Changes in family functioning amongst nonconventional families.
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Attitude↗
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Family functioning and parent general health in families of adolescents with major depressive disorder.
Family functioning and parent mental health in families of adolescents with major depressive disorder (n = 61) were compared with a community control sample (n = 34) using the McMaster Family Assessment Device (FAD) and the General Health Questionnaire (GHQ). Mean FAD and GHQ scores for clinic families were significantly worse than controls. 56% of clinic and 29% of control families met operational criteria for current dysfunction. In the clinic group family dysfunction was associated with the additive effects of comorbid Oppositional Defiant disorder in the adolescent and mother's current poor mental health, while father's current mental health had no associations with family functioning.
Adolescent↗
The autistic child and family functioning: a developmental-family systems perspective.
Autism is a severe, long-term developmental disorder that potentially has substantial influence on different aspects of the family system. Principles from family-systems theory are considered as they relate to the autistic child within the family. A selective and critical review is presented of research findings on the influence of the autistic child on the functioning and interactions of family members, including parents, siblings, and the family as a whole. Research findings are also reviewed on resources associated with successful family adaptation to the autistic child. Suggestions are offered for improved research to assess the relationship between certain child variables and measures of family functioning.
Adaptation, Psychological↗
The role of family functioning in the stress process of dementia caregivers: a structural family framework.
PURPOSE: The purpose of the study was to evaluate the role of family functioning in the stress process in a sample of caregivers of dementia patients by using a structural family framework. The stress-process model of caregiver distress included family functioning as an intervening variable in the relationship between objective burden and distress. We theorized family functioning to partially mediate the relationship between objective burden and distress and to significantly account for the prediction of distress beyond well-recognized predictors. DESIGN AND METHODS: One hundred eighty-one family caregivers from the Miami site of the Resources for Enhancing Alzheimer's Caregiver Health project participated in this study. We assessed sociodemographics, burden, depression, anxiety, and perceived health for each caregiver. We measured family functioning by using a multidimensional and observational instrument. We used structural equation modeling to assess the fit of the model for the overall sample and for different caregiver subgroups and to examine whether demographic variables affected the relationships in the model. RESULTS: The results of the study indicated that family functioning significantly contributed to distress in the overall sample and partially mediated the relationship between objective burden and distress. We also found that the stress-process model was adequately fit by the hypothesized relationships between objective burden, family functioning, and distress for the overall sample and all of the subsamples, except for wives. IMPLICATIONS: This study provides support for the structural family approach as an explanatory model for the influence of family functioning on dementia caregivers. Family structural functioning is one contributor to the caregiver stress process. This suggests that interventions targeting structural family problems may reduce caregiver distress.
Aged↗
Adolescents with type 1 diabetes: family functioning and metabolic control.
Families play central roles in the care of their adolescents with chronic illnesses. This study examined the relationship between family functioning and metabolic control in adolescents with Type 1 diabetes. The McMaster Family Assessment Device (FAD) measured family functioning; the Youth Self-Report Form (YSR) measured adolescent behavior. Older adolescents reported increased family dysfunction. Adolescents who reported family dysfunction on affective responsiveness had HbA(1c) levels greater than 9. Older adolescents, males, and adolescents who reported a greater number of behavior problems were significantly more likely to have HbA(1c) levels greater than 9. Considered together, older age and greater attention problems were most significantly associated with higher HbA(1c) levels. These findings suggest the importance of the relationship between the adolescent's perception of family functioning and metabolic control in the adolescents with Type 1 diabetes.
Adolescent↗
The Process Model of Family Functioning.
The Process Model of Family Functioning differs from the McMaster Model of Family Functioning and their common source, the Family Categories Schema, by its increased emphasis on the dynamic interaction between the major dimensions of family functioning, and by its stress on the interface between intrapsychic subsystems and the interpersonal dimensions of the family system. A model of family process rather than family structure, it defines six universal criteria of family functioning. It describes the processes involved in each along with the content components and the critical aspects of each. A self-report test developed from the model (FAM-III) is being widely used both as a research tool and as a clinical adjunct. Tests to define its validity and reliability continue.
