Perceptions of problem behavior in adolescents' families: perceiver, target, and family effects.

Considerable research has focused on the reliability and validity of informant reports of family behavior, especially maternal reports of adolescent problem behavior. None of these studies, however, has based their orientation on a theoretical model of interpersonal perception. In this study we used the social relations model (SRM) to examine family members' reports of each others' externalizing and internalizing problem behavior. Two parents and two adolescents in 69 families rated each others' behavior within a round-robin design. SRM analysis showed that within-family perceptions of externalizing and internalizing behaviors are consistently due to three sources of variance; perceiver, target, and family effects. A family/contextual effect on informant reports of problem behavior has not been previously reported.

Healthy physical coactivity in parent-child dyads of children with overweight.

Parent and child physical activity levels are correlated, but are they interdependent? A dyadic version of the theory of planned behavior (TPB) was developed to investigate interdependence in the motivation and intention of parents and their children with overweight to engage in healthy physical coactivity (HPCA). Baseline measures of the TPB constructs (subjective norms, attitude, perceived behavior control, and intention) for both dyad members were used to predict parent-reports of their actual HPCA at 12 weeks using the actor-partner interdependence model. The sample included 65 mother-child dyads and 48 father-child dyads from 66 predominantly Caucasian families. In mother-child dyads, a positive attitude toward HPCA predicted each person's own intention to engage in HPCA (both actor effects). In addition, mother's perceived behavior control over HPCA predicted the child's intention to engage in HPCA (a partner effect). Mother's attitude toward HPCA also predicted mother-reported HPCA. In father-child dyads, perceived behavior control predicted each person's own intention to engage in HPCA (both actor effects). The child's intention was also predicted by the child's subjective norms (an actor effect) and the father's perceived behavior control (a partner effect). Only the child's perceived behavior control predicted father-reported HPCA. There is interdependence in the motivation to engage in HPCA because both parents' perceived behavior control predicted their child's intention. However, interventions targeting mother's attitude toward HPCA with her child and the child's perceived behavior control in relation to the father would be most likely to increase HPCA in the parent-child dyads of children with overweight. (PsycINFO Database Record

Sources of perceived responsiveness in family relationships.

Perceived responsiveness has become one of the most important constructs in the relationship sciences. It is central to the development of a secure attachment style, the experience of social support, an internal locus of control, and the sense of control in close relationships. Conversely, an unresponsive environment is associated with learned helplessness and depression. Viewed through the lens of the social relations model (SRM), perceived responsiveness in family relationships could have multiple sources: the perceiver; the target or partner; the perceiver-target relationship; and the family group. This study used the SRM to determine the relative importance of these sources of perceived responsiveness in the relationships of 207 two-parent two-child families. Characteristics of the perceiver and the target each accounted for about 25% of the systematic variance in perceived responsiveness, whereas the perceiver-target relationship accounted for approximately 48%. At the individual level of analysis, reciprocity of perceived responsiveness was pervasive in the family relationships of the two children. Regardless of age, young people who generally perceived others as responsive were generally perceived by others as responsive. At the dyadic level of analysis, reciprocity was present in two dyads: mother-father and older child-younger child. Reliable target variances support the view that perceived responsiveness is not just "inside the head" of the perceiver, and reciprocity correlations suggest potentially useful systemic interventions. (PsycINFO Database Record

Level validity of self-report whole-family measures.

This article introduces an approach to testing the level validity of family assessment instruments (i.e., whether a family instrument measures family functioning at the level of the system it purports to assess). Two parents and 2 adolescents in 69 families rated the warmth in each of their family relationships and in the family as a whole. Family members' ratings of whole-family warmth assessed family functioning not only at the family level (i.e., characteristics of the family as a whole) but also at the individual level of analysis (i.e., characteristics of family members as raters), indicating a lack of level validity. Evidence was provided for the level validity of a latent variable based on family members' ratings of whole-family warmth. The findings underscore the importance of assessing the level validity of individual ratings of whole-family functioning.

