Applied mult~le regression~correlationana~sis for the behavioral sciences. Hillsdale, NJ: Erlbaum. Cole, D. A., & Jordan, A. E. (1989). Assessment of cohesion and adaptability in component family dyads: A question of convergent and discriminant validity. Journal of Counseling Psychology, 36, 456-463. Costello, A., Edelbrock, C., Dulcan, M., Kalas, R., & Klaric, S. (1984). Development and testing of the NIMH Diagnostic Interview Schedule for Children on a clinical population: Final report (contract RFP-DB-81-0027). Center for Epidemiological Studies, National Institute of Mental Health, Rockville, MD. Fleiss, J. L. (1981). Statistical methods for rates and proportions. New York: John Wiley & Sons. Friedman, A. S., Utada, A., & Morrissey, M. R. (1987). Families of adolescent drug abusers are "rigid": Are these families either "disengaged" or "enmeshed" or both? Family Process, 26, 131-148. Friedman, R. M. (1988). The role of therapeutic foster care in an overall system of care: Issues in service delivery and program evaluation. (Available from Research and Training Center for Children's Mental Health, Florida Mental Health Institute, Tampa, FL 33612). Gore, W., & Crutchfield, R. (1982). The family and juvenile delinquency. Sociological Quarter&, 23, 301-319. Greenbaum, P. E., Prange, M. E., Friedman, R. M. & Silver, S. E. (1991). Substance abuse prevalence and comorbidity with other psychiatric disorders among adolescents with severe emotional disturbances. Journal of the American Academy of Child and Adolescent Psychiatry, 30, 575-583. Henggeler, S. W., Burr-Harris, A. W., Borduin, C. M., & McCallum, G. (1991). Use of the family adaptability and cohesion evaluation scales in child clinical research. Journal of Abnormal Child Psychology, 19, 53-63, Jensen, G., & Eve, R. (1976). Sex differences in delinquency: An examination of popular sociological explanations. Criminology, 13, 427-448. Kaplan, H. B., & Pokorny, A. D. (1969). Self-derogation and psychosocial adjustment. Journal of Nervous and Mental Disease, 149, 421-434. Knitzer, J. (1989, February). Report on national study of services for children with emotional problems in public schools 1980s. Paper presented at the second annual research conference on Children's Mental Health Services and Policy: Building a Research Base, Tampa, FL. Mann, B. J., Borduin, C. M., Henggeler, S. W., & Blaske, D. M. (1990). An investigation of systemic conceptualizations of parent-child coalitions and symptom change. Journal of Consulting and Clinical Psychology, 58, 336-344. Minuchin, S. (1974). Families and family therapy. Cambridge, MA: Harvard University Press. Minuchin, S., Rossman, B. L., & Baker, L. (1978). Psychosomatic families. Cambridge, MA: Harvard University Press. Olson, D. H., McCubbin, H. I., Barnes, H. L., Larsen, A. S., Muxen, M. J., & Wilson, M. A. (1983). Families, what makes them work? Beverly Hills, CA: Sage Publications. Olson, D. H., Portner, J., & Lavee, Y. (1985). Fami~ adaptability and cohesion evaluation scales Ill. Unpublished manuscript available from Department of Family Social Science, University of Minnesota, St. Paul, MN 55117. Olson, D. H., Sprenkle, D. H., & Russell, C. (1979). Circumplex model of marital and family systems: I. Cohesion and adaptability dimensions, family types, and clinical applications. Fami& Process, 18, 3-28. Patterson, G. R. (1982). Coercive ram@ process. Eugene, OR: Castalia. Patterson, G. R., & Bank, L. (1986). Bootstrapping your way in the nomological thicket. Behavioral Assessment, 8, 49-73. Rodick, J., Henggeler, S., & Hanson, C. (1986). An evaluation of Family Adaptability and Cohesive Evaluation Scales (FACES) and the circumplex model. Journal of Abnormal Child Psychology, 14, 7%87. Skinner, H. (1988). Self-report instruments for family assessment. In T. Jacobs (Ed.), Family interaction and psychopathology (pp. 427-452). New York: Plenum Press.

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