Adaptation, Psychological↗
Family functioning and psychological distress among Japanese breast cancer patients and families.
GOALS OF WORK: The purpose of this study was to develop a typology of family functioning in the families of breast cancer patients. PATIENTS AND METHODS: Seventy-four families (189 individuals: 74 patients, 54 spouses, 46 offspring, and 15 other relatives) completed self-report questionnaires. Perception of family functioning was assessed using the family relationship index (FRI) and its three dimensions (cohesiveness, expressiveness, and conflict) and was classified into groups by a cluster analytic approach. Psychological distress was assessed using the Zung self-rating depression scale (SDS) and the Zung self-rating anxiety scale (SAS). MAIN RESULTS: Cluster analysis yielded three groups of patients and their family members: one cluster with high cohesiveness, high expressiveness, and low conflict ("supportive" type: n=64); a second group with low cohesiveness, low expressiveness, and high conflict ("conflictive" type: n=65); and a third group with limited cohesiveness, limited expressiveness, and low conflict ("intermediate" type: n=60). Analysis of variance revealed that conflictive families manifested the highest level of depression and anxiety among these clusters. CONCLUSIONS: Typology of family functioning can identify psychologically at-risk families. A family-focused approach can help to reduce psychological distress, especially in conflictive families.
Adult↗
Family functioning in school-age children with cystic fibrosis: an observational assessment of family interactions in the mealtime environment.
OBJECTIVE: To examine, using direct observation methodology, differences in family functioning at mealtime between families of school-age children with cystic fibrosis (CF) and families of school-age children without a chronic illness. METHOD: Family functioning was rated using the McMaster Mealtime Interaction Coding System (MICS) during a videotaped dinner among 28 families of children with CF and 27 families of non-ill, age-matched peers. Families were rated on overall family functioning and on six dimensions of the MICS: task accomplishment, communication, affect management, interpersonal involvement, behavior control, and role allocation. RESULTS: Ratings for families of a child with CF were significantly lower than they were for comparison families on overall family functioning and on four of the six MICS dimensions: communication, affect management, interpersonal involvement, and behavioral control. Moreover, a significantly greater percentage of families of children with CF were rated in the unhealthy range on overall family functioning and on five of six MICS dimensions. There was no relationship between family functioning and child weight status for children with CF. CONCLUSIONS: The current study suggests that for families of school-age children with CF, the family system is negatively affected during mealtime. Dietary interventions need to address family-centered, as well as child-centered, interventions to help families manage challenges presented during the family meal.
Child↗
Perceived family functioning and adolescent suicidal behavior.
OBJECTIVE: Family problems increase the risk of adolescent suicidal behavior, but the specific dimensions of family functioning related to adolescent suicidal ideation and suicide attempts have not been identified clearly. This study examined the relationship between family functioning and adolescent suicidal ideation and suicide attempts. Participating adolescents included psychiatric inpatients who had attempted suicide (n = 35), high school students reporting suicidal ideation (n = 33), nonsuicidal psychiatric inpatients (n = 29), and nonsuicidal high school students (n = 37). METHOD: The Family Assessment Measure was used to assess adolescents' perceptions of family functioning on two levels: (1) the family system and (2) parent-adolescent dyadic relationships. RESULTS: The suicidal psychiatric inpatients and the suicidal high school students did not differ in their perceptions of family functioning and mother-adolescent relationships. However, both suicide groups reported more distress and family dysfunction than did the nonsuicidal high school students. Perceived family functioning and mother-adolescent relationships were significantly correlated with levels of depression, hopelessness, and self-esteem. CONCLUSIONS: Family functioning is important to consider when assessing and treating adolescents for suicidal behavior.
Adolescent↗
Adult onset diabetes mellitus: glycemic control and family function.