Examining the validity of self-report assessments of family functioning: a question of the level of analysis.

Family assessment instruments attempt to measure family functioning at a particular level of the family system: individual, dyad, or family as a whole. This article introduces the concept of level validity, that is, whether an assessment measures family functioning at the level that it was intended to measure. The authors argue that whenever higher-order factors (e.g., dyadic subsystems) are the target of a measure, these factors should explain variance that is independent of their lower-order constituents (e.g., individual-level characteristics). Previously published data targeting dyadic subsystems within the family were reanalyzed using a model that controls for lower-order effects. Dyad-level factors rarely emerged independent of individual-level factors and, when they did, they did not replicate across samples. The results suggest that level validity should be tested and reported along with other aspects of construct validity before accepting such measures as valid assessments of family functioning.

Analyzing nonindependent outcomes in couple therapy using the actor-partner interdependence model.

The nonindependent components of couple data require data-analytic strategies tailored to the interpersonal processes occurring between relationship partners. This article examines the benefits of a specifically dyadic analytic method, the actor-partner interdependence model (APIM), for evaluating interpartner influence across time. Both conceptual and methodological features of the APIM are exemplified by applying this model to observations of negative and positive affect and global distress in spouses participating in a randomized trial of couple therapy. In addition to elucidating specific advantages of the APIM relative to alternative data-analytic strategies, the current results shed new light on previous findings from a comparative treatment outcome study evaluating behavioral and insight-oriented approaches to couple therapy.

Application of the social relations model to family assessment.

A family assessment serves two primary purposes: the guidance of clinical interventions and the evaluation of clinical outcomes. To support these activities, a family assessment should provide a level of descriptive detail with respect to family functioning that is commensurate with a family systems perspective. Unfortunately, most widely used self-report family assessment instruments do not provide that level of detail. This article presents a descriptive approach to family assessment that is based on the application of the social relations model (SRM; D. A. Kenny & L. La Voie, 1984) to round-robin family data. In contrast to previous presentations of the SRM, this article outlines the procedure for assessing a single family, thus translating SRM analysis from a basic research tool into an applied, clinical assessment tool.

Partner interdependence and coping with life-threatening illness: the impact on dyadic adjustment.

General systems theory and Bodenmann's theory of dyadic coping (Bodenmann, 1997) provided the framework for exploring the impact of life-threatening illness on the dyadic relationship. The sample included 193 dyads experiencing the stress of treatment by bone-marrow transplantation (BMT) for cancer which had not responded to first-line therapies. A prospective design over 12 months included four measurements at designated periods in the treatment process. Except for the symptom checklist, which was completed only by the recipient, data were obtained on each measure from both partners at each time point. The primary outcome was dyadic adjustment measured by the Dyadic Adjustment Scale (DAS; Spanier, 1976). A general linear mixed model indicated that dyadic adjustment was stable over time for BMT recipients and family caregivers; however, caregivers had lower mean values on dyadic adjustment than recipients, and higher mean values on negative affect. Bayesian path analysis was used to test actor-partner interdependence models reflecting the theory of dyadic coping. Models exhibited adequate fit to the data and indicated that apart from baseline dyadic adjustment, partner-related coping had the greatest positive impact on dyadic adjustment over the trajectory for both recipients and their caregivers. Limitations in resources for health care occurring on a national level have increased the extent of in-home care for acutely ill family members, including BMT recipients. This has serious implications for the mental health of the caregiver and for the integrity of the family system. Mental health assessment and integration of supportive interventions would be important in the prevention of secondary psychosocial morbidity.

Change in neuropsychological functioning over one year in youth at clinical high risk for psychosis.

