title: Family functioning, social impairment, and symptoms among adolescents with bipolar disorder.
abstract: OBJECTIVE
  Impaired social functioning is common among youth with bipolar disorder (BD), emerges in multiple settings, and persists over time. However, little is known about factors associated with poor peer and family functioning in the early-onset form of BD. Using a sample of adolescents with BD I or II, we examined which symptoms of BD, including nonspecific symptoms such as inattention, aggression, and anxiety/depression, were associated with family functioning (adaptability, cohesion, and conflict) and peer relationship quality.
  
  
  METHODS
  Adolescents (N = 115; 46% male) with BD I and II and their parents were evaluated before participation in a multi-site randomized controlled trial. Adolescents had experienced an episode of depression, mania, or hypomania within the previous 3 months and were not in full remission. Adolescents' problem behaviors were assessed using the parent-rated Child Behavior Checklist (CBCL). Family functioning was assessed via child- and parent-report questionnaires.
  
  
  RESULTS
  Depressive symptoms were associated with lower child-ratings of family functioning. Contrary to hypotheses, moderate mania was associated with better parent-reported family conflict, adaptability, and cohesion. Aggression was associated with poorer family functioning across reporters and measures, even when controlling for the effects of depression, mania, and inattention. None of these symptom clusters were associated with peer functioning.
  
  
  CONCLUSIONS
  Aggression was the strongest correlate of family functioning in pediatric BD in this cross-sectional study. Findings speak to the potential value of addressing aggression and family dysfunction in the treatment of youth with BD. Clinical trial registration information-Effectiveness of Family-Focused Treatment Plus Pharmacotherapy for Bipolar Disorder in Adolescents; http://clinicaltrials.gov/; NCT00332098.
authors.affiliation: University of Southern California, Los Angeles 90089, USA. keenanmi@usc.edu
authors.forename: Danielle
authors.initials: D
authors.lastname: Keenan-Miller
authors.forename: Tara
authors.initials: T
authors.lastname: Peris
authors.forename: David
authors.initials: D
authors.lastname: Axelson
authors.forename: Robert A
authors.initials: RA
authors.lastname: Kowatch
authors.forename: David J
authors.initials: DJ
authors.lastname: Miklowitz
mesh_terms: D000293:Adolescent; D000374:Aggression / Q000523:psychology*; D001714:Bipolar Disorder / Q000523:psychology*; D054541:Family Conflict / Q000523:psychology*; D005195:Family Relations; D005260:Female; D006801:Humans; D008297:Male; D015337:Multicenter Studies as Topic; D010287:Parent-Child Relations; D016032:Randomized Controlled Trials as Topic