To test the hypothesis that family function differs in patients according to their level of diabetes control, family function was assessed using the Family APGAR questionnaire in low-income patients with adult-onset diabetes who were under comprehensive care in five community health centers. From 3,000 active patients, a group of 385 with the following characteristics were randomly selected: mean age, 59.1 (range 25-93); M:F ratio, 1:4; and ethnic distribution (blacks: Hispanics: whites, 48%:31%:21%). Categorizing patients by their extent of diabetes control, good family function was found in 92% of patients in good control of their diabetes mellitus, in 66% of those in fair control, and only in 50% of those in poor control (p less than 0.005, chi 2 = 44.1, df = 2). Since these data point to the association between levels of family functioning and control of diabetes, further studies are needed to ascertain if an improvement in family functioning will lead to better diabetic control.
Adult↗
The effect of multiple family therapy on addict family functioning: a pilot study.
Family therapy may help addicts remain drug abstinent by improving family functioning. In a outpatient pilot study eight addict families were evaluated before and after 16 weeks of multiple family therapy (MFT), while the addict was maintained on naltrexone, an opiate antagonist. The Beavers Timberlawn Family Assessment was used to rate videotapes on problem solving, family structure, individual autonomy, and affect. The 8 families showed significant improvement in global functioning, problem solving, structure, and autonomy, but not in affect. One addict relapsed during the 10 month follow up, and his was the only family that functioned worse at follow up. We concluded that MFT can help addict families progress from chaotic interactions to more stable family structures and from rigid to more flexible family functioning. This improvement in family functioning may be associated with ex-addicts remaining abstinent.
Adult↗
Does the family APGAR effectively measure family functioning?
BACKGROUND: The Family APGAR has been widely used to study the relationship of family function and health problems in family practice offices. METHODS: Data were collected from 401 pediatricians and family physicians from the Pediatric Research in Office Settings network and the Ambulatory Sentinel Practice Network. The physicians enrolled 22,059 consecutive office visits by children aged 4 to 15 years. Parents completed a survey that included the Family APGAR and the Pediatric Symptom Checklist. Clinicians completed a survey that described child psychosocial problems, treatments initiated or continued, and specialty care referrals. RESULTS: Family dysfunction on the index visit often differed from dysfunction at follow-up (kappa=0.24). Only 31% of the families with positive Family APGAR scores at baseline were positive at follow-up, and only 43% of those with positive scores at follow-up had a positive score at the initial visit. There were many disagreements between the Family APGAR and the clinician. The Family APGAR was negative for 73% of clinician-identified dysfunctional families, and clinicians did not identify dysfunction for 83% of Family APGAR-identified dysfunctions (kappa=0.06). CONCLUSIONS: Our data do not support the use of the Family APGAR as a measure of family dysfunction in the primary care setting. Future research should clarify what it does measure.
Adolescent↗
Does adding conjoint therapy to individually focused alcoholism treatment lead to better family functioning?
This report examines functioning in the families of alcoholics undergoing outpatient treatment. Alcoholic patients were randomly assigned to two social-learning-based alcoholism treatments, one of which contained a conjoint therapy component. Patients (Pts) and significant others (SOs) provided ratings of family functioning before treatment and at a 6-month follow-up. According to the perceptions of both Pts and SOs, there were significant improvements in family functioning in a number of areas at posttreatment. Contrary to what was expected, however, the improvements were not greater in the conjoint condition. The usefulness of alcoholics' level of autonomy as a matching variable also was explored. According to the perceptions of both Pts and SOs, posttreatment family functioning was better when low-autonomy alcoholics were treated without other family members. There also was evidence that conjoint treatment was more effective with high-autonomy alcoholics and their families, although it was less convincing and limited to the SOs' perceptions. Implications for alcoholism treatment and the limitations of the findings are discussed.
Alcoholism↗
A new, short family function assessment questionnaire for use in family medical practice in Israel: construction, validation and preliminary application.