Schizophrenia and related psychotic disorders are associated with significant neuropsychological (NP) impairments. Yet the onset and developmental evolution of these impairments remains incompletely characterized. This study examined NP functioning over one year in a sample of youth at clinical high risk (CHR) for psychosis participating in a treatment study. We assessed functioning across six cognitive domains at two time points in a sample of 53 CHR and 32 healthy comparison (HC) subjects. Linear regression of HC one-year scores was used to predict one-year performance for CHR from baseline scores and relevant demographic variables. We used raw scores and MANOVAs of the standardized residuals to test for progressive impairment over time. NP functioning of CHR at one year fell significantly below predicted levels. Effects were largest and most consistent for a failure of normative improvement on tests of executive function. CHR who reached the highest positive symptom rating (6, severe and psychotic) on the Structured Interview of Prodromal Syndromes after the baseline assessment (n = 10/53) demonstrated a particularly large (d = -1.89), although non-significant, discrepancy between observed and predicted one-year verbal memory test performance. Findings suggest that, although much of the cognitive impairment associated with psychosis is present prior to the full expression of the psychotic syndrome, some progressive NP impairments may accompany risk for psychosis and be greatest for those who develop psychotic level symptoms.

Comparative Effectiveness of a 12-Week Physical Activity Intervention for Overweight and Obese Youth: Exergaming with "Dance Dance Revolution".

OBJECTIVE: Experts recommend that children engage in 60 minutes of daily moderate to vigorous PA (PA), but few meet these goals. Exergames like "Dance Dance Revolution" (DDR) (Konami of America, Redwood City, CA) have the potential to provide PA. We sought to determine if DDR would boost PA among overweight or obese children. SUBJECTS AND METHODS: Children over the 85th percentile for body mass index (BMI) and between 9 and 17 years old were randomly assigned to receive DDR+pedometers (treatment group) or pedometers only (comparison group). PA levels were tracked for 12 weeks by self-report, pedometer, and accelerometer data. RESULTS: Sixty-five families completed the study. The average BMI percentile of the participant was over 96 percent. Despite randomization, participants in the treatment (DDR) group were more often male, older, and heavier than participants in the comparison group. Self-reported frequency of moderate to vigorous PA increased significantly from baseline to 12 weeks for the treatment group and declined for the comparison group. Accelerometer results indicated a significant decline in moderate activity over time for the comparison group. However, there were no significant between-group differences based on the accelerometer or pedometer data. CONCLUSION: Based on self-report measures, DDR may have increased PA levels in obese and overweight children. However, we are led to question the validity of these results because analyses based on objective measures do not confirm them. Accelerometer results indicate that although DDR did not boost PA, it may have helped to slow the decline in moderate to vigorous PA over time.

Deeds matter: daily enacted responsiveness and intimacy in couples' daily lives.

Perceived responsiveness is a fundamental ingredient of satisfying romantic relationships, especially insofar as it facilitates the development of intimacy. This study investigates how partner's concrete responsive acts-named here enacted responsiveness-affect the perception of responsiveness in the daily life of dating couples. Additionally, the subsequent association of perceived partner responsiveness with intimacy was examined. Data from both partners in 102 young heterosexual couples were gathered simultaneously 4 times a day over one week. Multilevel analysis within the framework of the actor-partner interdependence mediation model showed that perception of responsiveness is predicted by partner's enacted responsiveness. However, own enacted responsiveness also predicts own perception of responsiveness in the partner, suggesting a projection process. Perception of responsiveness, in turn, predicts not only own but also partner's feelings of intimacy, demonstrating an intimacy enhancing effect of being perceived as a responsive partner. Mediation analysis showed that perception of responsiveness mediates the effects of both own and partner's enacted responsiveness on intimacy. It can be concluded that the development of intimacy in the daily life of romantic couples is truly an interactive process that ought to be investigated from a dyadic perspective.

Negativity in problematic and nonproblematic families: a multigroup social relations model analysis with structured means.

The aim of the study was to determine whether there are differences in patterns of negativity between families with and without an adolescent with externalizing problem behavior. We used a structured means Social Relations Model in order to examine negativity in multiple levels of the family system. The sample consisted of 120 problematic and 153 nonproblematic families (two parents, two children), who rated the level of negativity in the relationship with each family member. Although a simple mean differences test would lead us to believe that differences in negativity between groups of families can be ascribed to the interaction between parent and adolescent, the results of the present study indicate that these differences are actually related to the characteristics of a problematic child.

Neuropsychological profiles in individuals at clinical high risk for psychosis: relationship to psychosis and intelligence.

BACKGROUND: Characterizing neuropsychological (NP) functioning of individuals at clinical high risk (CHR) for psychosis may be useful for prediction of psychosis and understanding functional outcome. The degree to which NP impairments are associated with general cognitive ability and/or later emergence of full psychosis in CHR samples requires study with well-matched controls. METHODS: We assessed NP functioning across eight cognitive domains in a sample of 73 CHR youth, 13 of whom developed psychotic-level symptoms after baseline assessment, and 34 healthy comparison (HC) subjects. Groups were matched on age, sex, ethnicity, handedness, subject and parent grade attainment, and median family income, and were comparable on WRAT-3 Reading, an estimate of premorbid IQ. Profile analysis was used to examine group differences and the role of IQ in profile shape. RESULTS: The CHR sample demonstrated a significant difference in overall magnitude of NP impairment but only a small and nearly significant difference in profile shape, primarily due to a large impairment in olfactory identification. Individuals who subsequently developed psychotic-level symptoms demonstrated large impairments in verbal IQ, verbal memory and olfactory identification comparable in magnitude to first episode samples. CONCLUSIONS: CHR status may be associated with moderate generalized cognitive impairments marked by some degree of selective impairment in olfaction and verbal memory. Impairments were greatest in those who later developed psychotic symptoms. Future study of olfaction in CHR samples may enhance early detection and specification of neurodevelopmental mechanisms of risk.

Portland identification and early referral: a community-based system for identifying and treating youths at high risk of psychosis.

OBJECTIVE: The Portland [Maine] Identification and Early Referral (PIER) program was established in 2000 as a prevention system for identifying and treating youths at high risk of an initial psychotic episode. METHODS: During six years, 7,270 professionals from the educational, medical, and mental health sectors were provided information on prodromal symptoms and means for rapid referral of at-risk youths, which resulted in referral of 780 youths who met eligibility criteria. RESULTS: After screening, 37% of the community referrals were found to be at high risk of psychosis, and another 20% had untreated or early psychosis, yielding an efficiency ratio of 57%. Prodromal cases identified were 46% of the expected incidence of psychosis in the catchment area. Community educational presentations were significantly associated with referrals about six months later; half of referrals were from outside the mental health system. CONCLUSIONS: Community-based identification is an efficient public health strategy, offering the opportunity for preventive intervention.

Family expressed emotion prior to onset of psychosis.

UNLABELLED: This study compared components of expressed emotion (EE; rejection, warmth, protectiveness, and fusion) across three samples: two in which the subjects had an established schizophrenic or mood disorder, and a third in which the subjects were at high risk for an initial psychosis. METHODS: Family members rated themselves on the Social Adjustment Scale-III and, in the prodromal sample, estimated the duration of the prodrome. RESULTS: Scores were all but identical in the two established-disorder samples but were markedly higher than scores in the prodromal sample on all four factors. In mothers, warmth (decreasing), rejection, protectiveness, and fusion (increasing) were significantly correlated with duration of prodrome, whereas for fathers, warmth and protectiveness were similarly correlated. CONCLUSION: These data suggest that expressed emotion is largely reactive to deterioration manifested by the young person developing a psychotic disorder, rather than a trait of family members.

Demographic characteristics and employment among people with severe mental illness in a multisite study.

People with psychiatric disabilities experience disproportionately high rates of unemployment. As research evidence is mounting regarding effective vocational programs, interest is growing in identifying subgroup variations. Data from a multisite research and demonstration program were analyzed to identify demographic characteristics associated with employment outcomes, after adjusting for the effects of program, services, and study site. Longitudinal analyses found that people with more recent work history, younger age, and higher education were more likely to achieve competitive employment and to work more hours per month, while race and gender effects varied by employment outcome. Results provide strong evidence of demographic subgroup variation and need.