This report describes the compilation and initial steps in the field testing of a new questionnaire intended for Israeli family physicians wishing to rapidly assess the general level of family functioning of their patients as part of everyday routine history taking in practice. The questionnaire was shown to have reasonable reliability and validity in a nonrepresentative sample of 140 married Israeli adults in three different family medicine practices. The questionnaire yielded a sum score ranging from 0 to 20. Preliminary estimates, based on a comparison of the sum score of each patient's questionnaire with the doctor's assessment of the family's functioning, suggest that patients of families with poor function score 11 or less, with satisfactory function 12 to 17, and with good function more than 17. These ranges require further refinement and standardization by testing the questionnaire among other groups of the Israeli population.
Adult↗
Patterns of family functioning and adolescent outcomes among urban African American and Mexican American families.
The relations of patterns of family functioning, prosocial behaviors, and internalizing and externalizing symptoms over time were evaluated among a sample of economically disadvantaged inner-city African American and Mexican American male adolescents. Ethnic group differences for configurations of family functioning over time, levels of prosocial and problem behaviors, and relations of family functioning to risk were found. Among both ethnic groups, exceptionally functioning families provided a protective effect against risk. Overall, African American youth had stronger attitudes toward school and higher educational aspirations than Mexican American youth. Unlike previous investigations, once socioeconomic status was controlled, no differences were found for either internalizing or externalizing problems between the 2 groups. The importance of considering socioeconomic status and community context when evaluating minority parenting and family functioning is discussed.
Adolescent↗
Adolescents' weight, sex, and family functioning.
The study explored family functioning with adolescents of varying weight. The participants were 572 adolescents (286 boys and 286 girls) (M = 15.7 years, SD = 1.04) who comprised four weight groups: underweight (less than 90% expected weight), normal weight (90 to 110%), overweight (111 to 125%), and obese (over 125%). They completed 9 of the 15 subscales of the Self-Report Measure of Family Functioning pertaining to family styles (e.g., Authoritarian) and relationships (e.g., Conflict, Enmeshment). Obese girls rated their families lower on Cohesion, Expressiveness, and Democratic Family Style. Obese and moderately overweight girls seem to perceive their families differently. Obese and overweight boys did not differ from normal weight boys on any of the measures. There was a tendency for underweight boys to report lower Cohesion, Expressiveness, and Democratic Family Style. The need to consider family environment, particularly the family's differing expectations for obese daughters and underweight sons, is discussed with reference to treatment.
Adolescent↗
Improving family functioning and child outcome in methadone maintained families: the Parents Under Pressure programme.
Twelve families responded to posters displayed in a methadone clinic for inclusion in a pilot study assessing the viability and potential utility of an intensive, multi-component family-focused intervention, the Parents Under Pressure programme. The programme was designed to improve child behaviour, decrease parental stress and improve family functioning in methadone-maintained families by targeting affect regulation, mood, views of self as a parent, drug use and parenting skills. Nine of the families completed the programme delivered in their homes; eight were recontacted at 3 months. Each family reported significant improvements in three domains: parental functioning, parent-child relationship and parental substance use and risk behaviour. In addition to the changes in family functioning, the majority of families reported a decrease in concurrent alcohol use, HIV risk-taking behaviour and maintenance dose of methadone. The families reported high levels of satisfaction with the programme. It is recommended that future studies include independent measures (e.g. behavioural observations) of child outcome and parental functioning. The results were optimistic and provided the impetus to evaluate the treatment programme using a randomized controlled trial.
Adult↗
The Family Functioning in Adolescence Questionnaire: a measure of psychosocial family health during adolescence.
An instrument has been developed to assess psychosocial health of the family during the stage of having adolescent children, as perceived by the adolescent. The measure is based on a model integrating family systems research and the developmental tasks of adolescents. It examines six dimensions of family functioning: (1) Structure, (2) Affect, (3) Communication, (4) Behaviour control, (5) Value Transmission and (6) External Systems. A sample of 413 Year 10 students (means = 15.7 years) participated in the development of the instrument. Satisfactory levels of reliability and validity are reported. The Family Functioning in Adolescence Questionnaire (FFAQ) provides a means of assessment for researchers interested in family functioning during adolescence, and also for therapists and counsellors working with teenagers.
Adolescent↗